Montazer Majid, Hashemzade Shahryar, Gargari Reza Movassaghi, Ramouz Ali, Sanaie Sarvin, Rasihashemi Seyed Ziaeddin
Majid Montazer, Assistant Professor, Dept. of Cardiothoracic Surgery, Imam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran.
Shahryar Hashemzade, Professor, Dept. of Cardiothoracic Surgery, Imam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran.
Pak J Med Sci. 2017 Jan-Feb;33(1):42-47. doi: 10.12669/pjms.331.11581.
To assess the efficacy of intercostal nerve protection by intercostal muscle (ICM) flap in post-thoracotomy pain improvement compared to intracostal suturing.
In a randomized controlled trial, ninety-four patients undergoing posterolateral thoracotomy surgery were divided into two subgroups. Intracostal sutures in isolation and in combination with ICM flap techniques were used for thoracotomy closure in both groups. Numeric Pain Scale and Visual Pain Scale as pain scores were assessed on the first, second, third, fourth, fifth, sixth and seventh postoperative days and follow-up visits during the 2 week, 1, 2, 4 and 6 months after thoracotomy.
Out of 94 patients, 58 were male and 36 were females. While the mean age of patients in intracostal group was 45.3 ± 17.6 years, it was 47.4 ± 16.1 years in intracostal plus ICM flap group. The mean operation time for the first group was 191.0 ± 74.7 minutes, while it was 219.3 ± 68.8 minutes in the second (p>0.05). Numeric rating score and visual pain scale did not demonstrate any significant difference in pain severity on postoperative days and follow-up visits between both groups (p>0.05). Although the trend of pain reduction was significant in each group (p<0.001), the difference was not statistically significant (p>0.001).
Intracostal sutures in combination with muscle flap did not reduce postoperative pain in thoracotomy compared with intracostal sutures alone in thoracotomy closure.
评估肋间肌（ICM）皮瓣保护肋间神经在开胸术后疼痛改善方面的疗效，并与肋间内缝合术进行比较。
在一项随机对照试验中，94例行后外侧开胸手术的患者被分为两个亚组。两组均采用单纯肋间内缝合术以及联合肋间肌皮瓣技术进行开胸闭合术。分别在术后第1、2、3、4、5、6和7天以及开胸术后2周、1、2、4和6个月的随访中，使用数字疼痛量表和视觉疼痛量表评估疼痛评分。
94例患者中，男性58例，女性36例。肋间内缝合组患者的平均年龄为45.3±17.6岁，肋间内缝合加肋间肌皮瓣组为47.4±16.1岁。第一组的平均手术时间为191.0±74.7分钟，第二组为219.3±68.8分钟（p>0.05）。数字评分量表和视觉疼痛量表显示，两组在术后各天及随访时的疼痛严重程度均无显著差异（p>0.05）。尽管每组疼痛减轻的趋势均显著（p<0.001），但差异无统计学意义（p>0.001）。
在开胸闭合术中，与单纯肋间内缝合术相比，肋间内缝合联合肌皮瓣并未减轻开胸术后疼痛。
