Clinical Study on Surgical Stabilization for Traumatic Flail Chest_West China Medical Journal

Authors：

SHU Jun , CONG Wei , XUE Yang , WANG Xuehai.

Department of Cardiothoracic Surgery, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu 610072, China;

Corresponding author：

Keywords：

连枷胸; 镍钛记忆合金环抱式接骨器; 内固定

DOI：

10.7507/1002-0179.20130165

Video：

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目的　通过对连枷胸两种不同治疗方法的比较，探讨该病的优化治疗方案。方法　将2005年1月－2012年11月收治的80例枷胸患者按入选标准分为：保守组40例，通过胸部外固定和（或）呼吸机内固定等方法治疗；手术组40例，采用镍钛记忆合金环抱式接骨器手术内固定骨折的肋骨，比较两种治疗方法和疗效及并发症情况。结果　保守组和手术组各死亡3例，原因为呼吸道感染致呼吸衰竭，两组无差异，但ICU停留和住院天数、机械通气时间、呼吸道感染等并发症手术组明显低于保守组（P＜0.01）。手术组无胸壁畸形，而保守组有18例，两组比较差异有统计学意义（P＜0.01）。出院3个月后，手术组患者部分肺功能指标显著优于保守组（P＜0.01）。结论　手术治疗连枷胸可迅速稳定胸壁，消除反常呼吸和激烈疼痛对呼吸的影响，还可减轻连枷胸对患者远期肺功能的影响，具有较高的临床应用价值。

Citation： SHU Jun,CONG Wei,XUE Yang,WANG Xuehai.. Clinical Study on Surgical Stabilization for Traumatic Flail Chest. West China Medical Journal, 2013, 28(4): 517-519. doi: 10.7507/1002-0179.20130165 Copy

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7.	Menard A, Testart J, philippe JM, et al. Treatment of flail chest with Judet’s Struts [J]. J Thorac Cardiovasc Surg, 1983, 86(2): 300-305.
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9.	Lardinos D, Krueger T, Dusmet M, et al. Pulmonary function testing after operative stabilization of the chest wall for flail chest[J]. Eur J Cardio-thoracic Surg, 2001, 20(3): 496-501.
10.	Fitzpatric DC, Denard PJ,Phelan D, et al. Operative stabilization of flail chest injuries: review of literature and fixation option[J]. Eur J Trauma Emerg Sury, 2010, 36(3): 427-433.
11.	Nirula R, Diaz JJ, TrunKey DD, et al. Rib fracture repair indications technical issues, and future directions[J]. World J Surg, 2009, 33(1): 14-22.
12.	Tscharner C, Schupbach P, Meier P, et al. Surgical treatment of the unstable thorax in respiratory insufficiency[J]. Helvchir Acta, 1989, 55(5): 711-717.
13.	肖接承, 华菲, 朱江, 等. 采用镍钛合金环抱器微创重点肋骨内固定治疗连枷胸的临床应用[J]. 苏州大学学报·医学版, 2007, 27(5): 775-777.

1. 　Keel M, Meier C. Chest injuries what is new[J]. Curr Opin Crit Care, 2007, 13(6): 674-679.
2. 　Sanchez-Lloret J, Letang E, Mateum, et al. Indications and surgical treatment of the traumatic flail chest Syndrome. An original technique[J]. Thorac Cardiovasc Surg, 1982, 30(5): 294-297.
3. 　苏泓洁, 都定元, 赵兴吉, 等. 连枷胸的诊治进展[J]. 创伤外科杂志, 2008, 10(4): 368-370.
4. 　BastosR, Calhoon JH, Baisden CF. Flail chest and pulmonary contusion[J]. Semin Thorac Cardiovasc Surg, 2008, 20(1): 39-45.
5. 　Ahmed Z, Mohyuddin Z. Management of flail chest injury: internal fixation versus endotracheal intubation and ventilation[J]. Thorac Cardiovasc Surg, 1995, 110(6): 1676-1680.
6. 　Vecsei V, Frenzel L, Plenk H Jr. A new rib plate of the stabilization of multiple rib fractures and thoracic wall fracture with paradoxical respiration [J]. Heffe Unfallheikd, 1979, 38(3): 279-282.
7. 　Menard A, Testart J, philippe JM, et al. Treatment of flail chest with Judet’s Struts [J]. J Thorac Cardiovasc Surg, 1983, 86(2): 300-305.
8. 　Granetzny A, Abd M, Emam E, et al. Surgical versus conservation treatment of flail chest ,evaluation of the pulmonary status[J]. Interact Cardiovasc Thorac Surg, 2005, 4(6): 583-587.,.
9. 　Lardinos D, Krueger T, Dusmet M, et al. Pulmonary function testing after operative stabilization of the chest wall for flail chest[J]. Eur J Cardio-thoracic Surg, 2001, 20(3): 496-501.
10. 　Fitzpatric DC, Denard PJ,Phelan D, et al. Operative stabilization of flail chest injuries: review of literature and fixation option[J]. Eur J Trauma Emerg Sury, 2010, 36(3): 427-433.
11. 　Nirula R, Diaz JJ, TrunKey DD, et al. Rib fracture repair indications technical issues, and future directions[J]. World J Surg, 2009, 33(1): 14-22.
12. 　Tscharner C, Schupbach P, Meier P, et al. Surgical treatment of the unstable thorax in respiratory insufficiency[J]. Helvchir Acta, 1989, 55(5): 711-717.
13. 　肖接承, 华菲, 朱江, 等. 采用镍钛合金环抱器微创重点肋骨内固定治疗连枷胸的临床应用[J]. 苏州大学学报·医学版, 2007, 27(5): 775-777.

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