中国组织工程研究

中国组织工程研究 ›› 2010, Vol. 14 ›› Issue (22): 4155-4159.doi: 10.3969/j.issn.1673-8225.2010.22.041

• 骨与关节临床实践 clinical practice of the bone and joint • 上一篇    下一篇

肋骨接骨板置入内固定治疗肋骨骨折39例：同一机构2年资料回顾

李智成，王长涛，薛  冰，吕一峰，熊  健，王冬冬   

  1. 复旦大学附属华山医院南汇分院胸外科，上海市  201300
  • 出版日期:2010-05-28 发布日期:2010-05-28
  • 作者简介:李智成★，男，1966年生，浙江省永康市人，汉族，2004年上海交通大学医学院毕业，硕士，主治医师，讲师，主要从事心胸外科的基础和临床研究。 zcli_renji@hotmail.com

Internal fixation of fractured ribs with rib plates in 39 patients: A review of 2-year data in the same institution

Li Zhi-cheng, Wang Chang-tao, Xue Bing, Lü Yi-feng, Xiong Jian, Wang Dong-dong   

  1. Department of Thoracic Surgery, Nanhui Branch of Huashan Hospital, Fudan University, Shanghai 201300, China
  • Online:2010-05-28 Published:2010-05-28
  • About author: Li Zhi-cheng★, Master, Attending physician, Lecturer, Department of Thoracic Surgery, Nanhui Branch of Huashan Hospital, Fudan University, Shanghai 201300, China zcli_renji@hotmail.com

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摘要：

背景：肋骨骨折是否需要植入物内固定治疗，何种情况下需要植入物固定及固定技术达成共识均不多。
目的：回顾性分析过去2年中39例胸部钝性创伤患者采用肋骨接骨板置入内固定治疗肋骨骨折的必要性和可行性。
方法：选择胸部钝性创伤患者39例，男32例，女7例，平均年龄(47.8±13.8)岁；其中有连枷胸无肺挫伤4例，有连枷胸有肺挫伤10例，无连枷胸无肺挫伤15例，无连枷胸有肺挫伤10例。根据患者临床状况，可首先保守治疗，待病情稳定后再行肋骨接骨板置入内固定治疗，或急症剖胸同时行肋骨接骨板置入内固定。
结果与结论：患者经置入内固定治疗后胸壁稳定，胸壁塌陷畸形接近矫正，疗效满意。然而，1例68岁有连枷胸有肺挫伤患者，因肺炎、脓毒症，进而出现感染性休克于术后26 d死亡。其余患者胸壁塌陷、胸廓畸形在置入内固定治疗后都得到满意矫正。术后胸片或胸部CT复查肋骨接骨板内固定区肋骨复位好，无松脱移位，双侧胸廓大致对称，患侧与固定前相比胸廓塌陷畸形消失，基本恢复正常。因此，肋骨接骨板置入内固定治疗肋骨骨折，不论是否连枷胸及有无伴发肺挫伤患者均能达到满意的效果。

关键词: 连枷胸, 肋骨骨折, 胸部创伤, 置入固定, 肋骨板, 医学植入体, 硬组织植入物

Abstract:

BACKGROUND: The management of rib fracture varies greatly due to lack of consensus regarding if internal fixation of fractured ribs is needed, who and which methods to achieve stability.
OBJECTIVE: To retrospectively analyze the necessity and feasibility of internal fixation of rib plate implanted into 39 patients with blunt chest trauma last two years.
METHODS: A total of 39 patients suffering from sustained blunt chest trauma, including 32 males and 7 females, averagely aging (47.8±13.8) years, were treated with operative chest wall fixation. There were 4 patients with flail chest without pulmonary contusion, 10 patients with flail chest and pulmonary contusion, 15 patients without flail chest and pulmonary contusion, and 10 patients without flail chest but with pulmonary contusion. According to different clinical statuses, patients were either treated with conservative therapy at admission and secondary operative stabilization or need urgent surgery to manage intrathoracic injuries and underwent surgical stabilization of chest wall with rib plates.
RESULTS AND CONCLUSION: Satisfactory effects were aquired in all patients with rib fracture using rib plates, including stabilization in chest wall, rectification of collapsed chest walls and thoracic deformity. However, a 68-year-old patient died for pneumonia, sepsis, and then septic shock at 26 days after operation. Clinical results in other patients were excellent after surgical stabilization of chest wall. Postoperative chest X-rays or chest CT demonstrated favorable reduction, no migration or dislocation, general symmetry in two side thorax. Compared with preoperation, collapsed chest walls and thoracic deformity were vanished and retrieved to normal on the whole. Patients with rib fractures, no matter with or without flail chest or pulmonary contusion, treated with operative chest wall fixation with rib plates are practicable, and will have a satisfactory effect.  

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