单孔胸腔镜联合内固定术治疗多发肋骨骨折并血气胸的临床疗效

目的:探讨单孔胸腔镜联合内固定术治疗多发性肋骨骨折并血气胸的临床疗效。方法:选择2016年4月至2019年4月诊治的44例多发肋骨骨折并血气胸患者。44例患者均在骨折后72 h内接受单孔胸腔镜探查、肺修补术,并在肋骨骨折腔镜定位后接受肋骨环抱式接骨板内固定术。结果:13例患者合并肺挫裂伤出血,行单孔胸腔镜肺修补术;26例患者肋间及壁层胸膜出血,行腔镜下止血术;5例行单孔胸腔镜胸腔探查术。患者平均骨折后(43.71±11.82)h接受手术,固定肋骨(3.7±1.1)根,手术时间(63.48±17.22)min,术中出血量(70.11±19.38)mL,术后引流量(162.75±20.60)mL。术后第1天疼痛评估(4.0±1.3)分,第5天疼痛评估(2.8±0.8)分。术后(2.1±1.1)d首次下床活动、术后(4.7±1.8)d拔除胸引管,住院时间(9.61±2.08)d。术后切口感染1例,多次换药后切口愈合;4例术后切口红肿,可能为缝线反应,拆线后红肿消退;肺不张4例、肺部感染4例,给予祛痰雾化治疗后逐渐好转;胸腔积液9例,均为少量积液,术后1个月胸部X线片或CT示积液消失。痊愈16例,有效28例,骨折愈合时间(9.7±1.4)周。术后所有患者随访3~6个月,影像学结果提示肋骨对位良好,骨痂形成,愈合良好,均未出现肋骨接骨板松动和断裂。结论:单孔胸腔镜联合内固定术治疗多发肋骨骨折并血气胸,具有微创、疼痛轻、临床效果确切的优点,及早进行可以明显改善患者的呼吸循环功能,可作为治疗多发肋骨骨折合并血气胸的首选方法。

Clinical effect of single-port thoracoscopy combined with internal fixation in treatment of multiple rib fractures with hemopneumothorax

Objective: To investigate the clinical effect of single-port thoracoscopy combined with internal fixation in the treatment of multiple rib fractures with hemopneumothorax. Methods: A total of 44 patients with multiple rib fractures and pneumothorax were selected from April 2016 to April 2019. Single-port thoracoscopic exploration and pulmonary repair were performed within 72 h after the injury, rib embracing bone plate fixation was performed after laparoscopic positioning of rib fractures. Results: Thirteen patients with pulmonary contusion and hemorrhage underwent single-port thoracoscopic pulmonary repair, 26 patients with intercostal and parietal pleural hemorrhage underwent endoscopic hemostasis, and 5 patients underwent single-port thoracoscopic thoracic exploration. The mean interval time was (43.71±11.82) h from fracture to surgery. The average fixation time was (63.48±17.22) min, intraoperative blood loss was (70.11±19.38) mL, and postoperative drainage was (162.75±20.60) mL. The mean pain assessment score was (4.0±1.3) on day 1 and (2.8±0.8) on day 5. The first time to get out of bed after surgery was (2.1±1.1) d, the time to remove the thoracic catheter after surgery was (4.7±1.8) d after surgery, and the length of stay was (9.61±2.08) d. The wound infection occurred in 1 patient after the operation and was healed after multiple dressing changes. The wound redness and swelling occurred in 4 cases, which may be suturing reaction and subsided after suture was removed. There were 4 cases of atelectasis and 4 cases of pulmonary infection, and patients gradually improved after expectorant atomization treatment. There were 9 cases of pleural effusion, all of which was a small amount of effusion. The chest X-ray or CT examination one month after the operation showed that the effusion disappeared. Sixteen patients were cured and 28 cases were effectively treated, and the fracture healing time was (9.7±1.4) weeks. All patients were followed up for 3-6 months after the operation, and the imaging results indicated good rib alignment, callus formation, and good healing. No loosening or fracture of the rib bone plate was found in all the patients. Conclusions: Single-port thoracoscopy combined with internal fixation has the advantages of minimal invasion, mild pain, and accurate clinical effect for the treatment of multiple rib fractures with hemopneumothorax. It is recommended that early and timely operation should be performed after injury, so as improve the respiratory and circulatory function of patients, and the method might be as first choice for the treatment of multiple rib fractures combined with hemopneumothorax.