Zhang Jian-Peng, Sun Lin, Li Wei-Qiang, Wang Yan-Yu, Li Xin-Zhen, Liu Yang
Department of Thoracic Surgery, Beijing Luhe Hospital, Capital Medical University, Beijing 101100, China.
World J Clin Cases. 2019 Nov 26;7(22):3718-3727. doi: 10.12998/wjcc.v7.i22.3718.
Many patients have inadequate long-term analgesia, respiratory distress, and hypoxemia due to a long-standing substantial smoking history or the presence of primary pulmonary diseases; analgesic treatment is not valid in these patients. Even if the imaging findings of rib fractures are relatively mild, rib fractures may cause severe position limitation, respiratory distress, and hypoxemia.
To investigate the curative effect of surgical treatment for patients with severe non-flail chest rib fractures.
A total of 78 patients from our hospital with severe noncontinuous thoracic rib fractures from September 2016 to September 2018 were enrolled in our study. Thirty-nine patients underwent surgical treatment, and 39 underwent conservative treatment. The surgical treatment group received surgery performed with titanium plates, and the screws were inserted with open reduction and internal fixation. The conservative treatment group received analgesia and symptomatic treatment. The pain scores at 72 h, 1 wk, 2 wk, 4 wk, 6 wk, 3 mo, and 6 mo were compared, and the SF-36 quality of life scores were compared atthe 3 and 6 months.
Pain relief in the surgical group was significantly better than that in the conservative group at each time point (72 h, 1 wk, 2 wk, 4 wk, 6 wk, 3 mo, and 6 mo after surgery, < 0.001). ( The SF-36 scores were significantly higher in the surgical group than in the conservative group at 1 mo and 6 mo ( < 0.05).
Patients with severe non-flail chest rib fractures have a better quality of life following surgical treatment than following conservative treatment, and surgical treatment is also useful for relieving pain. We should pay more attention to the physiological functions and clinical manifestations of patients with severe rib fractures. In patients with non-flail chest rib fractures, surgical treatment is feasible and effective.
许多患者因长期大量吸烟史或存在原发性肺部疾病而长期镇痛不足、呼吸窘迫和低氧血症；镇痛治疗对这些患者无效。即使肋骨骨折的影像学表现相对较轻，肋骨骨折也可能导致严重的体位受限、呼吸窘迫和低氧血症。
探讨手术治疗严重非连枷胸肋骨骨折患者的疗效。
选取2016年9月至2018年9月我院收治的78例严重非连续性胸肋骨骨折患者纳入研究。39例患者接受手术治疗，39例接受保守治疗。手术治疗组采用钛板进行手术，切开复位内固定并植入螺钉。保守治疗组接受镇痛及对症治疗。比较两组患者术后72小时、1周、2周、4周、6周、3个月和6个月时的疼痛评分，并比较3个月和6个月时的SF-36生活质量评分。
手术组在各时间点（术后72小时、1周、2周、4周、6周、3个月和6个月）的疼痛缓解情况均显著优于保守组（P<0.001）。手术组在1个月和6个月时的SF-36评分显著高于保守组（P<0.05）。
严重非连枷胸肋骨骨折患者手术治疗后的生活质量优于保守治疗，手术治疗对缓解疼痛也有效。我们应更加关注严重肋骨骨折患者的生理功能和临床表现。对于非连枷胸肋骨骨折患者，手术治疗可行且有效。
