电视胸腔镜辅助肋骨内固定术治疗多发肋骨骨折的效果

目的探讨电视胸腔镜辅助肋骨内固定术治疗多发肋骨骨折的效果。方法将60例多发肋骨骨折患者随机分为胸腔镜组(n=30,电视胸腔镜辅助肋骨内固定术)与开胸组(n=30,传统开胸手术)。比较两组治疗效果。结果术后2个月,胸腔镜组的MVV、FEV1/FVC、FVC均高于开胸组(P<0.05)。术后1 d,两组的SaO2、PaO2/FiO2均较术前升高,且胸腔镜组高于开胸组(P<0.05)。术后3 d,胸腔镜组VAS评分低于开胸组(P<0.05)。胸腔镜组并发症总发生率低于开胸组,骨折愈合率高于开胸组(P<0.05)。结论胸腔镜辅助肋骨内固定术可明显改善多发肋骨骨折患者的肺通气功能及血气指标,术后疼痛程度较轻,并发症较少,骨折愈合率高。     

胸腔镜下小切口镍钛记忆合金肋骨接骨板固定术治疗多发肋骨骨折的效果观察

目的探讨在胸腔镜下进行小切口肋骨接骨板(镍钛记忆合金)固定术对多发肋骨骨折患者术后视觉模拟(VAS)评分及生活质量的影响。方法选取2015年5月至2017年2月多发肋骨骨折患者77例,依据治疗方案不同分组,对照组38例予以常规胸部护板固定治疗,观察组39例给予胸腔镜下小切口肋骨接骨板(镍钛记忆合金)固定术,比较两组手术效果及治疗前后疼痛程度(VAS)评分,并统计两组生活质量(QOL)评分。结果观察组治疗总有效率为97.44%(38/39),高于对照组的78.95%(30/38)(P0.05);治疗后观察组VAS评分低于对照组,QOL评分高于对照组(P0.05)。结论胸腔镜小切口镍钛记忆合金肋骨接骨板固定术应用于肋骨骨折(多发)患者,效果较佳,有助于缓解患者术后疼痛程度,改善其生活质量。     

胸腔镜联合记忆合金环抱式接骨板治疗多发性肋骨骨折的临床研究

目的:探讨胸腔镜在多发肋骨骨折记忆合金环抱式接骨板内固定术中的应用。方法:回顾性分析2016年4月至2019年4月广东省台山市人民医院胸心外科收治的胸腔镜操作肋骨骨折记忆合金环抱式接骨板内固定术25例的临床资料。结果:25例患者术后顺利康复,无漏诊,无严重手术并发症,无植入物排斥发生。结论:对多发肋骨骨折合并血气胸患者采用胸腔镜联合记忆合金环抱式接骨板内固定治疗,创伤小,康复快,可减少漏诊,有效降低死亡率。     

可吸收肋骨钉与记忆合金接骨板在治疗多根多处肋骨骨折中的应用

目的:比较采用可吸收肋骨钉与记忆合金接骨板内固定治疗肋骨骨折的疗效。方法:胸部外伤致多发肋骨骨折的患者58例,入院后均经胸部影像学检查确诊为多根多处肋骨骨折并重叠移位。对其中38例患者采用可吸收肋骨钉行肋骨骨髓腔内固定术(研究组),对其余20例患者采用记忆合金接骨板行内固定术(对照组)。比较两组的疗效。结果:两组均无死亡病例,研究组出现3例胸腔积液,3例肺部感染;对照组出现2例肺部感染,3例切口感染;所有患者经对症处理后均痊愈。两组的手术时间、固定肋骨根数、住院时间及并发症发生情况差异均无统计学意义(P>0.05);与对照组相比,研究组术中失血量少、术后呼吸机使用时间短、术后疼痛减轻、术后下床活动早,结果差异有统计学意义(P<0.05)。术后6个月复查胸部X线片,两组均无骨折再移位;术后1～2年对照组有14例患者行等二次手术以取出内固定物。结论:采用可吸收肋骨钉治疗多发性肋骨骨折,疗效优于记忆合金接骨板。     

肋骨爪形接骨板内固定治疗多发肋骨骨折的疗效分析

目的探讨多发肋骨骨折切开复位肋骨爪形接骨板内固定治疗的临床价值及意义。方法对54例采用肋骨爪形接骨板内固定治疗多发肋骨骨折患者的临床资料进行回顾性分析。结果所有患者手术后呼吸状况明显改善;胸廓畸形矫正,创伤性疼痛明显减轻,能耐受;胸廓形态良好,未发生肺部感染、肺不张、异物反应以及手术切口感染等并发症。所有患者均痊愈出院。结论肋骨爪形接骨板内固定术治疗多发肋骨骨折固定效果可靠,手术操作简单快捷、创伤小,术后不需取出,疗效满意。     

环抱式接骨板内固定治疗多发性肋骨骨折临床效果分析

目的观察环抱式接骨板内固定治疗多发性肋骨骨折的临床效果。方法对采用环抱式接骨板内固定治疗的多发性肋骨骨折69例的临床资料进行回顾性分析。结果本组手术时间50~180 min;术中出血量30~200 ml;术后胸痛明显得到缓解,反常呼吸消失,胸廓畸形得到恢复,呼吸困难也明显改善;按照Johner Wruhs标准对胸部功能进行评定,优51例,良16例,可2例,优良率97.1%。8例术后切口有红肿,术后9 d拆线后红肿消退;1例术后发生切口感染,给予相应治疗切口愈合。所有患者均得到随访,术后随访时间7~22(10.6±1.2)个月,骨折愈合时间12~23(16±0.5)周。结论环抱式接骨板内固定治疗多发性肋骨骨折手术操作简单、损伤小、固定可靠,且患者呼吸功能恢复快,并发症少。     

电视胸腔镜辅助下钛镍合金肋骨接骨板对多发肋骨骨折患者术后住院时间及VAS评分的影响

目的探讨电视胸腔镜辅助下钛镍合金肋骨接骨板对多发肋骨骨折患者术后住院时间及视觉模拟量表(VAS)评分的影响.方法选取2017年4月至2019年4月某院多发肋骨骨折患者137例,按手术方案不同分试验组69例、对照组68例.两组均行钛镍合金肋骨接骨板内固定治疗,对照组采用传统开胸方式,试验组通过电视胸腔镜辅助下进行.比较两组手术时间、术中出血量、胸腔引流时间、住院时间、术前及术后8 hVAS评分.结果试验组手术时间、胸腔引流时间、住院时间均短于对照组,术中出血量少于对照组,差异有统计学意义(P<0.05);术后8 h,试验组VAS评分低于对照组,差异有统计学意义(P<0.05).结论电视胸腔镜辅助下钛镍合金肋骨接骨板治疗多发肋骨骨折手术效果显著,可有效缓解患者疼痛,促进其恢复.     

胸壁负压引流对肋骨骨折内固定术后康复的影响

目的:探讨胸壁负压引流对肋骨骨折内固定术患者术后康复的影响。方法:回顾分析2009年7月—2014年12月收住入院的多发肋骨骨折内固定手术患者266例。根据处理方式将其分为对照组和试验组。对照组(n=65)采用常规手术康复治疗与护理;试验组(n=201)在对照组基础上行胸壁负压引流。比较两组术后皮下积液患者比例、切口拆线时间、切口感染患者比例、住院天数、生活质量评分等。结果:试验组术后皮下积液和切口感染患者比例均显著低于对照组[(1.49%,3/201)vs(30.77%,20/65),(0,0/201)vs(4.62%,3/65),P0.05];试验组切口拆线时间及住院天数短于对照组[(9.1±1.2)d vs(14.2±1.3)d,(10.2±0.9)d vs(16.3±1.1)d,P0.05];试验组生活质量评分显著高于对照组(P0.05)。结论:胸壁负压引流可促进肋骨骨折内固定术后皮下积液的排出、降低切口感染率,从而缩短切口愈合时间和住院时间,降低住院费用。建议在肋骨骨折内固定术中,尤其是在肋骨骨折多、胸部损伤重、并发症多的肋骨骨折内固定术中,予以胸壁负压引流。     

电视胸腔镜联合肋骨接骨板治疗多发性肋骨骨折合并血胸的临床研究

目的探究电视胸腔镜联合肋骨接骨板治疗多发性肋骨骨折合并血胸的临床研究。方法拟选取我院2016年1月～2018年6月收治的多发性肋骨骨折合并血胸患者70例,按数字表法将其随机分为对照组和观察组各35例。对照组给予使用单独传统经胸内固定术治疗,观察组给予电视胸腔镜联合肋骨接骨板治疗;观察比较两组患者胸痹缓解时间、手术时间、术后出血量、下床活动时间、拔除引流管时间等临床指标情况,并观察两组患者肺不张、胸腔感染、伤口感染等术后并发症情况。结果观察组胸痹缓解时间、手术时间以及术后出血量均优于对照组,差异有统计学意义(P0.05);观察组患者下床活动时间、拔除引流管时间明显少于对照组,差异有统计学意义(P0.05);观察组患者术后肺不张、胸腔感染、伤口感染并发症总发生率低于对照组,差异有统计学意义(P0.05)。结论电视胸腔镜联合肋骨接骨板治疗多发性肋骨骨折并血气胸者疗效显著,可缩短手术时间、胸痹缓解时间,降低术后出血量,且安全性高,并发症少。     

镍钛环抱式接骨板内固定治疗多发性肋骨骨折临床分析

目的探讨镍钛合金环抱式接骨板治疗多肋骨折内固定的临床效果。方法 35例多发生肋骨骨折患者使用镍钛合金环抱式接骨板行内固定治疗,并对其治疗效果进行分析总结。结果本研究35例多肋骨折患者术后胸痛显著减轻,胸廓形状恢复正常,反常呼吸消失,呼吸困难显著改善。所有患者均获随访8～34个月,平均(14.6±1.2)个月;术后随访胸片骨折愈合,愈合时间(5.3±1.6)个月;内固定无松动、脱落及断裂,胸廓无畸形。无严重并发症出现。结论应用镍钛合金环抱式接骨板内固定治疗多肋骨折,手术操作简单方便、创伤小、组织相容性好,固定牢靠,并发症少,临床效果满意。     

多发性肋骨骨折合并血气胸的急救处理与康复护理

目的 讨论多发性肋骨骨折合并血气胸的急救处理和康复护理。方法 对60例多发性肋骨骨折合并血气胸病人的护理及康复情况进行回顾性分析。结果 59例病人恢复良好，1例因肺部感染死亡。结论 合理的急救处理及康复护理对病人的伤情恢复、减少并发症的发生起到非常重要的作用。     

胸腔镜辅助下钛镍记忆合金钢板内固定治疗肋骨多发性骨折患者的疗效与安全性

目的探讨胸腔镜辅助下钛镍记忆合金钢板内固定在肋骨多发性骨折患者中的疗效与安全性。方法选取该院2018年1月-2019年12月87例肋骨多发性骨折患者作为研究对象,随机分为对照组(n=43)和观察组(n=44);对照组行胸部护板外固定,观察组行胸腔镜辅助下钛镍记忆合金钢板内固定;比较两组术后恢复情况、肺功能指标、治疗效果和并发症发生情况。结果观察组ICU停留时间、机械通气时间、住院时间、下床活动时间和胸腔引流时间明显短于对照组[(3.74±0.63)和(5.58±1.21) d、(2.68±1.65)和(9.78±2.36) d、(19.46±3.27)和(26.85±2.73) d、(10.18±2.22)和(16.23±2.42) d、(4.72±1.91)和(7.23±2.12) d],视觉模拟评分(VAS)明显低于对照组[(3.62±1.21)和(5.89±1.34)分],两组比较,差异均有统计学意义(P <0.05)。观察组第1秒用力呼气容积(FEV1)、最大自主通气量(MVV)和用力肺活量(FVC)均明显优于对照组[(101.37±18.46)%和(88.82±16.15)%,(89.21±14.36)和(68.37±18.46) L/min,(94.26±18.25)%和(82.15±12.67)%](P <0.05)。观察组有效率(95.45%)明显高于对照组(69.77%)(P <0.05)。观察组肺部感染、肺不张和胸部畸形发生率均明显低于对照组(13.64%和37.21%、18.18%和39.53%、0.00%和32.56%)(P <0.05)。结论胸腔镜辅助下钛镍记忆合金钢板内固定能明显改善患者恢复情况和肺功能,提高治疗有效率,降低并发症发生率。     

胸腔镜下辅行手术与传统手术治疗多发性肋骨骨折的不同疗效对比

目的分析多发性肋骨骨折患者实施胸腔镜下辅行手术和传统手术的效果。方法选取2014年1月-2017年12月该院102例多发性肋骨骨折患者,平分两组后实施不同疗法:51例对照组给予传统手术,51例观察组给予胸腔镜下辅行手术,统计临床结果。结果观察组患者术中出血量、术后引流量均明显多于对照组(P0.05);观察组患者手术时间明显长于对照组,两组比较差异具有统计学意义(P0.05);观察组患者的疼痛时间、下床活动时间和住院时间等指标明显少于传统手术患者,差异有统计学意义(P0.05);观察组患者术后并发症发生率明显低于对照组,差异有统计学意义(P0.05)。结论临床给予多发性肋骨骨折患者胸腔镜下辅行手术作用显著,可预防并发症,减少医疗费用,值得借鉴。     

Effectiveness of surgical rib fixation on prolonged mechanical ventilation in patients with traumatic rib fractures: A propensity score–matched analysis

PurposeWe investigated whether surgical rib fixation improved outcomes in patients with traumatic rib fractures.Materials and MethodsThis was a retrospective study using a Japanese administrative claim and discharge database. We included patients with traumatic rib fractures admitted to hospitals where surgical rib fixation was available from July 1 2010, to March 31, 2013. We detected patients who underwent surgical rib fixation within 10 days of hospital admission (surgical group) and those who did not (control group). The main outcome was prolonged mechanical ventilation, defined as that performed for 5 or more days, or death within 28 days. One-to-four propensity score matching was performed between the 2 groups with adjustment for possible confounders.ResultsAmong 4577 eligible patients, 90 (2.0%) underwent the surgical rib fixation. After the matching, we obtained 84 and 336 patients in the surgical and control groups, respectively. Logistic regression analyses showed that the surgical group was significantly less likely to receive prolonged mechanical ventilation or die within 28 days than the control group (22.6% vs 33.3%; odds ratio, 0.59; 95% confidence interval, 0.36-0.96; P = .034).ConclusionsSurgical rib fixation within 10 days of hospital admission may improve outcomes in patients with traumatic rib fractures.     

Laparoscopic single-port Burch colposuspension with an extraperitoneal approach and standard instruments for stress urinary incontinence: Early results from a series of 15 patients

Abstract

Objective:We aimed to investigate the use of single-port laparoscopy in a series of patients undergoing Burch colposuspension with an extraperitoneal approach as an alternative treatment for scarless surgery in stress urinary incontinence. Material and methods: From September 2010 to May 2011 we performed single-port extraperitoneal laparoscopic Burch colposuspension for stress incontinence in 15 patients. Fifteen women who were diagnosed with urodynamic stress incontinence were included in the study. Demographic and clinical data, intraoperative findings, and postoperative course were recorded. Results:The mean age was 45,80 ± 9,91 years (range: 38–70 years). The mean body mass index was 25,67 ± 4.06 kg/m2 (range: 22.23–35.38 kg/m²). The mean operation time and mean blood loss were 40.80 ± 5.94 minutes (range: 30–50 minutes) and 30.67 ± 11.00 cc (range: 10–50 cc), respectively. The single-port laparoscopic operations were technically completed successfully without placement of additional trocars and there were no complications. The cure and improvement rates following laparoscopic Burch colposuspension via single port were 73.3 % and 20 % respectively. Conclusion: Single-port laparoscopic Burch can be an alternative treatment for scarless surgery in stress incontinence. Single-incision laparoscopic Burch colposuspension can offer suitable, effective and safe treatment in women with stress incontinence.     

Association of thoracic cage fractures and pericardial effusion in blunt trauma

BackgroundSeveral case reports suggest that penetrating thoracic cage fractures are an important cause for hemopericardium and cardiac tamponade following blunt trauma. However, the prevalence of this mechanism of injury is not fully known, and considering this association may provide a better understanding of the utility of cardiac component of the FAST (Focused Assessment with Sonography for Trauma).ObjectiveTo determine the association of thoracic cage fractures and pericardial effusion in patients with blunt trauma.MethodsWe performed a retrospective, multicenter cohort study using the Trauma Quality Improvement Program (TQIP) database (2015–2017) of adults ≥18 years of age whose mechanism of injury was either a fall or motor vehicle accident. Thoracic cage fractures were defined as any rib or sternum fracture. The primary outcome was the presence of pericardial effusion. Confounding variables were accounted for using multivariable logistic regression.ResultsWe included 1,673,704 patients in the study; 226,896 (14%) patients had at least one thoracic cage fracture. A pericardial effusion was present in 4923 (0.3%) patients. When a thoracic cage fracture was present, the odds of having a pericardial effusion was significantly higher (adjusted Odds Ratio [aOR] 6.5 [95% CI: 6.1–7.0]). Patients with left and right-sided rib fractures had similar odds of a pericardial effusion (aOR 1.2 [95% CI 1.04–1.4]). Sternal fractures carried the highest odds of having a pericardial effusion (aOR 11.1 [9.9–12.3]).ConclusionThoracic cage fractures secondary to blunt trauma represent a significant independent risk factor for the development of a pericardial effusion. Our findings lend support for the mechanism of bony injuries causing penetrating cardiac trauma. Given these findings, and the fact that many thoracic cage fractures are detected after the initial evaluation, we support maintaining the cardiac view in the FAST examination for all blunt trauma patients.     

Surgical rib fixation for flail chest deformity improves liberation from mechanical ventilation

Purpose

The goal of this study was to determine the impact of surgical rib fixation (SRF) in a treatment protocol for severe blunt chest trauma.

Materials and methods

Patients with flail chest admitted between September 2009 and June 2010 to our level I trauma center who failed traditional management and underwent SRF were matched with an historical group. Outcome variables evaluated include age, injury severity score, intensive care unit length of stay (LOS), hospital LOS, ventilator days, total number of rib fractures, and total number of segmental rib fractures.

Results

The 2 groups were similar in age, injury severity score, intensive care unit LOS, hospital LOS, total number of rib fractures, and total segmental rib fractures. The operative group demonstrated a significant reduction in total ventilator days as compared with the nonsurgical group (4.5 [0-30] vs 16.0 [4-40]; P = .040). Patients with SRF were permanently liberated from the ventilator within a median of 1.5 days (0-8 days).

Conclusions

Surgical rib fixation resulted in a significant decrease in ventilator days and may represent a novel approach to decreasing morbidity in flail chest patients when used as a rescue therapy in patients with declining pulmonary status. Larger studies are required to further identify these benefits.     

胸外伤肋骨骨折内固定术治疗的适应证及疗效评价

目的探讨胸外伤肋骨骨折施行内固定手术的适应证并评估其疗效。方法总结我科2009—2011年因胸外伤肋骨骨折行内固定术治疗27例病人的适应证并分析其疗效。结果内固定术适应证：①严重肋骨骨折并发内脏损伤;②胸部严重变形,胸壁软化,出现连枷胸;③骨折端错位明显;④肋骨骨折保守治疗无法缓解疼痛,并且伴有血气胸;⑤病人无严重其他疾病,耐受手术。本组病人全部康复出院,无死亡及严重术后并发症发生。随访所有病人生活均能自理,部分病人恢复正常工作。结论严重胸外伤肋骨骨折选择适当的适应证行内固定术治疗是可行的。