摘要
目的分析和讨论连枷胸伴和不伴肺挫伤行胸壁固定手术的适应证、禁忌证及其效果,并明确肺挫伤的影响;方法 42例连枷胸手术内固定患者,男34例,女8例,年龄20～77(50.9±12.3)岁。根据患者有无肺挫伤,将42例患者分为两组:A组—有连枷胸无肺挫伤组(n=11);B组—连枷胸伴肺挫伤组(n=31)。比较两组患者的性别、年龄、肋骨骨折数、伴发伤、术前胸引数、肋骨固定数、住院时间、手术时机、ICU数、机械通气数和并发症情况等;结果所有42例患者术后连枷胸消失,左右胸廓基本对称,未见反常呼吸和胸壁坍陷等征象。两组患者的性别、年龄、肋骨骨折数、术前胸引数、肋骨固定数、住院时间、手术时机、ICU数、机械通气数和并发症等情况虽均无统计学差异(均P>0.05),但B组患者有更高的ICU入住率和机械通气率。B组中有2例高龄男性患者分别死于休克和多脏器功能障碍综合征;结论连枷胸伴发肺挫伤患者虽有更高的ICU入住率和机械通气率,但也适于手术胸壁固定,并可获得满意的效果。
Objective To analyze and discuss indications, contraindications and outcomes of surgical fixation for flail chest in patients with and without pulmonary contusion and to clarify the impact of pulmonary contusion. Methods The average age of 42 patients with flail chest, including 34 males and 8 females, was 50.9 - 12.3 years. These patients were operated by chest wall stabilization. According to pulmonary contusion or not, patients were separated into two groups： flail chest without pulmonary contusion （ Group A, n = 11 ） and flail chest with pulmonary contusion （ Group B, n = 31 ）. Factors of sex, age, number of rib fracture, preoperative tube thoracotomy, number of rib fixation, hospital stay, timing of operative chest wall stabilization, incidence of ICU, incidence of ventilator, and complication between two groups were compared respectively. Results After operations, characteristics of flail chest in all patients disappeared and both sides of thoracic skeleton were symmetric. Meanwhile, paradoxical movement of the chest wall segment and collapsed chest wall were not found. There was no significant difference in sex, age, number of rib fracture, preoperative tube thoracotomy, number of rib fixation, hospital stay, timing of operative chest wall stabilization, incidence of ICU, incidence of ventilator and complication between two groups. There wers higher incidences of ICU and ventilator in Group B compared with Group A. Two of eldly male patients died of shock and multiple organ dysfunction syndrome in Group B. Conclusion Although having higher incidences of ICU and ventilator, patients with flail chest and pulmonary contusion still have indications to perform operative chest wall stabilization because of its satisfactory outcome .
出处
《健康研究》
CAS
2012年第3期170-174,F0003,共6页
Health Research
关键词
连枷胸
肺挫伤
肋骨骨折
胸部创伤
置入固定
肋骨板
Flail chest
pulmonary contusion
rib fracture
chest contusion
stabilization
