非连枷胸肋骨骨折手术疗效评估

目的评估非连枷胸肋骨骨折的手术疗效。 方法回顾性性分析上海交通大学附属第六人民医院胸外科2015年5月至2016年6月收治的109例非连枷胸肋骨骨折病例(骨折数≥3根)，测定并比较患者入院即刻(IN)、术前1天(PRE)以及术后第1、2和7天(D1、D2、D7)的相应疼痛指数(PAIN)、肺功能指标，即肺活量(VC)、第一秒用力呼气量(FEV₁)、呼气流量峰值(PEF)的差异。 结果109例非连枷胸肋骨骨折患者中男性85例(78.0%)，女性24例(22.0%)；年龄23～74岁(平均年龄52岁)；合并多发伤75例(68.8%)，单纯胸外伤34例(31.2%)；平均损伤严重度评分(ISS)18.21分；平均肋骨骨折数5.79(3～16)根；平均入院至手术时间4.36(1～16)d。术后所有患者获得治愈，术后切口感染2例(1.8%)，切口周围麻木5例(4.6%)。肋骨骨折手术治疗后第7天即可明显缓解疼痛，改善肺功能指标(VC、FEV₁和PEF)，与术前比较差异均有统计学意义(P<0.05)。 结论对于骨折数≥3根的非连枷胸肋骨骨折患者手术治疗早期即可明显缓解疼痛，快速恢复肺功能，手术简单安全。

Evaluation on the curative effect of surgical treatment of non-flail chest rib fractures

ObjectiveTo evaluate the effect of operative treatment of non-flail chest rib fractures. MethodsA retrospective analysis of 109 patients who underwent non-flail chest rib fractures between May 2015 and June 2016 was conducted. We compared patients’ pain index and pulmonary function parameters (vital capacity, VC; forced vital capacity in the first second, FEV₁; peak expiratory flow, PEF) at different stages: at hospital admission (IN), on the day before surgery (PRE), and on postoperative days one (D1), two (D2), and seven (D7). ResultsThe 109 patients included 85 men (78.0%) and 24 women (22.0%) between the age of 23 and 74 ( with a mean of 52). 75 had multiple injuries (68.8%), 34 had chest trauma solely (31.2%), the average injury severity score (ISS) was 18.2.The average number of fractured ribs was 5.8 ( ranging from 3-16). The average length of time from admission to operative intervention was 4.4 days (ranging from 1-16). The fractures healed in all patients, while superficial wound infections occurred in two cases (1.8%), skin numbness around the incision occurred in 5 cases (4.6%). Pain and pulmonary function parameters (VC, FEV₁, PEF) had improved significantly by postoperative day seven (P<0.05). ConclusionsIn patients with three or more non-flail chest rib fractures , early surgical treatment is safe, and can effectively relieve pain , leading to rapid recovery of lung function.