Department of Cardiothoracic Surgery, Shijiazhuang Third Hospital, No. 15 Tiyu South Street, Shijiazhuang, 050011, Hebei, China.
Eur J Trauma Emerg Surg. 2022 Oct;48(5):3613-3622. doi: 10.1007/s00068-021-01676-2. Epub 2021 May 13.
Rib fracture is closely related to thoracic injury with high morbidity and mortality. This study aimed to investigate the clinical effect of Zhang ZhiFei (ZZF) zoning method on the selection of incision and approach in minimally invasive surgery for rib fracture.
A total of 110 patients with rib fractures from July 2017 to July 2019 were enrolled in the study. Preoperative computed tomography and three-dimensional reconstruction of ribs was performed. Then, the rib fractures to be surgically fixed were divided into costal cartilage zone, chest zone, lateral costal zone, high posterior costal zone, low posterior costal subscapular zone, and low posterior costal paraspinal zone, which was called ZZF zoning method. Rib fractures in each zone had unique minimally invasive incision approach, and the open reduction and internal fixation of rib fracture was performed under minimally invasive surgery of corresponding small incision.
The average incision length and number of incisions of the 110 patients were 6.2 cm and 1.3, respectively. The average number of internal fixation was 5.3 and the average operation time was 82 min. The postoperative fracture end was well aligned. After 3 months of follow-up, no internal fixation was displaced or detached.
Based on the anatomical characteristics of different zones of the chest wall, ZZF zoning method provides a new idea and reference for the selection of incision and approach in minimally invasive internal fixation for rib fracture.
肋骨骨折与胸部损伤密切相关，发病率和死亡率均较高。本研究旨在探讨张志强（ZZF）分区法在微创治疗肋骨骨折中切口和入路选择的临床效果。
回顾性分析 2017 年 7 月至 2019 年 7 月收治的 110 例肋骨骨折患者的临床资料。术前对肋骨进行 CT 检查和三维重建。然后，将需要手术固定的肋骨骨折分为肋软骨区、胸区、侧肋区、高后肋区、肩胛下后肋区和后肋区，即 ZZF 分区法。每个区的肋骨骨折都有独特的微创切口入路，在相应小切口的微创下进行肋骨骨折的切开复位内固定。
110 例患者的平均切口长度和切口数量分别为 6.2cm 和 1.3。平均内固定数为 5.3 个，平均手术时间为 82min。术后骨折端对位对线良好。随访 3 个月，无内固定移位或脱落。
根据胸壁不同区域的解剖特点，ZZF 分区法为微创内固定治疗肋骨骨折的切口和入路选择提供了新思路和参考。
