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目的观察手术治疗创伤性连枷胸的疗效。方法将86例以创伤性连枷胸为主的多发伤病例,随机分为手术组和保守组。手术组45例,采用镍钛记忆合金环抱式接骨器手术内固定肋骨骨折;保守组41例,采用外固定胸廓非手术保守治疗,比较两组的临床疗效。结果手术组患者均胸壁畸形消失,而保守组中有19例患者遗留胸壁畸形。手术组患者平均住院时间、平均住ICU时间和平均机械通气时间均显著短于保守组(P<0.01),手术组患者呼吸系统并发症(包括肺部炎症、肺不张、呼吸功能衰竭)发生率显著低于保守组(P<0.01)。出院3个月后,手术组患者各项肺功能指标均显著高于保守组(P<0.01)。结论肋骨内固定手术治疗创伤性连枷胸,可以迅速纠正畸形,稳定胸廓,消除反常呼吸,减少并发症,还可减轻连枷胸对患者远期肺功能的影响。镍钛记忆合金环抱式接骨器内固定肋骨骨折,手术简单、方便,疗效确切。
Objective To observe the effect of surgical treatment of traumatic flail chest. Methods Totally 86 cases of traumatic flail chest-based multiple injuries were randomly divided into operation group and conservative group. In the operation group, 45 cases were treated with nickel-titanium memory alloy embracing cage for internal fixation of rib fractures. In conservative group, 41 cases were treated conservatively with external fixation thoracic non-surgical treatment. The clinical curative effect was compared between the two groups. Results In the operation group, the thoracic wall deformity disappeared, while in the conservative group, 19 patients had the chest wall deformity. The mean hospital stay, ICU duration and mean duration of mechanical ventilation in the operation group were significantly shorter than those in the conservative group (P <0.01). Respiratory complications (including pulmonary inflammation, atelectasis and respiratory failure) occurred in the operation group The rate was significantly lower than the conservative group (P <0.01). Three months after discharge, the indexes of pulmonary function in the operation group were significantly higher than those in the conservative group (P <0.01). Conclusion The treatment of traumatic flail chest with internal fixation with rib can quickly correct deformity, stabilize the thorax, eliminate abnormal breathing, reduce complications and reduce the influence of flail chest on long-term lung function. Ni-Ti memory alloy embracing cage internal fixation of rib fractures, surgery is simple, convenient and effective.