手术内固定治疗连枷胸的临床研究

目的通过对连枷胸两种不同治疗方法的比较，探讨该病的优化治疗方案。方法将2005年1月-2012年11月收治的80例枷胸患者按入选标准分为：保守组40例，通过胸部外固定和（或）呼吸机内固定等方法治疗；手术组40例，采用镍钛记忆合金环抱式接骨器手术内固定骨折的肋骨，比较两种治疗方法和疗效及并发症情况。结果保守组和手术组各死亡3例，原因为呼吸道感染致呼吸衰竭，两组无差异，但ICU停留和住院天数、机械通气时间、呼吸道感染等并发症手术组明显低于保守组（P〈0．01）。手术组无胸壁畸形，而保守组有18例，两组比较差异有统计学意义（P〈O．01）。出院3个月后，手术组患者部分肺功能指标显著优于保守组（P〈0．01）。结论手术治疗连枷胸可迅速稳定胸壁，消除反常呼吸和激烈疼痛对呼吸的影响，还可减轻连枷胸对患者远期肺功能的影响，具有较高的临床应用价值。

Clinical Study on Surgical Stabilization for Traumatic Flail Chest

Objective To compare different treatments for flail chest injuries to explore the optimal treatment approach. Methods The 80 cases of flail chest patient in our hospital from January 2005 to November 2012 were divided into conservative treatment group and surgical treatment group. The clinical data in two groups were compared. Results Three cases died in each group for the reason of respiratory failure caused by respiratory infection. Nevertheless, the length of staying in ICU, the ventilator usage duration and lung infection in surgical treatment group were obviously less than that in conservative treatment group （P 〈 0.01 ）. Surgical treatment group had no thoracic deformity, however, there were 45% （18/40） thoracic deformities in conservative group （P 〈 0.01 ）. The pulmonary function examination was performed three months after the patients left the hospital, and the patients in surgical group had better results than that in the conservative treatment group. Conclusion Surgical treatment could immediately stabilize the chest wall, eliminate paradoxical respiration and the effect of intensive pain to breath, and patients have less impairment of pulmonary function.