骨创伤治疗仪联合胸腔镜下肋骨骨折内固定手术治疗多发肋骨骨折合并血气胸的临床疗效

Clinical effect on bone trauma therapeutic apparatus combined with internal fixation surgery for rib fracture under thoracoscopy in treating multiple rib fractures with hemopneumothorax

摘要:

目的 探讨胸腔镜下肋骨骨折内固定术后，辅助给予骨创伤治疗仪，治疗多发肋骨骨折（MRF）合并血气胸的临床疗效及安全性。方法 选取2021年1月－2024年1月该院收治的MRF合并血气胸患者86例，采用随机数表法将患者分为两组，各43例。两组均接受胸腔镜下肋骨骨折内固定手术治疗，对照组于术后给予常规处理，观察组在对照组基础上，接受骨创伤治疗仪辅助治疗。观察两组患者近期和远期疗效。比较两组患者术前、术后3 d、术后7 d和术后14 d的血胸出血量和疼痛视觉模拟法（VAS）评分。比较两组患者术前和术后14 d的凝血功能指标［凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、凝血酶时间（TT）、纤维蛋白原（FIB）和D-二聚体（D-D）］。比较两组患者术后恢复情况（引流管留置时间、肿胀消退时间、住院时间和骨折愈合时间）和术后并发症发生情况。结果 观察组近期疗效总有效率为97.67%（42/43），明显高于对照组的81.40%（35/43），差异有统计学意义（P < 0.05）。观察组远期疗效总有效率为97.67%（42/43），与对照组的88.37%（38/43）比较，差异无统计学意义（P > 0.05）。术后3、7和14 d，两组患者血胸出血量明显少于术前，且观察组明显少于对照组，两组患者疼痛VAS评分明显低于术前，且观察组明显低于对照组，差异均有统计学意义（P < 0.05）。术后14 d，两组患者PT、APTT和TT明显长于术前，且观察组明显长于对照组，两组患者FIB和D-D明显低于术前，且观察组明显低于对照组，差异均有统计学意义（P < 0.05）。观察组引流管留置时间、肿胀消退时间、住院时间和骨折愈合时间明显短于对照组，差异均有统计学意义（P < 0.05）。观察组术后并发症总发生率为2.33%（1/43），与对照组的11.63%（5/43）比较，差异无统计学意义（P > 0.05）。结论 胸腔镜下肋骨骨折内固定术后辅助给予骨创伤治疗仪治疗，能有效地促进MRF合并血气胸患者胸腔积气和积液的吸收，减轻疼痛程度，改善凝血功能，加快术后机体恢复。值得临床推广应用。

Abstract:

Objective To explore the clinical efficacy and safety of adjuvant administration of bone trauma therapeutic apparatus after thoracoscopic internal fixation of rib fractures in the treatment of multiple rib fractures (MRF) complicated with hemopneumothorax.Methods 86 patients with MRF combined with hemoppneumothorax from January 2021 to January 2024 were selected. The patients were divided into two groups by random number table method, with 43 cases in each group. Both groups received thoracoscopic internal fixation surgery for rib fractures. The control group was given conventional treatment after the operation, while the observation group was treated with a bone trauma therapeutic apparatus on the basis of the control group. Observe the short-term and long-term therapeutic effects of the two groups of patients. The amount of hemothorax bleeding and the visual analogue scale (VAS) score for pain of the two groups of patients were compared before the operation, 3 days after the operation, 7 days after the operation and 14 days after the operation. The coagulation function indicators [prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), fibrinogen (FIB), and D-dimer (D-D)] of the two groups of patients before the operation and 14 days after the operation were compared. Compare the postoperative recovery status (the duration of the drainage tube, the time for swelling to subside, the length of hospital stay and the fracture healing time) and incidence of postoperative complications between two groups of patients.Results The total effective rate of short-term efficacy in the observation group was 97.67% (42/43), which was significantly higher than that in the control group (81.40%, 35/43), and the difference was statistically significant (P < 0.05). The total effective rate of long-term efficacy in the observation group was 97.67% (42/43), compared with 88.37% (38/43) in the control group, and the difference was not statistically significant (P > 0.05). At 3, 7 and 14 days after the operation, the amount of hemothorax bleeding in both groups was significantly less than that before the operation, and the amount in the observation group was significantly less than that in the control group. The VAS score for pain was significantly lower than that before the operation in both groups, and the amount in the observation group was significantly lower than that in the control group. The differences were statistically significant (P < 0.05). At 14 days after the operation, PT, APTT and TT in both groups were significantly longer than those before the operation in both groups, and the observation group was significantly longer than the control group, FIB and D-D were significantly lower than those before the operation, and the observation group was significantly lower than the control group. The differences were statistically significant (P < 0.05). The duration of the drainage tube, the time for swelling to subside, the length of hospital stay and the fracture healing time in the observation group were significantly shorter than those in the control group, and the differences were statistically significant (P < 0.05). The total incidence of postoperative complications in the observation group was 2.33% (1/43), compared with 11.63% (5/43) in the control group, and the difference was not statistically significant (P > 0.05).Conclusion After thoracoscopic internal fixation of rib fractures, adjuvant administration of bone trauma therapeutic apparatus can effectively promote the absorption of pleural effusion and pneumothorax in patients with MRF combined with hemopneumothorax, reduce the degree of pain, improve coagulation function, and accelerate postoperative recovery of the body. It is worthy of clinical promotion and application.