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Finite Element Modeling and Clinical Analysis of Internal Fixation of Multiple Rib Fractures and Flail Chest Using Four-claw Ti-planes

Objective To evaluate clinical efficacy of four-claw Ti-planes for internal fixation of multiple rib fractures and flail chest. Methods Clinical data of 93 patients with multiple rib fractures and flail chest who were admittedto Shanghai Pudong Hospital from December 2011 to November 2012 were retrospectively analyzed. There were 78 male and 15 female patients with their age of 20-80 years. All the patients received internal fixation of rib fractures using four-clawTi-planes. Finite element modeling and analysis were performed to investigate biomechanical behaviors of rib fractures after internal fixation with four-claw Ti-planes. Results The average number of rib fractures of the 93 patients was 5.9±2.1，and each patient received 3.8±1.3 four-claw Ti-planes for internal fixation. The operations were performed 6.3±3.2 days after admission. After the rib fractures were fixed with four-claw Ti-planes，rib dislocations and chest-wall collapse of flail chest were restored，and patients’ pain was relieved. Postoperative CT image reconstruction of the chest showed no dislocationor displacement at the fixation areas of the four-claw Ti-planes. Rib fractures were stabilized well，and normal contours of the chest were restored. Finite element analysis showed that the maximum bearable stress of the rib fractures after internal fixation with four-claw Ti-planes was twice as large as normal ribs. Conclusion Clinical outcomes of four-claw Ti-planesfor internal fixation of rib fractures are satisfactory with small incisions and less muscle injury of the chest wall，so this technique deserves wide clinical use.

老年患者创伤性连枷胸保守治疗与手术治疗的疗效对比

目的比较老年创伤性连枷胸患者采用手术治疗与保守治疗的疗效。方法回顾性分析自 1998年 1月至 2009年 10月兰州市解放军第一医院 22例老年连枷胸患者经手术治疗 /保守治疗的临床资料，按治疗方法不同将 22例患者分为两组，手术治疗组： 12例，男 9例，女 3例；年龄（ 67.3±10.3）岁；行手术内固定治疗。保守治疗组：10例，男 8例，女 2例；年龄（ 68.7±11.6）岁；为无开胸探查指征患者，行保守治疗。比较两组患者的临床疗效及并发症发生情况。结果围术期死亡 4例，死于脓毒血症 1例，成人呼吸窘迫综合征 2例，急性心肌梗死 1例。手术治疗组患者病死率低于保守治疗组（ 8.3% vs. 30.0%，P＜ 0.05）；手术治疗组患者机械通气时间［（4.7±2.5）d vs.（17.3±7.1）d］、住院时间［（25.6±11.8）d vs.（36.1±16.5）d］和住 ICU时间［（ 8.2±3.5）d vs.（15.9±8.4）d］均短于保守治疗组（ P＜ 0.05）；手术治疗组中呼吸系统并发症、肺外并发症、胸廓畸形等并发症均少于保守治疗组（P＜ 0.05）。随访 18例（保守治疗组 7例、手术治疗组 11例），随访时间 6个月～ 2年，复查胸部 X线片示：骨折全部骨性愈合，但保守治疗组残留胸廓畸形 4例，手术治疗组 2例。结论多发性肋骨骨折，尤其是老年、且伤前具有特定合并疾病的患者预后不良，应积极采取手术内固定治疗。

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

目的探讨应用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的方法和疗效。方法自 2009年 1～ 12月上海交通大学医学院附属新华医院（崇明）胸心外科收治 38例多发性肋骨骨折患者（内固定组），均行电视胸腔镜探查、止血、胸腔内血凝块清除、肺裂伤修补，应用电视胸腔镜定位肋骨骨折部位，切开复位，并采用形状记忆环抱接骨板行肋骨内固定。选择 2008年 1 ～ 12月我科收治的 44例胸部创伤经保守治疗的患者作为对照（非内固定组）。术后观察两组患者的胸痛缓解时间、坐起时间、下床时间、住院时间、胸壁畸形、骨折愈合时间及相关并发症（肺不张、肺部感染）发生情况。结果内固定组患者均临床愈合，治愈率为 100%。平均手术时间 48.2 min，术后胸痛明显缓解，平均 2.5 d可坐起， 6.8 d可站立行走，平均住院时间为 10.2 d，原有的胸壁畸形均矫正、平均骨折愈合时间为 4周，无明显并发症发生。内固定组患者的胸痛缓解时间、坐起时间、下床时间、住院时间、胸壁畸形、骨折愈合时间及相关并发症（肺不张、肺部感染）发生率均短于或少于非内固定组（ P＜ 0.05）。内固定组随访 38例，随访时间 2～ 14周，均复查胸部 X线片，未见明显并发症发生，无再次骨折，接骨板无松动、断裂。结论应用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具有创伤小、操作简便、固定可靠、组织相容性好及并发症少等优点，有利于促进骨折愈合和呼吸功能改善，是治疗多发性肋骨骨折较理想的方法。

记忆合金环抱器在创伤性连枷胸治疗中的应用

目的　总结记忆合金环抱器在创伤性连枷胸治疗中的应用经验。　方法　2008年10月至2011年8月甘肃省酒泉市人民医院应用镍钛记忆合金环抱器内固定治疗创伤性连枷胸38例，其中男31例，女7例；年龄 19～62 （42.6±12.5）岁。致伤原因为交通伤31例，高处坠落伤4例， 塌方挤压伤2例， 殴打外伤1例。对其手术时机、适应证选择及临床效果等进行分析。　结果　本组无手术相关死亡，随访34例，随访率91.89% （34/37），随访1～16 （10.3±2.6）个月。随访时胸部X线片或胸部CT提示肋骨骨折端对位好，双侧胸廓基本对称，连枷胸得到满意矫正，患者呼吸良好，无长期疼痛等并发症。全组无1例因环抱器有排斥反应、不适等需取出者。　结论　创伤性连枷胸患者早期行记忆合金环抱器内固定治疗可以使连枷胸得到有效的矫正，改善和恢复呼吸功能，降低病死率及各类并发症的发生率。

连枷胸内固定手术方法的临床应用比较

摘要： 目的 比较4种对多根、多段肋骨骨折内骨的内固定方法，总结其治疗经验。 方法 2006年7月至2009年7月三峡大学仁和医院收治75例多根、多段肋骨骨折患者，男51例，女24例；年龄17～74岁,平均年龄43.50岁。致伤原因为:交通伤44例,高处坠落伤21例,撞击伤10例；采用钢丝固定5例，钢板固定12例，Judet固定架固定51例，人工合成树脂骨内固定7例。 结果 75 例患者均采用内固定手术治疗，术后胸廓恢复正常形态，纵隔摆动消失，疼痛和呼吸困难明显改善；随访6个月~2年，复查胸部X线片示：钢丝固定的患者中有2例发生2处固定移位，其余患者无再次移位，恢复良好。 结论 内固定手术治疗是治疗多根、多段肋骨骨折患者的有效方法，但各有利弊，应严格掌握手术适应证。

多孔有机玻璃板治疗多发性肋骨骨折

目的　观察多孔有机玻璃板治疗多发性肋骨骨折的临床效果。　方法　采用自制多孔有机玻璃板外固定器行肋骨骨折外固定 86例。　结果　 86例患者均治愈出院 ,且住院时间短 ,并发症少 ,胸廓无畸形。　结论　多孔有机玻璃板外固定器治疗多发性肋骨骨折简便易行 ,该方法安全可靠 ,疗效满意。

Clinical Study on Surgical Stabilization for Traumatic Flail Chest

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。

气囊导尿管在连枷胸治疗中的应用

Three-point Bending Test of Two Methods for Rib Internal Fixation

ObjectiveTo use claw-shaped blade plate and self-made 'titanium clip' blade plate for rib fracture fixation, and compare outcomes of these two internal fixation methods through mechanical tests. MethodsThoracic cage specimens of six adults (male)corpses were numbered. Bilateral 4th, 6th and 8th thoracic ribs of each corpse were taken from the rib nodules (0%)to costal cartilage junction (CJJ points, 100%)along the long axis of the ribs. Rib fragments about 130 mm in length with 50% locus were selected for mechanical tests of the lateral area. A total of 36 rib fragments were sampled and numbered. Each rib fragment was placed on electronic universal mechanical tester. A span of 100 mm and a loading speed of 2.5 mm/min were set to perform a three-point bending test until specimens fractured. The loads at displacement of 2, 4, 6, 8, 10, 15 and 20 mm respectively and maximum load were recorded, then the load-displacement curve was drawn. Above rib fragments were randomly divided into 2 groups, which were fixed using 'titanium clip' blade plate (titanium plate group)and claw-shaped blade plate (claw-shape group)respectively. Three-point bending test was performed under above loading conditions until the fixed specimens fractured again, and relevant data were recorded. ResultsBefore fixation, there was no statistical difference in maximum load and peak deformation of the 4th, 6th and 8th ribs between the 2 groups (P > 0.05). Maximum load and peak deformation of the 4th, 6th and 8th ribs in the claw-shape group after fixation were statistically different from those before fixation (P < 0.05). Maximum load and peak deformation of the 4th, 6th and 8th ribs in the titanium plate group after fixation were also statistically different from those before fixation (P < 0.05). After fixation, maximum loads of the 4th, 6th and 8th ribs in the claw-shape group were statistically different from those in the titanium plate group (P < 0.05), but there was no statistical difference in peak deformation between the 2 groups (P > 0.05). ConclusionsFractured ribs fixed with 'titanium clip' blade plates are more stable and stronger than those fixed with claw-shaped blade plates.

手术内固定治疗创伤性连枷胸对患者呼吸功能的影响

目的观察连枷胸患者胸壁加压包扎、肋骨牵引和手术内固定的治疗效果。 方法纳入2001年1月至2010年6月解放军第一医院心胸外科收治的56例连枷胸患者，分为3组：牵引治疗组，14例，其中男10例、女4例，年龄（39.7±11.6）岁；包扎治疗组，12例，其中男11例、女1例，年龄（40.2±13.2）岁；手术内固定组，30例，其中男26例、女4例，年龄（42.6±12.5）岁。比较3组的治疗效果。 结果手术内固定组与牵引治疗组和包扎治疗组比较，除需呼吸机支持率与牵引治疗组差异无统计学意义（P>0.05）外，呼吸机通气时间、住ICU时间、胸腔引流管拔除时间均缩短（P<0.05），胸部并发症发生率及死亡率降低（P<0.05），动脉血氧分压（PaO2）、动脉血氧饱和度（SaO2）显著升高（P<0.01），肺挫伤评分下降明显；而牵引治疗组PaO2、SaO2及肺挫伤评分较入院时改善缓慢，胸壁加压包扎治疗组甚至有加重趋势。 结论大面积浮动胸壁的病理改变以胸腔容积减少为基础，胸壁加压包扎无治疗效果，甚至加重低氧；肋骨巾钳悬吊牵引固定对连枷胸缺氧内环境的改善效果不佳；手术切开复位内固定是改善大面积浮动胸壁呼吸功能障碍的有效方法。