胸腔镜辅助爪形钢板固定治疗伴有肺挫伤的连枷胸

目的探讨伴有肺挫伤的创伤性连枷胸外科内固定的治疗方法和疗效。方法回顾性分析本院2005年2月至2009年2月26例伴有肺挫伤的连枷胸患者资料，其中15例保守治疗，11例胸腔镜辅助爪形钢板手术内固定，比较两组需呼吸机通气支持率、机械通气时间、ICU时间、肺炎发生率、伤后第3天疼痛指数、病死率等指标。结果需呼吸机支持率手术组（27．3％）与保守组（26．7％）差异无统计学意义（P〉0．05）；机械通气时间手术组（4．45±0．37）d，保守组（14．33±0．50）d，手术组明显短于保守组（P〈0．01）；ICU住院时间手术组（6．09±0．37）d，保守组（20．20±0．98）d，手术组明显短于保守组（P〈0．01）；肺部感染发生率手术组18．2％，保守组73．3％，手术组明显低于保守组（P〈0．05）；病死率手术组9．1％，保守组13．3％，差异无统计学意义（P〉0．05）；疼痛指数手术组（4±1．9），保守组（7±1．5），手术组低于保守组（P〈0．05）。结论连枷胸肋骨骨折内固定可以迅速稳定胸壁、改善连枷胸对呼吸功能的影响，减少机械通气时间、ICU住院时间和肺部感染率，减轻疼痛程度，从而缩短病程。但是对病死率影响不大，对需要机械通气率亦影响不大。

Video-assisted thoracic internal fixation of the traumatic flail chest associated with pulmonary contusion using claw-steel-plate

Objective To explore effect and the surgical method of video -assisted thoracic internal fixation of the traumatic flail chest associated with pulmonary contusion using claw - steel - plate. Methods We made a retrospective analysis of 26 eases of flail chest patients associated with pulmonary contusion in our hospital between 2005 -2009 years, with 15 cases of conservative treatment, and 11 cases of surgical fixation. The admission of the group was that the existence of flail chest and pulmonary contusion confirmed by CT scan. And the exclusion criteria was as follows ： traunkatic brain injury or Abdominal organ injury and haemorrhage or bleeding caused by limbs and pelvic fractures. The internal fixation group were surgery within 6 hours. Compare the indicators between two groups such as ventilator support ,ventilatory period ,intensive care unit stay,the incidence of pneumonia,pain index in third day,and mortality. Finally we express measurement data using mean ± standard deviation, and using SPSS 13.0 statistical software for analysis, and we express the results of group differences by T tests or X2 test or rank sum test then define statistically significant when P 〈0. 05. Results There was no statistical difference in ventilator support （27. 3%vs 26. 7% ） （P 〉0. 05）. The ventilatory period in surgical internal fixation group was significantly shorter than that of conservative treatment group（4. 45 ±0. 37days vsl4. 33 ±0. 5days） （P 〈0. 01 ）. The intensive care unit stay in surgical internal fixation group was significantly shorter than that of conservative treatment group （6. 09 ± 0. 37 days vs20. 20 ± 0. 98days） （P 〈 0. 01）. The incidence of pneumonia in surgical internal fixation group was significantly lower than that of conservative treatment group （18. 2% vs73. 3% ） （P 〈0. 05）. However, there was no statistical difference in mortality（9, 1%vs13. 3% ） （P 〉0. 05）. Finally,the pain index in third day in surgical internal fixation group was significantly lower than that of conservative treatment group（4 ± 1.9 vs7 ± 1.5） （P 〈0. 05）. Conclusion Traumatic flail chest patients associated with pulmonary contusion, surgical stabilization can quickly stabilize the chest wall, with beneficial effects to improve the respiratory function, with shorter ventilatory period, shorter trauma intensive care unit stay, lower incidence of pneumonia, and pain relief therefore shortening the course of the disease. However, there was no difference in mortality and the necessity of ventilator support.