胸腔镜（辅助）肋骨骨折固定术中捆绑肋间血管、神经的影响研究

发布时间：2018-02-27 12:47

本文关键词： 胸腔镜肋骨骨折固定捆绑肋间血管神经　出处：《大连医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:电视胸腔镜手术已经广泛应用于胸外科的各领域。胸腔镜(辅助)肋骨骨折固定手术成为近年来治疗重症胸部创伤的热点,手术方法仍在探索阶段,手术的关键和难点主要是如何在狭小的空间将骨折牵开对位并牢固放置固定材料,目前常用的方法是应用可吸收线分别捆绑骨折肋骨两侧断端,前期进行牵引对位,不占用手术操作空间,使骨折固定物安放更加快捷,而后编织捆绑局段肋骨使骨折固定更加牢固,防止固定物移位、脱落。在肋骨捆绑过程中肋间血管、神经能否与肋骨共同捆绑尚无定论,本研究通过对比胸腔镜(辅助)肋骨骨折固定术中肋间血管、神经与肋骨共同捆绑组(捆绑组)与剥离肋间血管、神经后单纯捆绑肋骨组(剥离组)围手术期及随访数据的统计分析,探讨肋间血管、神经与肋骨共同捆绑对围术期及预后的影响,为手术方法的进一步探索提供循证依据。方法:单中心随机对照前瞻性研究。病例选择胸外科病房收治的胸外伤患者,年龄介于20-60岁之间,多发多段肋骨骨折——链枷胸或肋骨骨折合并严重肺裂伤、活动性血胸等需要行胸腔镜(辅助)探查手术者,排除头部、腹部、心脏及脊柱四肢骨骼严重损伤,无凝血功能障碍,无器官脏器功能衰竭等原发疾病。将入选患者先后顺序随机分入2个治疗组,肋间血管、神经与肋骨共同捆绑组(捆绑组)、剥离肋间血管、神经后单纯捆绑肋骨组(剥离组)。二组均给予常规治疗,即吸氧、气道湿化、抗感染、补液、支持等综合治疗。统计二组患者的一般特征:性别、年龄、身高、体重、肋骨骨折数量、胸部合并伤等。对二组患者的术中出血量、平均单处肋骨固定时间、切口长度、术后引流量、拔引流管时间、大于6分疼痛时间、术后镇痛药物剂量、并发症、住院时间、随访术后3周、5周及3月疼痛评分、骨折愈合、肺功能变化情况等相关数据进行统计分析。结果:两组患者一般特征无显著性差异,捆绑组手术时间短,切口小,术中出血量、术后引流量、拔引流管时间、大于6分疼痛时间、镇痛药物剂量、并发症率、住院时间及随访疼痛评分、肺功能、骨折愈合情况无显著差异性。结论:胸腔镜(辅助)肋骨骨折固定手术中肋间血管、神经与肋骨共同捆绑,不会造成患者术后疼痛加重,并发症增多,与剥离肋间血管、神经后单纯肋骨捆绑相比具有手术时间缩短,切口更小的优点,适合应用于手术中。
[Abstract]:Objective: video-assisted thoracoscopic surgery has been widely used in various fields of thoracic surgery. Thoracoscopic (assisted) rib fracture fixation has become a hot spot in the treatment of severe thoracic trauma in recent years. The key and difficulty of the operation is how to pull the fracture apart and firmly place the fixed material in the narrow space. At present, the commonly used method is to use absorbable line to bind the broken end of the two sides of the fracture rib separately, and to carry on the traction alignment in the early stage. Do not occupy the operation space, so that the fixation of fracture more quickly, and then braided local rib fixation to make the fracture more solid, prevent the removal of the fixation, falling off. In the rib binding process, intercostal vessels, It is not clear whether the nerve can be bound together with the rib. In this study, the intercostal vessels of thoracoscopic (assisted) rib fracture fixation, the nerve and rib joint binding group (the binding group) and the stripping of the intercostal vessels were compared. The data of perioperative period and follow-up were analyzed in the group of simple nerve ligation (stripping group). The influence of intercostal vessels, nerves and ribs on perioperative period and prognosis was studied. Methods: a single center randomized controlled prospective study was conducted. Patients with thoracic trauma in thoracic surgery ward, aged between 20 and 60 years old, were selected. Multiple segmental rib fractures-chain flail chest or rib fractures with severe lung laceration, active hemothorax, etc., that require thoracoscopic (assisted) exploration to remove serious head, abdomen, heart, and spine and limb bone injuries, without coagulation dysfunction, The patients were randomly divided into two treatment groups: intercostal vessels, nerves and ribs. The patients of the two groups were given routine treatment, namely oxygen inhalation, airway humidification, anti-infection, fluid resuscitation, support and so on. The general characteristics of the two groups were analyzed: sex, age, height, weight, etc. The amount of intraoperative bleeding, the average time of single rib fixation, the length of incision, the drainage flow, the time of drawing drainage tube, the time of pain more than 6 minutes, the dosage of analgesic drugs, complications, etc. Results: there was no significant difference in general characteristics between the two groups, the operation time was short, the incision was small, the operative time was short, and the incision was small in the binding group, and there was no significant difference between the two groups in terms of the duration of hospitalization, the pain score of 3 weeks, 5 weeks and March, the healing of fracture and the changes of pulmonary function. Intraoperative bleeding, postoperative drainage, drainage time, more than 6 minutes of pain time, dosage of analgesic drugs, complication rate, hospitalization time, follow-up pain score, pulmonary function, Conclusion: the intercostal vessels, nerves and ribs are bound together in thoracoscopic (assisted) rib fracture fixation, which will not cause postoperative pain and complications, and the exfoliation of intercostal blood vessels. Compared with the simple rib ligation of the nerve, the operation time is shorter and the incision is smaller, so it is suitable to be used in the operation.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R655

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