连枷胸伴肺挫伤的手术固定与非手术固定的临床研究

目的比较伴有肺挫伤的创伤性连枷胸加压包扎、肋骨牵引和手术内固定的治疗效果。方法本文回顾性分析浙江省立同德医院2000年～2009年收治的46例连枷胸伴肺挫伤的临床资料。治疗分组:A组(牵引治疗组)12例、B组(包扎治疗组)13例、C组(手术固定组)21例。C组治疗方法包括在胸腔镜指引下行止血、肺修补及采用记忆合金肋骨环抱接骨器内固定。比较3种治疗方法的呼吸机通气支持率、机械通气时间、ICU时间、肺炎发生率、伤后第3天疼痛指数、死亡率等指标,以P0.05为差异具有统计学意义。结果与A组比较,B组需呼吸机支持率增高(P0.05),肺部感染的发生率增加(P0.05),机械通气时间、ICU住院时间、死亡率、疼痛指数均无统计学差异(P0.05);C组需呼吸机支持率及死亡率无统计学差异(P0.05),机械通气时间缩短(P0.01),ICU住院时间缩短(P0.01),肺部感染的发生率减低(P0.05),疼痛指数下降(P0.05)。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,但是对死亡率无影响。总体上,手术内固定优于牵引治疗和包扎治疗,而包扎治疗效果最差。

Comparison of surgical and conservative treatment for traumatic flail chest associated with pulmonary contusion

Objective To compare the curative effect of pressure dressing,traction and internal fixation on the traumatic flail chest associated with pulmonary contusion.Methods We made a retrospective analysis of 46 cases of flail chest associated with pulmonary contusion in Tongde Hospital of Zhejiang Province between 2000-2009.All cases were divided into three groups as follows： group A（rib traction group） with 12 cases,group B（pressure dressing group） with 13 cases and group C（surgical fixation group）with 21 cases.The surgical fixation included： stopping bleeding under VATS control,lung repair and internal fixation with shape-memory alloy device.Indicators were compared,such as ventilator support,mechanical ventilation time,ICU stay,incidence of pneumonia,pain index in the third day and mortality.Finally measurement data was expressed using mean ± standard deviation,and SPSS 13.0 statistical software for analysis,and the results of group differences were expressed by T tests or X2 test.It was considered statistically significant when P0.05.Results Compared with group A and group B,there was no statistical difference in mechanical ventilation time,ICU stay,pain index in the third day and mortality（P0.05）,but statistical difference in the incidence of pneumonia and ventilator support（P0.05）;compared with group A and group C,the mechanical ventilation time was significantly shorter（P0.01）,ICU stay significantly shorter（P0.01）,the incidence of pneumonia significantly lower（P0.05）,the pain index in the third day was significantly lower（P0.05） in group C.However there was no statistical difference in ventilator support and mortality between group A and group C（P0.05）.Conclusion This study proves that for traumatic flail chest patients associated with pulmonary contusion,surgical stabilization has advantages of improving the respiratory function,shorter mechanical ventilation time,less ICU stay,lower incidence of pneumonia,and relieving pain.However,there was no difference in mortality.As a whole,surgical internal fixation is more effective than pressure dressing and traction,and pressure dressing is most effectless.