Efficacy and Safety of Internal Rib Fixation for Multiple Rib Fractures: A Randomized Controlled Trial_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANGLi , Barbie , KANGDi , Elham ,  DUPing

Department of Thoracic Surgery, Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi 830002, Xinjiang, P. R. China;

Corresponding author：

DUPing, Email: goldw@126.com

Keywords：

Multiple rib fracture; Internal fixation surgery; C-reactive protein; Efficacy; Safety

DOI：

10.7507/1007-4848.20140066

Video：

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Objective To investigate the efficacy and safety of internal rib fixation for patients with multiple rib fractures. Methods A total of 141 patients with multiple rib fractures who were admitted to Department of Thoracic Surgery of the Sixth Affiliated Hospital of Xinjiang Medical University between January 2010 and January 2013 and whose chest trauma score (AIS-ISS) was 9-20 (16±2) were recruited in this study. Using the random number generator of SPSS, all the patients were randomly divided into an internal fixation group [69 patients including 41 males and 28 females with their age of 25-61 (37±4) years] who underwent internal rib fixation, and a control group [72 patients including 43 males and 29 females with their age of 24-63 (35±5) years] who received conservative therapy. Plasma C-reactive protein (CRP) patients' satisfaction degree with thoracic appearance,incidence of lung infection,pain-relieving efficacy,postoperative chest drainage duration and length of hospital stay were compared between the 2 groups. Results Plasma CRP levels of the internal fixation group were not statistically different from those of the control group in 1-3 days after injury (P>0.05) but were significantly lower than those of the control group in 4-12 days after injury (P<0.05). Patients' satisfaction degree with thoracic appearance (97.1% vs. 48.6%,P<0.05) and pain-relieving efficiency (91.3% vs. 68.1%,P<0.05) of the internal fixation group were significantly higher than those of the control group. Incidence of lung infection of the internal fixation group was significantly lower than that of the control group(11.6% vs. 37.5%,P<0.01). Postoperative chest drainage duration [(3±2) d vs. (7±4) d,P<0.05] and length of hospital stay [(9±4) d vs. (15±7) d,P<0.05] of the internal fixation group were significantly shorter than those of the control group. Conclusions For patients with multiple rib fractures and stable vital signs,internal fixation surgery is helpful to shorten length of hospital stay, relieve chest pain and improve thoracic appearance. It can also reduce lung inflammation and increase surgical safety so as to improve treatment outcomes of multiple rib fractures.

Citation： WANGLi, Barbie, KANGDi, Elham, DUPing. Efficacy and Safety of Internal Rib Fixation for Multiple Rib Fractures: A Randomized Controlled Trial. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2014, 21(2): 228-232. doi: 10.7507/1007-4848.20140066 Copy

1.	王立,张淼,贲晓松,等.对多发性肋骨骨折行经胸腔镜探查+内固定手术的探讨.实用医学杂志,2013,29 (10):1714-1715.
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9.	Mayberry JC,Kroeker AD,Ham LB,et al.Long-termmorbidity,pain,and disability after repair of severe chest wall injuries.Am Surg,2009,75 (5):389-394.
10.	王立,边拜,康迪.无痛支气管灌洗在创伤性肺不张的应用.中华创伤杂志,2010,26 (4):342-343.
11.	陆善伟,钟肱,徐怀阳.电视胸腔镜联合形状记忆环抱接骨板治疗多发性肋骨骨折.中国胸心血管外科临床杂志,2012,19 (2):210-212.
12.	Lotfipour S,Kaku SK,Vaca FE,et al.Factors associated with complications in older adults with isolated blunt chest trauma.West J Emerg Med,2009,10 (2):79-84.
13.	李春光,陈和忠,李志刚,等.膨体聚四氟乙烯补片在胸壁重建中的应用.中国胸心血管外科临床杂志,2012,19 (3):248-250.
14.	韦春晖,谭勇明,邓滨,等.应用可吸收肋骨固定钉治疗多根多段肋骨骨折20例报告.中国微创外科杂志,2010,10 (6):551-553.
15.	范兴龙,李冬德,艾合买江,等.多根多段肋骨骨折的外科治疗经验.中国胸心血管外科临床杂志,2012,19 (2):219.

1. 王立,张淼,贲晓松,等.对多发性肋骨骨折行经胸腔镜探查+内固定手术的探讨.实用医学杂志,2013,29 (10):1714-1715.
2. 张业强,胡涛,高小见,等.爪形肋骨接骨板在多发性肋骨骨折内固定手术中的应用.中国胸心血管外科临床杂志,2012,19 (5):533.
3. 吴圣贤,蒋良铎,王建云.益气解毒活血法对动脉粥样硬化进程中高敏C反应蛋白及相关促炎因子的影响.北京中医药大学学报,2011,9 (34):627-631.
4. 郁秀莉,何元兵,夏宇,等.血清降钙素原及C反应蛋白在社区获得性肺炎和肺结核中的诊断价值.中国呼吸与危重监护杂志,2013,12 (2):190-193.
5. Bottlang M,Helzel I,Long WB,et al.Anatomically contoured plates for fixation of rib fractures.J Trauma,2010,68 (3):611-615.
6. 王洪斌,张明,刘海林,等.微创小切口肋骨内固定术治疗多根多处肋骨骨折及连枷胸.中国胸心血管外科临床杂志,2012,19 (4):449-450.
7. Nirula R,Diazz JJ Jr,Trunkey DD,et al.Rib fracture repair:indications,technical issues,and future directions.World J Surg,2009,33:14-22.
8. 杨仁荣,曹金林,郑海燕,等.损伤控制外科新理念在肺创伤急救中的临床应用.中国胸心血管外科临床杂志,2012,19 (1):98-100.
9. Mayberry JC,Kroeker AD,Ham LB,et al.Long-termmorbidity,pain,and disability after repair of severe chest wall injuries.Am Surg,2009,75 (5):389-394.
10. 王立,边拜,康迪.无痛支气管灌洗在创伤性肺不张的应用.中华创伤杂志,2010,26 (4):342-343.
11. 陆善伟,钟肱,徐怀阳.电视胸腔镜联合形状记忆环抱接骨板治疗多发性肋骨骨折.中国胸心血管外科临床杂志,2012,19 (2):210-212.
12. Lotfipour S,Kaku SK,Vaca FE,et al.Factors associated with complications in older adults with isolated blunt chest trauma.West J Emerg Med,2009,10 (2):79-84.
13. 李春光,陈和忠,李志刚,等.膨体聚四氟乙烯补片在胸壁重建中的应用.中国胸心血管外科临床杂志,2012,19 (3):248-250.
14. 韦春晖,谭勇明,邓滨,等.应用可吸收肋骨固定钉治疗多根多段肋骨骨折20例报告.中国微创外科杂志,2010,10 (6):551-553.
15. 范兴龙,李冬德,艾合买江,等.多根多段肋骨骨折的外科治疗经验.中国胸心血管外科临床杂志,2012,19 (2):219.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Efficacy and Safety of Internal Rib Fixation for Multiple Rib Fractures: A Randomized Controlled Trial

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