上海交通大学学报（医学版）

›› 2009, Vol. 29 ›› Issue (12): 1495-.

• 论著（临床研究） • 上一篇    下一篇

手术内固定与非手术外固定治疗创伤性连枷胸的效果比较

滕继平1, 程云阁1, 倪 达1, 潘荣华1, 程佑爽1, 朱智军1, 潘铁文2   

  1. 1. 上海交通大学 医学院第三人民医院胸心外科, 上海 201900；2. 第二军医大学 长征医院胸心外科, 上海 200003
  • 出版日期:2009-12-25 发布日期:2009-12-25
  • 作者简介:滕继平(1979—), 男, 主治医师, 硕士；电子信箱: tengjiping2000@yahoo.com.cn。
  • 基金资助:

    上海交通大学医学院附属第三人民医院基金(syz08-13)

Outcomes of traumatic flail chest treated by operative fixation versus conservative approach

TENG Ji-ping1, CHENG Yun-ge1, NI Da1, PAN Rong-hua1, CHENG You-shuang1, ZHU Zhi-jun1, PAN Tie-wen2   

  1. 1. Department of Cardiothoracic Surgery, The Third People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 201900, China；2. Department of Cardiothoracic Surgery, Changzheng Hospital, The Second Military Medical University, Shanghai 200003, China
  • Online:2009-12-25 Published:2009-12-25
  • Supported by:

    Foundation of The Third People's Hospital, School of Medicine, Shanghai Jiaotong University, syz08-13

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摘要：

目的 比较手术内固定与非手术外固定在治疗创伤性连枷胸为主的全身多发伤中的疗效。方法 对60例以创伤性连枷胸为主的全身多发伤患者的临床资料进行回顾性分析，比较手术组（手术内固定治疗，n=32）和非手术组（非手术外固定治疗，n=28）患者的临床疗效。结果 手术组患者平均住院时间、平均住ICU时间和平均机械通气时间均显著短于非手术组(P<0.05)，胸壁畸形、肺部炎症、肺不张和呼吸功能衰竭等并发症发生率均显著低于非手术组(P<0.05)。出院后6个月，手术组患者肺功能指标包括深吸气量、用力肺活量、第一秒用力呼气量、最大呼气流量、肺总量和最大呼气中段流量均显著高于非手术组(P<0.05)。结论 对存在复合伤的连枷胸患者行手术内固定可减少连枷胸引起的并发症，有良好的短期和长期疗效。

关键词: 连枷胸, 并发症, 肋骨骨折, 内固定

Abstract:

Objective To compare the outcomes of traumatic flail chest with multiple injuries treated by operative fixation versus conservative approach. Methods The clinical data of 60 patients with traumatic flail chest with multiple injuries were retrospectively analysed, and the outcomes between operation group （treated by operative fixation, n=32）and non-operation group （treated by conservative approach, n=28） were compared. Results The mean time of hospital stay, ICU stay and mechanical ventilation was significantly shorter, and the prevalences of chest wall deformity, pulmonary infection, pulmonary atelectasis and respiratory failure were significantly lower in operation group than those in non-operation group (P<0.05). Six months after discharge, the pulmonary function parameters such as inspiratory capacity, forced vital capacity, forced expiratory volume in one second, peak expiratory flow, total lung capacity and maximal midexpiratory flow were significantly higher in operation group than those in non-operation group (P<0.05). Conclusion Traumatic flail chest with multiple injuries treated by operative fixation may lead to less flail chest associated complications. Operative fixation has short- and long-term benefits to flail chest.

Key words: flail chest, complication, fracture of rib, internal fixation