电视胸腔镜手术及常规手术治疗多发性肋骨骨折的对比分析

目的比较电视胸腔镜手术与常规手术治疗多发性肋骨骨折的临床效果。方法自2010年1月至2012年12月，都江堰市人民医院收治多发性肋骨骨折173例，其中男122例，女51例；年龄19～71（41.3±7．1）岁。173例患者根据采用的治疗方法不同分为3组，非手术组：83例，肋骨骨折（4．9±1．3）处，连枷胸20例；常规手术组41例，肋骨骨折（5．2-＋1．1）处，连枷胸11例；电视胸腔镜手术组：49例，肋骨骨折（5_3±1．5）处，连枷胸14例。观察住院时间、疼痛时间、手术切口长度、手术时间、胸腔闭式引流时间及并发症发生情况，并进行比较。结果电视胸腔镜手术组切口长度（5．2±1．5）cmvs．（8．5±2-3）cm，P=0．031]、手术时间（1．1±0.3）hVS．（1．8±0．2）h，P=0．003]、胸腔引流时间（0-3±0．0）dVS．（3．2±1．1）d，P=0．007]和住院时间（13．7±1．5）dVS．（17．3±2．3）d，P=0．017]均短于常规手术组。本组159例患者完成随访，于出院后1、3、6个月随访复查胸部x线片，3个月后患者的肋骨骨折处均有明显的骨痂生长，未行手术治疗的部分患者肋骨畸形愈合。结论对多发性肋骨骨折的治疗，随着内固定材料的发展，手术治疗逐渐成为趋势，而电视胸腔镜手术具有微创手术的优点，效果良好。

Comparison between Video-assisted Thoracoscopic Surgery and Conventional Surgery for Multiple Rib Fractures

Objective To compare clinical outcomes between video-assisted thoracoscopic surgery （VATS） and conventional surgery for the treatment of multiple rib fractures. Methods A total of 173 consecutive patients with multiple rib fractures were admitted to Dujiangyan People＇s Hospital from January 2010 to December 2012. There were 122 males and 51 females with their age of 19-71 （41.3 ± 7.1 ） years. According to different treatment strategies, all the patients were divided into 3 groups： conservative treatment group （ 83 patients with a mean of 4.9 ± 1.3 fractured ribs, including 20 patients with flail chest）, conventional surgery group （41 patients with a mean of 5.2 ± 1.1 fractured ribs, including 11 patients with flail chest） and VATS group （49 patients with a mean of 5.3 ± 1.5 fractured ribs, including 14 patients with flail chest）. Length of hospital stay, duration of postoperative pain, incision length, operation time, chest drainage duration and morbidity were compared among the 3 groups. Results The incision length （5.2 ＋±1.5 cm vs. 8.5± 2.3 cm,P=0.031 ）, operation time （ 1.1 ± 0.3 hours vs. 1.8 ± 0.2 hours, P-0.003 ）, chest drainage duration （ 0.3 ± 0.0 day vs. 3.2 ＋ 1.1 days,P=-0.007 ） and length of hospital stay （ 13.7 ± 1.5 days vs. 17.3 ± 2.3 days,0.017 ） of VATS group were significantly shorter than those of the conventional surgery group. A total of 159 patients were followed up, and chest x-ray was examined at l, 3 and 6 months after discharge. After 3 months, bone callus formation was evident around the rib fractures in chest x-ray in patients undergoing surgery, while bone union with deformity was shown in some patients of the conservative group. Conclusion With the development of various internal fixation materials, surgical internal fixation has become a trend for patients with multiple rib fractures, and VATS internal fixation is minimally invasive with satisfactory clinical outcomes.