摘要：
Objective To investigate the clinical efficacy of rib's strapping-traction technology using absorbable implants combined with memory-alloy ribs embracing fixator in treating multiple rib fractures under video-assisted thoracoscope.Methods A retrospective case control study was performed to analyze 178 patients with multiple rib fractures treated from January 2015 to June 2017.According to the operation method,all patients were divided into observation group (91 patients) and control group (87 patients).The observation group including 59 males and 32 females aged (39.7 ± 7.8)years adopted internal fixation by rib's strapping-traction technology using absorbable implants combined with memory alloy ribs embracing fixator under video-assisted thoracoscopic surgery.The control group including 56 males and 31 females aged (40.2 ± 6.9) years adopted internal fixation by conventional rib's clamping-traction technology using towel forcep combined with memory-alloy ribs embracing fixator under video-assisted thoracoscopic surgery.The incision length,single rib internal fixation time,number of internal fixation rib fractures,visual analogue scale (VAS) score on postoperative 1 d,postoperative chest drainage,postoperative hospital stay,and postoperative fracture healing were compared between the two groups.Results All patients were followed up for 3-30 months (mean,16.7 months).All operations were successful,with no case of thoracotomy.The observation group had shorter incision length [(4.3 ± 1.2) cm vs.(6.2 ± 1.7) cm] and single rib internal fixation time [(10.3±2.9)min vs.(14.1 ±2.3)min] than the control group (P＜0.05).There were no significant differences (P ＞ 0.05) between the two groups in number of internal fixation rib fractures [(5.7±.3.6) vs.(5.9±3.3)],postoperative chest drainage [(668.3 ±131.4)ml vs.(703.7±116.2)ml],postoperative hospital stay [(6.4 ± 1.8) d vs.(6.8 ± 1.7) d],the VAS score on postoperative 1 d [0-3 point,62％ vs.61％;4-6 point,38％ vs.39％],postoperative osteophyte formation rate [postoperative 1 month,97％ vs.95％;postoperative 3 months,100％ vs.100％].Stable chest walls and thoracic deformity recovery were seen in all patients,with no significant complications occurred.Conclusion Rib's strapping-traction technology using absorbable implants combined with memory-alloy ribs embracing fixator under video-assisted thoracoscope is convenient and has exact efficacy for multiple rib fractures,with advantage of shorter incision length and operation time over conventional thoracoscopic surgery,and thus is worthy of clinical application.%目的 探讨电视辅助胸腔镜下可吸收线肋骨捆扎牵引技术配合记忆合金肋骨环抱器治疗多发肋骨骨折的临床疗效. 方法 采用回顾性病例对照研究分析2015年1月-2017年6月收治的178例多发肋骨骨折患者的临床资料,根据手术方法分为观察组(91例)和对照组(87例).观察组男59例,女32例;年龄(39.7±7.8)岁;行胸腔镜下可吸收线肋骨捆扎牵引技术配合记忆合金肋骨环抱器内固定手术.对照组男56例,女31例;年龄(40.2±6.9)岁;行胸腔镜下常用的巾钳或钳夹牵引复位配合记忆合金肋骨环抱器内固定手术.比较两组切口长度、单处肋骨内固定时间、内固定骨折根数、术后第1天视觉模拟评分(VAS)、术后胸腔引流量、术后住院时间、术后骨折愈合情况. 结果 患者均获随访3 ～ 30个月,平均16.7个月.手术均顺利,无一例中转剖胸.观察组切口长度[(4.3±1.2)cm:(6.2±1.7)cm]和单处肋骨内固定时间[(10.3±2.9)min:(14.1±2.3)min]显著短于对照组(P＜0.05);观察组和对照组内固定骨折根数[(5.7±3.6)根:(5.9±3.3)根]、术后胸腔引流量[(668.3±131.4) ml:(703.7±116.2)ml]、术后住院时间[(6.4±1.8)d:(6.8±1.7)d]、术后第1天VAS分布(0～3分,62％:61％;4～6分,38％:39％)、骨痂形成率(术后1个月,97％:95％;术后3个月,100％:100％)比较差异无统计学意义(P＞0.05).胸壁稳定,胸廓畸形均矫正满意,无明显并发症. 结论 电视辅助胸腔镜下可吸收线肋骨捆扎牵引技术配合记忆合金肋骨环抱器手术治疗多发肋骨骨折操作简便、疗效确切,较常规胸腔镜手术有切口更短、手术时间更少等优势,值得临床推广.
