摘要
目的:探讨完全胸腔镜下肋骨骨折内固定术（CTRRSF）的可行性及临床效果。方法:回顾性收集2019年9月至2021年9月石家庄市第三医院CTRRSF手术病例，统计患者手术时间、胸腔引流量、疼痛评分、内固定物移位及骨折复位满意程度等情况，初步分析手术可行性及临床效果。结果:共完成CTRRSF 18例，腔镜下固定骨折部位均为肩胛骨覆盖区附近后肋骨折，其中单纯CTRRSF 1例，CTRRSF合并行其他部位肋骨骨折常规直视下切开复位内固定术17例，完全腔镜下固定肋骨骨折共45处（平均2.5处/人），开放直视下固定肋骨骨折77处（平均4.3处/人）；所有患者均顺利完成手术，手术时间平均90（50~150）min，术后2~5天拔除胸腔引流管，胸腔引流量为（530.33±244.84）mL。术后视觉模拟评分法（VAS）评分为3（3.0~4.0），显著低于术前的7（6.75~8.0）分，差异有统计学意义（Z＝1.886，P＝0.002）；术后腔镜途径内固定物移位率4.44%（2/45），术后腔镜途径内固定物复位不良26.67%（12/45），所有患者术后均无明显胸廓畸形，切口愈合良好。全部病例电话随访12~24个月，术后半年均恢复劳动能力，无明显胸部不适症状，气温变化及触碰手术体表部位时无明显不适感，术后无因不适取出内固定物病例。结论:完全胸腔镜肋骨骨折记忆合金内固定术安全可行，尤其适用于肩胛骨覆盖区附近高位后肋骨折，是对传统手术方式的有益补充，但仍存在手术操作困难，内固定物移位率及骨折对位不良发生率高、广泛胸膜损害、术后胸腔积液量多等缺陷，仍需进一步总结探讨。
Abstract
Objective:To explore the feasibility and clinical efficacy of Complete Thoracoscopic surgical stabilization of rib fractures (CTSSRF) in patients with rib fracture.Methods:The CTSSRF cases admitted to The Third Hospital of Shijiazhuang from September 2019 to September 2021 were retrospectively collected, and the patients’operative time, thoracic drainage, pain score, internal fixation displacement and satisfaction degree of fracture reduction were analyzed for an initial analysis of the feasibility of operation and clinical effect.Results:A total of 18 cases of CTSSRF were completed, and the posterior rib fracture near the covering area of the scapula was all fixed under CTSSRF, including 1 case of CTSSRF and 17 cases of CTSSRF combined with conventional open surgical stabilization of rib fractures (SSRF) at other parts. A total of 45 rib fractures were fixed under CTSSRF (mean 2.5 ribs/person) and 77 ribs were fixed under conventional open SSRF (mean 4.3 ribs/person). The average operation time was 90 (50–150) min, and the thoracic drainage tube was removed 2–5 days after surgery. The thoracic drainage volume was (530.33±244.84) mL. The postoperative visual analogue scale (VAS) score was 3 (3.0–4.0), which was significantly lower than preoperative score of 7 (6.75–8.0), the difference was statistically significant (Z=1.886, P=0.002). The postoperative internal fixation displacement rate of CTSSRF is 4.44% (2/45), and the poor fixation reduction rate is 26.67% (12/45). All patients had no obvious thoracic malformations after surgery, and the incision healed well. They were followed up by telephone for 12 to 24 months. And the ability to work was recovered half a year after surgery, with no obvious symptoms of chest discomfort, and no obvious discomfort when the temperature changed and the body surface was touched, and no internal fixation was removed due to discomfort after surgery.Conclusions:CTSSRF is safe and feasible, especially suitable for high posterior rib fracture near the scapula covering area. It is a beneficial supplement to traditional surgery. However, there are still some defects such as surgical difficulties, high incidence of displacement of internal fixation and poor fracture position, extensive pleural injury, and a large amount of postoperative pleural effusion, which still need to be further summarized and discussed.
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