Sang Hong-Yang, Wu Song, Fan Zheng-Yang, Li Qian-Ping, Cheng Shao-Fei, Fan Kun
Department of Cardiothoracic Surgery, the Affiliated to Shanghai Jiaotong University, Shanghai 201306, China.
Zhongguo Gu Shang. 2022 Oct 25;35(10):979-83. doi: 10.12200/j.issn.1003-0034.2022.10.014.
This paper is aimed at investigating the efficacy of combining internal fixation using prefabricated rib-locking titanium plate with ultrasound-guided thoracic paravertebral nerve blockade in treating multiple rib fractures among the elderly.
Retrospective analysis of 221 elderly patients with multiple rib fractures treated from February 2016 to November 2020. According to whether surgery was performed, they were divided into the plate-blockage combination group (surgical group, 102 cases) and conservative treatment group (non-surgical group, 119 cases). The surgical group consisted of 58 males and 44 females aged from 60 to 85 years old, with an average of (67.2±3.6 ) years old, who suffered from 3 to 12 rib fractures with an average of (5.3±2.1) fractures. The non-surgical group consisted of 66 males and 53 females aged from 60 to 84 years old with an average of (66.8±3.2) years old, who suffered from 2 to 11 rib fractures with an average of(6.1±2.3) fractures. The clinical data, efficacies observed, and complications associated with both groups were compared and analyzed.
There was no significant difference in preoperative clinical data between two groups (>0.05), and all patients were discharged smoothly. Pulmonary infection (=0.028), atelectasis (=0.032), respiratory failure (=0.026), time to get out of bed (=0.040), time to fracture healing (=0.035), length of hospital stay in the operation group (=0.043), visual analogue scale (VAS) at 3 days (=0.028), 5 days(=0.032), and 7 days(=0.019), maximal voluntary ventilation (MVV) at 3 months after surgery (=0.042), forced expiratory volume in one second (FEV1)(=0.035), and maximal voluntary ventilation at 6 months, the maximal voluntary ventilation(MVV)(=0.021) and forced FEV1(=0.026) were all significantly better than those in non-surgical treatment group.
For elderly patients with severe multiple rib fractures, the proposed plate-blockade combination can timely and effectively relieve pain, restore thoracic stability, shorten hospital stay, and reduce the incidence of complications such as pulmonary infections and acute respiratory distress syndrome(ARDS) compared with non-surgical treatments. Prefabricated rib-locking titanium plates have proved to demonstrate high clinical efficacy in treating multiple rib fractures among the elderly.
探讨预制肋骨锁定钛板内固定联合超声引导下胸椎旁神经阻滞治疗老年多发性肋骨骨折的疗效。
回顾性分析2016年2月至2020年11月收治的221例老年多发性肋骨骨折患者。根据是否行手术治疗，将其分为钢板阻滞联合组（手术组，102例）和保守治疗组（非手术组，119例）。手术组男58例，女44例，年龄60～85岁，平均（67.2±3.6）岁，肋骨骨折3～12根，平均（5.3±2.1）根。非手术组男66例，女53例，年龄60～84岁，平均（66.8±3.2）岁，肋骨骨折2～11根，平均（6.1±2.3）根。比较分析两组患者的临床资料、观察疗效及相关并发症。
两组术前临床资料比较差异无统计学意义（>0.05），所有患者均顺利出院。手术组肺部感染（=0.028）、肺不张（=0.032）、呼吸衰竭（=0.026）、下床时间（=0.040）、骨折愈合时间（=0.035）、住院时间（=0.043）、术后3天（=0.028）、5天（=0.032）、7天视觉模拟评分（VAS）（=0.019）、术后3个月最大自主通气量（MVV）（=0.042）、第1秒用力呼气容积（FEV1）（=0.035）、术后6个月最大自主通气量（MVV）（=0.021）及FEV1（=0.026）均明显优于非手术治疗组。
对于老年重度多发性肋骨骨折患者，与非手术治疗相比，采用钢板阻滞联合治疗能及时有效缓解疼痛，恢复胸廓稳定性，缩短住院时间，降低肺部感染、急性呼吸窘迫综合征（ARDS）等并发症的发生率。预制肋骨锁定钛板治疗老年多发性肋骨骨折临床疗效显著。
