连枷胸的手术与保守治疗的回顾性分析

摘要

Objective To compare the effect of internal fixation and external fixation of flail chest. Methods The clinical data of 40 cases with flail chest,treated by external fixation(n= 20) and memory alloy ribs embracing fixators(n= 20) respectively,were retrospectively analyzed. Results All patients were cured and no death occurred. The average ICU stay tirne,average hospital stay time,VAS scores at every time point of Surgical group were lower than that of non surgery group. Surgery could effectively stabilize flail chest,significantly reduce the time of mechanical ventilation, the incidence of deformities of chest wall and lung infection. Lung function index of surgery group,including forced vital capacity(FVC) ,forced expiratory volume in 1st second(FEV1.0) ,total lung capacity(TLC) ,peak expiratory flow rate(PEFR) ,maximal mid expiratory flow velocity(MMEF) ,were higher than that of non surgical group. Conclusion Internal fixation surgery treatment for patients with flail chest can reduce hospitalization time, lower long term complications caused by flail chest,promote recovery of lung function,and thus bring about a good short term and long term treatment efficacy.%目的 比较手术内固定与非手术外固定治疗连枷胸的疗效.方法 回顾性分析40例采用外固定方法或记忆合金肋骨环抱器的内固定方法治疗的连枷胸患者临床资料,比较手术组(手术内固定治疗,n=20)和非手术组(非手术外固定治疗,n=20)患者的临床疗效.结果 两组患者全部治愈,无死亡病例.手术组患者平均住ICU时间、平均住院时间、各时间点视觉模拟评分法(VAS)评分均低于非手术组,手术治疗能够有效稳定连枷胸,能显著降低使用机械通气的时间,降低胸廓畸形、肺部感染的发生率.伤后2个月时,手术组患者肺功能指标最大肺活量(FVC)、第一秒用力呼气量(FEV1.0)、肺总容量(TLC)、呼气高峰流量(PEFR)、最大用力呼气中段流速(MMEF)均高于非手术组.结论 对连枷胸患者行手术内固定可减少住院时间,降低远期连枷胸引起的并发症,促进肺功能恢复,有良好的短期和长期疗效.