连枷胸保守治疗与手术治疗对比研究

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1、连枷胸保守治疗与手术治疗对比研究作者：都定元，苏泓洁，谭远康，孔令文，张为民，赵兴吉，马丁【摘要】目的探讨连枷胸的优化救治方案，降低肺功能损害，提高救治成功率。方法回顾性分析1991年2月~2008年12月我院收治的35例连枷胸病例。分为保守治疗组［巾钳肋骨悬吊牵引和(或)呼吸机气体内固定］13例，手术内固定组22例。手术组除行止血、肺修补等处理外，还采用“钢丝+克氏针”或记忆合金肋骨环抱接骨器内固定。结果(1)治愈率97.1%(34/35),保守组1例死于多器官功能衰竭(MOSF)。(2)手术组与保守组ISS值(25

2、.7±6.9vs29.8±8.5)、双侧肋骨骨折数(11・8±3.5vs9.8±1.8)差异无统计学意义(P>0.05,0.05);大量血胸发生率手术组明显高于保守组(40.9%vs7.7%)(P<0.05),呼吸系统并发症及胸廓畸形发生率手术组显著低于保守组(36.4%vs84.6%,27.3%vs92.3%)(P<0.01,0.01);需呼吸机支持率手术组(4/22,18.2%)与保守组(3/13,23.1%)差异无统计学意义(P>0.05)o(3)记忆合金肋骨环抱接骨器内固定呼吸并发症(4

3、/16,25%)明显低于“钢丝+克氏针”内固定(4/6,66.7%)(P<0.05);手术组后遗胸廓畸形均为“钢丝+克氏针”内固定组，记忆合金肋骨环抱接骨器恢复胸廓形态、纠正胸壁软化满意。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，尤其记忆合金肋骨环抱接骨器内固定可达到恢复胸壁完整形态，明显优于保守治疗组。【关键词】连枷胸；保守治疗；手术；内固定；呼吸功能Abstract:ObjectiveToinvestigatethetherapeuticstrategies,decreasethe

4、damageofpulmonaryfunctionandimprovesurvivalrateforseverechesttraumawithflailchest.MethodsThe35patientswithseverechesttraumaandflailchest,admittedfromFeb.1991toDec.2008inChongqingEmergencyMedicalCenter,wereretrospectivelyanalyzed.Thepatientsweredividedintoconserv

5、ativetreatmentgroup(13cases)andsurgicalinternalfixationgroup(22cases)・ResultsThesurvivalratewas97.1%(34/35).OnecasediedofMOSFinconservativetreatmentgroup.TherewasnostatisticaldifferenceinthevalueofISSandthenumberoffracturedribsinbothsides(25.7±6.9vs29.8±8.5;11.8

6、±3.5vs9.8±1.8)(P>0.05,0・05)・Theincidenceofmassivehaematothoraxinsurgicalinternalfixationgroupwassignificantlyhigherthanthatofconservativetreatmentgroup(40.9%vs7.8%)(P<0・05).Butthecomplicationsofrespiratorysystemandthedeformityofchestwal1insurgicalinternalf

7、ixationgroupweresignificantlylowerthanthoseinconservativetreatmentgroup(36.4%vs84.6%,27.3%vs92.3%)(P<0.01,0.01).Therewasnostatisticalsignificanceinbothgroupsforventilatorsupport(18.2%vs23.1%)(P>0.05)・TherespiratorycomplicationsinthegroupofusingNiTishapemem

8、oryalloyofembracinginternalfixatorweremuchlowerthanthoseingroupofusingsteelwireandKirschnerwire(25%vs66.7%)(P<0.05).Thedeformityofchestwallafteroperationwasonlyexi