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改良肋骨内固定手术治疗前支肋骨骨折

目的 探索胸部损伤浮动胸壁中前支肋骨骨折内固定的有效方法。 方法 回顾性分析2007 年1 月至2009 年12 月广元市中心医院43 例多发性前支肋骨骨折患者采用形状记忆环抱接骨板内固定治疗的临床资料，根据手术方式不同，将43 例分为两组，常规手术组：18 例，其中男16 例，女2 例；年龄（38.5±3.8）岁，采用常规手术方法行肋骨内固定术；改良手术组：25 例，其中男21 例，女4 例；年龄（36.4±5.6）岁；采用改良手术方法行肋骨内固定术。对两种手术方法的难易程度、手术时间和术后效果进行比较。 结果 围术期无死亡，术后两组患者胸廓形状均恢复正常，反常呼吸消失，呼吸困难显著改善，肋骨骨折均达到解剖复位。术后无肺部、胸腔、切口感染和肺不张等并发症发生。改良手术组手术时间[（74.80±9.41） min vs.（91.94±17.42） min，P=0.006] 和术中出血量[（34.20±14.70） ml vs.（83.33±20.72） ml, P=0.000）] 明显短于或少于常规手术组。随访28 例（改良手术组17 例、常规手术组11 例），随访时间1 个月～ 1 年，失访15 例。随访期间两组患者肋骨骨折均愈合，无胸廓畸形和呼吸功能受损，亦未见记忆环抱接骨板脱落、断裂和移位。患者恢复正常生活或工作。 结论 前支肋骨骨折内固定的改良手术操作简单、方便、创伤小、出血少和临床效果好，值得临床推广应用。

不同内径胸腔引流管行胸腔引流的效果比较

Short-term efficacy of improved Bentall operation with "pericardium lining" for aortic root dilatation

Objective To explore the feasibility of modified Bentall operation with pericardium lining in patients with aortic root dilatation (ARD). MethodsThis study was a retrospective study. From January 2023 to February 2024, the patients were selected for treatment in Suzhou Municipal Hospital, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University and Guangyuan First People's Hospital. The preoperative clinical and imaging evaluation data (including echocardiography and CT of aortic root and whole aorta), the data of coronary intervention, the surgical effect and the postoperative follow-up results were collected. All patients were treated with improved Bentall operation with "pericardium lining": the aortic valve was replaced, and the autologous pericardium was divided into three parts according to the circumferential diameter of the aortic valve ring measured by the valve measuring instrument, and sutured with to the valve ring respectively; two pericardial slices "opened the window" and anastomosed anastomosis with the left and right coronary artery openings; the pericardial piece was sutured with to the aortic sinus wall to form a whole, narrowing the sinus. Artificial blood vessels were used to suture the proximal and distal aorta without aortic root-right atrial shunt. Results Five patients were collected, aged from 37 to 68 years. The average STS risk score was 3.4%. The preoperative ascending aorta diameter was (56.4±16.6) mm, the preoperative left ventricular end diastolic diameter was (62.0±9.0) mm, and the preoperative left ventricular ejection fraction was (56.0±8.0%. The time of aortic occlusion was (129.6±50.4) min, and the time of cardiopulmonary bypass was (188.2±113.8) min. Echocardiography showed that the diameter of ascending the ascending aorta was (30.2±4.8) mm, the end diastolic diameter of left the left ventricle was (48.2±8.8) mm, and the left ventricular ejection fraction was 51.4%±9.6%. The operation was successfully completed, and the immediate effect was satisfactory. There were no complications during the operation. There was no death and reoperation no reoperation during the follow-up period. Conclusion For patients with ARD, the preliminary results of improved Bentall operation with "pericardium lining" are satisfactory and the technique is feasible.