连枷胸保守治疗与手术治疗对比研究.docVIP

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 作者单位：重庆市急救医疗中心、重庆市急救医学研究所胸心外科，重庆 400014 【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（25.7±6.9 vs 29.8±8.5）、双侧肋骨骨折数（11.8±3.5 vs 9.8±1.8）差异无统计学意义（P0.05，0.05）；大量血胸发生率手术组明显高于保守组（40.9% vs 7.7%）(P0.05)，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% vs 84.6%,27.3% vs 92.3%）(P0.01,0.01)；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（P0.05）。（3）记忆合金肋骨环抱接骨器内固定呼吸并发症（4/16，25%）明显低于钢丝+克氏针内固定（4/6，66.7%）（P0.05）；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 Comparison between surgical and conservative treatment for flail chest DU Dingyuan,SU Hongjie,TAN Yuankang,et al. (Department of Cardiothoracic Surgery,Chongqing Emergency Medical Center,Chongqing Institute of Accident Emergency Medicine,Chongqing 400014,China ) Abstract： Objective To investigate the therapeutic strategies,decrease the damage of pulmonary function and improve survival rate for severe chest trauma with flail chest.Methods The 35 patients with severe chest trauma and flail chest,admitted from Feb.1991 to Dec.2008 in Chongqing Emergency Medical Center,were retrospectively analyzed.The patients were divided into conservative treatment group(13 cases) and surgical internal fixation group(22 cases).Results The survival rate was 97.1%(34/35).One case died of MOSF in conservative treatment group.There was no statistical difference in the value of ISS and the number of fractured ribs in both sides(25.7±6.9 vs 29.8±8.5;11.8±3.5 vs 9.8±1.8）(P0.05,0.05).The incidence of massive haematothorax in surgical internal fixation group was significantly higher than that of conservative treatment group (40.9% vs 7.8%)(P0.05).But the complications of respiratory system and