胸腔镜下治疗连枷胸接骨板及器械的研制和动物实验研究

发布时间：2018-05-02 19:06

  本文选题：连枷胸 + 胸腔镜　； 参考：《河北医科大学》2012年硕士论文

【摘要】：连枷胸是由于严重的胸部损伤导致的多根多处肋骨骨折，引起胸壁软化，常合并有急性呼吸衰竭、心肺挫伤、血气胸、失血性休克等，甚至危及生命。 在连枷胸的治疗中,采用内固定器械进行手术固定已成为趋势。手术内固定在减少连枷胸的机械通气时间、ICU时间和机械通气而导致的并发症等方面有明显作用。由于连枷胸同时伴有肺部的损伤，常规开胸手术在进行修复胸内损伤、固定胸壁时给患者带来更大的创伤。如何使胸部损伤治疗微创化是摆在临床医师面前急待解决的问题。本课题在此方面进行了探讨。 目的：设计不同类型的肋骨接骨板及固定器械使之能够合理应用于胸腔镜下内固定。选择最佳固定板进行模拟胸腔镜内固定，明确接骨板的可行性及操作的便捷性。选定最佳的内固定接骨板后建造连枷胸模型并进行犬的实验研究，通过观察犬的生命体征及相关监测指标来讨论内固定的可行性及其治疗效果。 方法：本研究分两部分 第一部分：连枷胸肋骨接骨板的设计：1、螺丝钉固定式接骨板及其固定器械。2、环抱式接骨板及其固定器械。3、“钛夹”固定式接骨板及其固定器械。取动物肋骨及人肋骨分别对三种接骨板进行模拟胸腔镜下固定实验，判断进板方向是否合适，固定后是否牢固等实验内容。 第二部分：犬连枷胸模型制作及胸腔镜下肋骨固定的实验研究。健康杂种犬15只,分为三组，A组(对照组)、B组(常规内固定组)和C组(胸腔镜下内固定组)，每组5只。首先，建立大面积(15cm2/kg)连枷胸动物摸型。对模型进行三种方式内固定手术治疗。通过血气分析、心电监护仪等观察犬呼吸频率(RR)、动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)、动脉血氧饱和度(SaO2)、心率（HR）等变化。比较常规内固定治疗和胸腔镜内固定的治疗效果及可操作性。 结果： 第一部分： 1、螺丝钉固定式接骨板及其固定器械。优点：可以很好的对肋骨进行有力的固定，固定完成后不易脱落。缺点：胸腔镜下操作性不佳，，螺丝在进入胸腔后容易脱落，使用万向钻力度不够，不易固定螺丝。 2、环抱式接骨板及固定器械。优点：容易进入胸腔，好操作，进入胸腔过程顺利。缺点：不易固定，固定后易脱落，不能对接骨板进行较好的抓持。 3、“钛夹”固定式接骨板及其固定器械。优点：容易进入胸腔，操作简便，固定牢靠，不易脱落，使用抓持工具送入胸腔及固定时不易滑落。缺点：目前对前胸壁和后胸壁肋骨的固定有很好的效果。但是对侧胸壁肋骨的固定有着一定的难度，主要是方向不易调整，固定不是很牢固。 对三种接骨板进行比较总结，第三种接骨板“钛夹”固定式接骨板的模式是既合理又易操作的，同时需进一步改进。 第二部分： 1、连枷胸模型完成后，均出现反常呼吸。术后1小时RR为33±2.5次/分，HR为121±9.91次/分，术前术后差异有显著性(P0.01)。PaO2为6.96±0.41kPa，术前术后差异有显著性(P0.05)。PaCO2为4.10±0.35kPa、SaO2为83.8±1.8%，术前术后差异有显著性(P0.01)。 2、对照组及手术固定组3小时后，B组与A组比较, HR显著升高，差异有显著性(P0.01), PaO2、PaCO2、SaO2、RR差异均无统计学意义(P0.05)。C组与A组比较，PaO2、SaO2显著升高，差异有显著性(P0.01),PaCO2、RR显著减少，差异有显著性(P0.01), HR变化不大，差异无统计学意义(P0.1)。C组与B组比较，C组PaO2、SaO2显著升高，差异有显著性(P0.01), PaCO2、RR显著减少，差异有显著性(P0.01)，HR差异无统计学意义(P0.1)。 结论： 1、三种肋骨接骨板及其器械的应用中“钛夹”固定式接骨板及其固定器械的模式是较为可行的。 2、胸腔镜下连枷胸内固定组较对照组及常规内固定治疗组术中及术后生命体征变化小，机体影响小，术后恢复快。 3、胸腔镜下肋骨接骨板辅助治疗多发性肋骨骨折具有微创、固定可靠、操作方便等优点，是一种治疗多发性肋骨骨折较理想的方法。
[Abstract]:Flail chest is a kind of multiple rib fracture caused by severe chest injury, which causes the softening of the chest wall, often combined with acute respiratory failure, cardiopulmonary contusion, haemopneumothorax, hemorrhagic shock and so on, and even endangers life.
Internal fixation has become a trend in the treatment of flail chest. Internal fixation has a significant role in reducing the mechanical ventilation time of flail chest, ICU time and complications caused by mechanical ventilation. When the chest wall is fixed, it will bring more trauma to the patient. How to make the treatment of the chest injury minimally invasive is an urgent problem to be solved in front of the clinician. This topic has been discussed in this field.
Objective: to design a different type of rib plate and fixer to make it suitable for the internal fixation under the thoracoscope. To select the best fixed plate to simulate the thoracoscopy, to make clear the feasibility and the convenience of the operation. The model of flail chest was built after the best internal fixation plate was selected and the experimental study of the dog was carried out. After observing the vital signs and monitoring indexes of dogs, we discussed the feasibility and therapeutic effect of internal fixation.
Methods: This study is divided into two parts
The first part: the design of the flail chest and rib bone plate: 1, the screw fixed plate and its fixed instrument.2, the encircling plate and its fixed instrument.3, the titanium clip fixed plate and its fixed apparatus. The animal ribs and the human ribs were used to fix the three kinds of plates by quasi thoracoscopy, and the direction of the board was judged. Whether it is appropriate, whether it is firmly fixed or not, and so on.
The second part: the experimental study of the canine flail chest model and the thoracoscopic rib fixation. 15 healthy hybrid dogs were divided into three groups, A group (control group), group B (routine internal fixation group) and group C (thoracoscopic internal fixation group), 5 rats in each group. First, a large area (15cm2/ kg) flail chest animal touch type was established. Three internal fixation operations were performed on the model. Treatment. Through blood gas analysis and electrocardiogram monitor, the respiratory frequency (RR), arterial oxygen partial pressure (PaO2), arterial blood carbon dioxide pressure (PaCO2), arterial oxygen saturation (SaO2), heart rate (HR) and other changes were observed. The therapeutic effect and maneuverability of conventional internal fixation and thoracoscopy were compared.
Result锛

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