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电视胸腔镜联合形状记忆环抱接骨板治疗多发性肋骨骨折

目的探讨应用电视胸腔镜联合形状记忆环抱接骨板治疗多发性肋骨骨折的方法和疗效。方法自 2009年 1～ 12月上海交通大学医学院附属新华医院（崇明）胸心外科收治 38例多发性肋骨骨折患者（内固定组），均行电视胸腔镜探查、止血、胸腔内血凝块清除、肺裂伤修补，应用电视胸腔镜定位肋骨骨折部位，切开复位，并采用形状记忆环抱接骨板行肋骨内固定。选择 2008年 1 ～ 12月我科收治的 44例胸部创伤经保守治疗的患者作为对照（非内固定组）。术后观察两组患者的胸痛缓解时间、坐起时间、下床时间、住院时间、胸壁畸形、骨折愈合时间及相关并发症（肺不张、肺部感染）发生情况。结果内固定组患者均临床愈合，治愈率为 100%。平均手术时间 48.2 min，术后胸痛明显缓解，平均 2.5 d可坐起， 6.8 d可站立行走，平均住院时间为 10.2 d，原有的胸壁畸形均矫正、平均骨折愈合时间为 4周，无明显并发症发生。内固定组患者的胸痛缓解时间、坐起时间、下床时间、住院时间、胸壁畸形、骨折愈合时间及相关并发症（肺不张、肺部感染）发生率均短于或少于非内固定组（ P＜ 0.05）。内固定组随访 38例，随访时间 2～ 14周，均复查胸部 X线片，未见明显并发症发生，无再次骨折，接骨板无松动、断裂。结论应用电视胸腔镜联合形状记忆环抱接骨板治疗多发性肋骨骨折具有创伤小、操作简便、固定可靠、组织相容性好及并发症少等优点，有利于促进骨折愈合和呼吸功能改善，是治疗多发性肋骨骨折较理想的方法。

手术内固定治疗创伤性连枷胸对患者呼吸功能的影响

目的观察连枷胸患者胸壁加压包扎、肋骨牵引和手术内固定的治疗效果。 方法纳入2001年1月至2010年6月解放军第一医院心胸外科收治的56例连枷胸患者，分为3组：牵引治疗组，14例，其中男10例、女4例，年龄（39.7±11.6）岁；包扎治疗组，12例，其中男11例、女1例，年龄（40.2±13.2）岁；手术内固定组，30例，其中男26例、女4例，年龄（42.6±12.5）岁。比较3组的治疗效果。 结果手术内固定组与牵引治疗组和包扎治疗组比较，除需呼吸机支持率与牵引治疗组差异无统计学意义（P>0.05）外，呼吸机通气时间、住ICU时间、胸腔引流管拔除时间均缩短（P<0.05），胸部并发症发生率及死亡率降低（P<0.05），动脉血氧分压（PaO2）、动脉血氧饱和度（SaO2）显著升高（P<0.01），肺挫伤评分下降明显；而牵引治疗组PaO2、SaO2及肺挫伤评分较入院时改善缓慢，胸壁加压包扎治疗组甚至有加重趋势。 结论大面积浮动胸壁的病理改变以胸腔容积减少为基础，胸壁加压包扎无治疗效果，甚至加重低氧；肋骨巾钳悬吊牵引固定对连枷胸缺氧内环境的改善效果不佳；手术切开复位内固定是改善大面积浮动胸壁呼吸功能障碍的有效方法。

连枷胸内固定手术方法的临床应用比较

摘要： 目的 比较4种对多根、多段肋骨骨折内骨的内固定方法，总结其治疗经验。 方法 2006年7月至2009年7月三峡大学仁和医院收治75例多根、多段肋骨骨折患者，男51例，女24例；年龄17～74岁,平均年龄43.50岁。致伤原因为:交通伤44例,高处坠落伤21例,撞击伤10例；采用钢丝固定5例，钢板固定12例，Judet固定架固定51例，人工合成树脂骨内固定7例。 结果 75 例患者均采用内固定手术治疗，术后胸廓恢复正常形态，纵隔摆动消失，疼痛和呼吸困难明显改善；随访6个月~2年，复查胸部X线片示：钢丝固定的患者中有2例发生2处固定移位，其余患者无再次移位，恢复良好。 结论 内固定手术治疗是治疗多根、多段肋骨骨折患者的有效方法，但各有利弊，应严格掌握手术适应证。

气囊导尿管在连枷胸治疗中的应用

Establishment of flail chest in a rabbit model

Objective To explore the feasibility of establishing a rabbit model of flail chest. Methods Flail chest model was eatablished in 12 New Zealand white rabbits after anesthesia and sterile surgery. The paradoxical movement of chest wall was recorded by the biological signal acquisition system, arterial blood was collected for blood gas analysis, the vital signs were recorded by electrocardiogram (ECG) and the lung tissue was taken for the pathological analysis at the end of the experiment. The effect of flail chest on the respiratory function of experimental animals was analyzed to evaluate the feasibility of establishing flail chest model. Results All surgeries were successful without mortality. The operation time was 41.42±7.08 min. Duration of endotracheal intubation was 79.33±12.21 min. Statistical results showed that the pH, partial pressure of arterial carbon dioxide (PaCO2) and base excess (BE) increased; while partial pressure of oxygen (PaO2) and oxygen saturation (SaO2) reduced. Pathological results showed that flail chest not intervented for a long period would lead to organic lesions. Conclusion The rabbit model of flail chest is feasible, safe, repeatable, easy and simple to handle. The animal is easy to access which is the foundation to study the disease process, recovery procedure and the efficacy after intervention.

记忆合金环抱器在创伤性连枷胸治疗中的应用

目的　总结记忆合金环抱器在创伤性连枷胸治疗中的应用经验。　方法　2008年10月至2011年8月甘肃省酒泉市人民医院应用镍钛记忆合金环抱器内固定治疗创伤性连枷胸38例，其中男31例，女7例；年龄 19～62 （42.6±12.5）岁。致伤原因为交通伤31例，高处坠落伤4例， 塌方挤压伤2例， 殴打外伤1例。对其手术时机、适应证选择及临床效果等进行分析。　结果　本组无手术相关死亡，随访34例，随访率91.89% （34/37），随访1～16 （10.3±2.6）个月。随访时胸部X线片或胸部CT提示肋骨骨折端对位好，双侧胸廓基本对称，连枷胸得到满意矫正，患者呼吸良好，无长期疼痛等并发症。全组无1例因环抱器有排斥反应、不适等需取出者。　结论　创伤性连枷胸患者早期行记忆合金环抱器内固定治疗可以使连枷胸得到有效的矫正，改善和恢复呼吸功能，降低病死率及各类并发症的发生率。

Three-point Bending Test of Two Methods for Rib Internal Fixation

ObjectiveTo use claw-shaped blade plate and self-made 'titanium clip' blade plate for rib fracture fixation, and compare outcomes of these two internal fixation methods through mechanical tests. MethodsThoracic cage specimens of six adults (male)corpses were numbered. Bilateral 4th, 6th and 8th thoracic ribs of each corpse were taken from the rib nodules (0%)to costal cartilage junction (CJJ points, 100%)along the long axis of the ribs. Rib fragments about 130 mm in length with 50% locus were selected for mechanical tests of the lateral area. A total of 36 rib fragments were sampled and numbered. Each rib fragment was placed on electronic universal mechanical tester. A span of 100 mm and a loading speed of 2.5 mm/min were set to perform a three-point bending test until specimens fractured. The loads at displacement of 2, 4, 6, 8, 10, 15 and 20 mm respectively and maximum load were recorded, then the load-displacement curve was drawn. Above rib fragments were randomly divided into 2 groups, which were fixed using 'titanium clip' blade plate (titanium plate group)and claw-shaped blade plate (claw-shape group)respectively. Three-point bending test was performed under above loading conditions until the fixed specimens fractured again, and relevant data were recorded. ResultsBefore fixation, there was no statistical difference in maximum load and peak deformation of the 4th, 6th and 8th ribs between the 2 groups (P > 0.05). Maximum load and peak deformation of the 4th, 6th and 8th ribs in the claw-shape group after fixation were statistically different from those before fixation (P < 0.05). Maximum load and peak deformation of the 4th, 6th and 8th ribs in the titanium plate group after fixation were also statistically different from those before fixation (P < 0.05). After fixation, maximum loads of the 4th, 6th and 8th ribs in the claw-shape group were statistically different from those in the titanium plate group (P < 0.05), but there was no statistical difference in peak deformation between the 2 groups (P > 0.05). ConclusionsFractured ribs fixed with 'titanium clip' blade plates are more stable and stronger than those fixed with claw-shaped blade plates.

Research Progress of Flail Chest with Pulmonary Contusion

Pulmonary contusion is frequent and a serious injury in the chest trauma patients in emergency department. And it is easy to induce acute respiratory distress syndrome (ARDS) and respiratory failure. Since the development of modern technology and transportation, flail chest with pulmonary contusion happens more frequently than the past. And its complications and mortality are higher. In order to understand it better and improve the effect of the therapy on flail chest with pulmonary contusion, we reviewed the relative literatures. In this article, the main contents are as followed:① The pathophysiological changes of pulmonary contusion; ② The pathophysiological changes of flail chest with pulmonary contusion; ③ Clinical manifestation of flail chest with pulmonary contusion; ④ Imaging change of flail chest with pulmonary contusion; ⑤ progress in diagnosis and treatment.

多孔有机玻璃板治疗多发性肋骨骨折

目的　观察多孔有机玻璃板治疗多发性肋骨骨折的临床效果。　方法　采用自制多孔有机玻璃板外固定器行肋骨骨折外固定 86例。　结果　 86例患者均治愈出院 ,且住院时间短 ,并发症少 ,胸廓无畸形。　结论　多孔有机玻璃板外固定器治疗多发性肋骨骨折简便易行 ,该方法安全可靠 ,疗效满意。

Assisted Thoracic Rib Internal Fixation for Flail Chest

目的探讨胸腔镜辅助肋骨内固定术治疗连枷胸的优势及合理性。 方法纳入我院2006年1月至2012年1月因外伤导致连枷胸行肋骨内固定手术40例患者，采用胸腔镜辅助对多发性肋骨骨折连枷胸行NiTi合金肋骨环抱器内固定术20例为胸腔镜辅助组，其中男14例、女6例，年龄（44.8±7.7）岁；常规开胸切口进胸探查暴露肋骨骨折并行NiTi合金肋骨环抱器内固定术20例为传统手术组，其中男15例、女5例，年龄（43.0±4.7）岁；比较两组临床结果。 结果与传统手术组相较，胸腔镜辅助组无再出血，患者能较早脱离呼吸机并适当活动，术后疼痛症状较轻，住院时间短，6个月后随访无慢性胸痛，伤侧胸部切口无麻木感。 结论胸腔镜辅助肋骨内固定术较常规开胸手术治疗多发性肋骨骨折有优势，值得推广。