Thoracoscopic versus thoracotomic internal fixation by memory alloy embracing fixator for rib fractures
Objective To investigate the clinical effect of internal fixation of rib fractures by using memory alloy embracing fixator(MAEF)under thoracoscopy.Methods Clinical data of 78 cases of rib fractures admitted to the Department of Thoracic Surgery,Sichuan GEM Flower Hospital,from Jan.2016 to Jun.2023 were retrospec-tively analyzed,including 47 males and 31 females aged 30-65 years,mean 50.5 years.The injury mechanisms were road traffic injuries in 50 cases,falls from height in 22,and others in 6.According to the surgical method,patients were divided into thoracoscopy group(thoracoscopic MAEF internal fixation,n=43)and thoracotomy group(thora-cotomic MAEF internal fixation,n=35).The following variables were recorded and compared:perioperative indexes such as intraoperative blood loss,operation time,postoperative drainage time,ventilator support time and postopera-tive hospitalization time,pain degree before and 7 d after surgery,pulmonary function indicators such as forced vital capacity(FVC),forced expiratory volume in the first second(FEV1),maximum peak expiratory flow rate(PEF),fracture healing at 6 months after surgery,and postoperative complications.Results Compared with the thoracotomy group,the thoracoscopy group showed much less intraoperative blood loss(mL,182.1±26.4 vs.218.1±18.0),op-eration time(min,54.7±5.8 vs.82.3±7.5),postoperative drainage time(d,2.33±0.41 vs.4.29±0.40),ventila-tor support time(d,1.66±0.24 vs.3.35±0.36)and postoperative hospitalization time(d,7.55±0.71 vs.13.50±0.79,all P<0.05).At 7 d after surgery,VAS was much lower in the thoracoscopy group than in the thoracotomy group(3.15±0.20 vs.3.30±0.23,P<0.05),and the pulmonary function indicators were much better:FVC(L,4.26±0.26 vs.4.07±0.24),FEV1(L,2.22±0.23 vs.2.11±0.20),PEF(L/s,5.72±0.51 vs.5.38±0.46,all P<0.05).At 6 months after surgery,the rate of excellent-to-good fracture healing revealed no significant difference between the two groups(93.0%vs.94.3%,P>0.05),but a much lower incidence of postoperative complications such as pulmonary infection,atelectasis,intercostal neuralgia in the thoracoscopy group(4.7%vs.22.9%,P<0.05).Conclusion Thoracoscopic MAEF internal fixation for rib fractures has less trauma,quicker postoperative recovery,and fewer complications,which is conducive to patients,but the effect on fracture healing at 6 months after surgery is insignificant.