ObjectiveTo investigate the feasibility and effectiveness of fast track surgery (FTS) in rib fracture fixation. MethodsFifty-two patients with chest trauma who underwent rib fracture fixation surgery in Mingji Affiliated Hospital of Nanjing Medical University from October 2010 to June 2013 were enrolled in this study. All the patients were divided into FTS group and control group. In the FTS group, there were 26 patients including 22 males and 4 females with their age of 45.62±8.20 years, who received FTS strategies. In the control group, there were 26 patients including 21 males and 5 females with their age of 46.42±7.60 years, who received traditional treatment strategies. Postoperative visual analogue scale (VAS), gastrointestinal function recovery time, postoperative hospital stay and hospitalization cost were compared between the 2 groups. ResultsVAS at 6 hours, 24 hours and 48 hours postoperatively of FTS group (4.5±0.3, 4.2±0.2, 3.2±0.1) were significantly lower than those of the control group (6.5±0.1, 6.1±0.3, 4.8±0.2) respectively (P < 0.05). Gastrointestinal function recovery time of FTS group (0.8±0.2 days) was significantly shorter than that of the control group (1.5±0.5 days, P < 0.05). Length of hospital stay (21.0±2.6 days) and hospitalization cost (5.18±0.75 ten thousand yuan) of FTS group were significantly shorter or lower than those of the control group (26.2±3.4 days and 5.78±0.64 ten thousand yuan) respectively (P < 0.05). ConclusionFTS strategies can effectively reduce postoperative VAS, shorten length of hospital stay, decrease hospitalization cost, and promote postoperative recovery of rib fracture patients.
ObjectiveTo compare clinical outcomes between video-assisted thoracoscopic surgery (VATS) and conventional surgery for the treatment of multiple rib fractures. MethodsA total of 173 consecutive patients with multiple rib fractures were admitted to Dujiangyan People's Hospital from January 2010 to December 2012. There were 122 males and 51 females with their age of 19-71 (41.3±7.1) years. According to different treatment strategies, all the patients were divided into 3 groups:conservative treatment group (83 patients with a mean of 4.9±1.3 fractured ribs, including 20 patients with flail chest), conventional surgery group (41 patients with a mean of 5.2±1.1 fractured ribs, including 11 patients with flail chest) and VATS group (49 patients with a mean of 5.3±1.5 fractured ribs, including 14 patients with flail chest). Length of hospital stay, duration of postoperative pain, incision length, operation time, chest drainage duration and morbidity were compared among the 3 groups. ResultsThe incision length (5.2±1.5 cm vs. 8.5±2.3 cm, P=0.031), operation time (1.1±0.3 hours vs. 1.8±0.2 hours, P=0.003), chest drainage duration (0.3±0.0 day vs. 3.2±1.1 days, P=0.007) and length of hospital stay (13.7±1.5 days vs. 17.3±2.3 days, P=0.017) of VATS group were significantly shorter than those of the conventional surgery group. A total of 159 patients were followed up, and chest x-ray was examined at 1, 3 and 6 months after discharge. After 3 months, bone callus formation was evident around the rib fractures in chest x-ray in patients undergoing surgery, while bone union with deformity was shown in some patients of the conservative group. ConclusionWith the development of various internal fixation materials, surgical internal fixation has become a trend for patients with multiple rib fractures, and VATS internal fixation is minimally invasive with satisfactory clinical outcomes.
ObjectiveTo explore the feasibility to use pain scale and arterial oxygen partial pressure(PaO2)as screening internal fixation indications for patients with multiple rib fractures. MethodsClinical data of 48 patients with multiple rib fractures who were admitted to Shanghai Pudong Hospital from September 2010 to February 2013 were retrospectively analyzed. Visual analogue scale (VAS) was used for pain assessment. Twenty-four patients whose VAS was greater than or equal to 6 and PaO2 was less than 60 mm Hg 3 days after injury were chosen as the experimental group, including 16 males and 8 females with their age of 49.29±15.73 years. Another 24 patients whose VAS was less than or equal to 5 and PaO2 was greater than 60 mm Hg 3 days after injury were chosen as the control group, including 19 males and 5 females with their age of 48.63±13.49 years. Patients in both groups received rib internal fixation with steel plates. Three days and 1 week after surgery respectively, VAS and PaO2 were compared between the 2 groups. ResultsIn the experimental group, VAS 3 days after surgery was significantly lower than preoperative VAS (4.09±0.93 vs. 8.21±1.18, P < 0.05), and VAS 1 week after surgery was significantly lower than preoperative VAS (3.20±0.98 vs. 8.21±1.18, P < 0.05). In the control group, there was no statistical difference between VAS 3 days after surgery and preoperative VAS (P > 0.05), and there was no statistical difference between VAS 1 week after surgery and preoperative VAS (P > 0.05). Three days after surgery, PaO2 of the experimental group was significantly higher than preoperative PaO2 (61.00±3.47 mm Hg vs. 53.00±3.97 mm Hg, P < 0.05). There was no statistical difference between PaO2 3 days after surgery and preoperative PaO2 in the control group (66.71±5.15 mm Hg vs. 66.00±5.00 mm Hg, P > 0.05). Three days after surgery, pneumonia occurred in 4 patients in the experimental group and 2 patients in the control group (χ2=0.762, P > 0.05). Three days after surgery, pain scale reduction of the experimental group was significantly higher than that of the control group (4.13±1.45 vs. 0.00±0.42, P < 0.05). One week after surgery, pain scale reduction of the experimental group was significantly higher than that of the control group (5.04±1.23 vs. 0.08±0.28, P < 0.05). Three days after surgery, PaO2 increase of the experimental group was significantly higher than that of the control group (7.42±3.59 mm Hg vs. 0.21±0.98 mmHg, P < 0.05). ConclusionIt's reasonable and feasible to use pain scale greater than or equal to 6 and PaO2 less than 60 mm Hg as internal fixation indications for patients with multiple rib fractures.
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.
ObjectiveTo evaluate the effect of surgical and traditional treatments for multiple rib fractures through systematic review and meta-analysis.MethodsCNKI, Wanfang, VIP, PubMed, OVID, EMbase, The Cochrane Library, Thieme and Springer Link database for information from inception to July 2019 were screened by computer. Randomized controlled trials (RCTs) of surgical and conventional methods for the treatment of multiple rib fractures were screened, assessed and extracted. RevMan 5.3 software was used for meta-analysis.ResultsTwelve studies were included, including 1 039 patients. There were 512 patients in the operation group and 527 patients in the traditional treatment group. The results of meta-analysis showed that there was a significant difference between the two groups in the incidence of pneumonia (RR=0.41, 99%CI 0.29 to 0.58, P<0.000 01), incidence of atelectasis (RR=0.24, 99%CI 0.06 to 0.94, P=0.007), duration of mechanical ventilation (SMD=–2.64, 99%CI –4.38 to –0.91, P<0.000 1), duration of intensive care unit stay (SMD=–1.33, 99%CI –2.26 to –0.40, P=0.000 2), duration of hospital stay (SMD=–2.25, 99%CI –3.30 to –1.19, P<0.000 01)and incidence of chest wall deformity (RR=0.08, 99%CI 0.04 to 0.17, P<0.000 01). There was no significant difference between the two groups in the hospital mortality (RR=0.75, 99%CI 0.23 to 2.46, P=0.53), incidence of tracheostomy (RR= 0.69, 99%CI 0.39 to 1.21, P=0.09), ventilator support rate (RR=0.65, 99%CI 0.41 to 1.05, P=0.02) and chest drainage time (SMD=–2.58, 99%CI –6.41 to 1.25, P=0.08).ConclusionSurgical treatment of multiple rib fractures can reduce pulmonary complications, shorten hospital stay, and reduce the incidence of chest wall deformity, which is conducive to rapid recovery and improves quality of life.