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肋骨骨折是胸部外伤中最为常见的疾病,约占46%[1],常见的致伤原因有道路交通伤、坠落伤、摔伤、暴力伤等[2]。肋骨骨折最常发生在第4~7肋。相比X线片,胸部CT能更准确地发现肋骨骨折的数量、部位及胸内脏器损伤情况[3]。对合并有连枷胸及严重并发症的多根多处肋骨骨折,目前多采用手术切开复位内固定治疗,临床报道疗效多比较满意[4-5]。而对于无严重并发症的肋骨骨折(骨折数 < 3根)病人,临床上多采用传统的胸廓外固定、镇痛、呼吸支持及并发症防治为主的非手术治疗,但对疼痛控制效果欠佳,病人需长期忍受疼痛折磨。为此,笔者前期针对肋骨骨折特点设计了新型微创外固定支架,并取得了国家专利(专利号:ZL 2016 20176973.5)。该新型微创外固定支架的优势:(1)结构小巧、固定效果确切,能有效缓解病人疼痛;(2)手术创伤小,胸膜外固定更为安全,肋间神经、血管、骨髓腔不容易遭受损伤,有效地保持了血液循环,手术时间短,有利于病人功能恢复;(3)操作简单、容易学习掌握。我们对24例肋骨骨折(骨折数 < 3根)病人采用此法治疗,比较保守治疗和新型外固定支架治疗的疗效差异,以期为肋骨骨折(骨折数 < 3根)的治疗提供参考依据。
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观察组病人术后15 d的镇痛药物用量为(11.00±4.31)片,少于对照组的(16.58±6.96)片(t=2.36,P < 0.05)。
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2组病人术后5、10、15 d VAS评分均较术前明显下降(P < 0.01)。观察组术后5、10 d VAS评分均低于对照组(P < 0.05)(见表 1)。
分组 术前 术后5 d 术后10 d 术后15 d F P MS组内 观察组 7.50±1.00 2.75±1.29** 1.83±1.80** 1.08±1.00**# 58.09 < 0.01 1.724 对照组 7.42±1.00 4.58±2.39** 3.42±1.78** 1.83±1.75**##▲ 20.62 < 0.01 3.237 t 0.20 2.34 2.17 1.29 — — — P >0.05 < 0.05 < 0.05 >0.05 — — — q检验:与术前比较** P < 0.01;与术后5 d比较#P < 0.05,##P < 0.01;与术后10 d比较▲P < 0.05 表 1 2组病人VAS评分比较(ni=12;x±s;分)
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术后随访3个月,2组病人均未发生局部感染、肺部感染、血气胸等并发症。
新型微创外固定支架在肋骨骨折病人中的临床应用
Clinical application of new minimally invasive external fixation stent in the treatment of rib fractures
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摘要:
目的探索新型微创外固定支架在肋骨骨折病人(骨折数 < 3根)中的临床疗效。 方法选取24例肋骨骨折(骨折数 < 3根)病人,按随机数字表法分为观察组和对照组,观察组采用新型微创外固定支架治疗,对照组采用保守治疗。比较2组病人镇痛药物用量、胸痛VAS评分和并发症发生情况。 结果观察组病人术后15 d的镇痛药物用量少于对照组(P < 0.05)。2组病人术后5、10、15 d VAS评分均明显下降,且术后VAS评分明显低于术前(P < 0.01)。观察组术后5、10 d VAS评分低于对照组(P < 0.05)。2组病人均未发生局部感染、肺部感染、血气胸等。 结论新型微创外固定支架治疗肋骨骨折(骨折数 < 3根)创伤小,可缓解病人疼痛,减少镇痛药物用量,实用性强。 Abstract:ObjectiveTo explore the clinical application of a new minimally invasive external fixation stent in the treatment of rib fractures(fracture number < 3). MethodsThe clinical data of 24 patients with rib fractures(fracture number < 3)were analyzed.The patients were randomly divided into the observation and control group.The observation group was treated with new minimally invasive external fixation stent, while the control group was treated with conservative method.The analgesic drug dosage, chest pain VAS score and complications were compared between two groups. ResultsThe analgesic drug dosage in observation group after 15d of operation was significantly lower than that in control group(P < 0.05).The VAS scores in two gorups after 5, 10 and 15d of operation significantly decreased, and the postoperative VAS scores in two groups were significnatly lower than that before opertaion(P < 0.01).The VAS scores in observation group were lower than those in control group after 5 and 10d of operation(P < 0.05).No local infection, pulmonary infection, hemopneumothorax occurred in two groups. ConclusionsThe treatment of rib fractures(fracture number < 3)with new minimally invasive external fixation stent is effective with small trauma, which can relieve the pain of patients, and reduce the dosage of analgesic drug. -
表 1 2组病人VAS评分比较(ni=12;x±s;分)
分组 术前 术后5 d 术后10 d 术后15 d F P MS组内 观察组 7.50±1.00 2.75±1.29** 1.83±1.80** 1.08±1.00**# 58.09 < 0.01 1.724 对照组 7.42±1.00 4.58±2.39** 3.42±1.78** 1.83±1.75**##▲ 20.62 < 0.01 3.237 t 0.20 2.34 2.17 1.29 — — — P >0.05 < 0.05 < 0.05 >0.05 — — — q检验:与术前比较** P < 0.01;与术后5 d比较#P < 0.05,##P < 0.01;与术后10 d比较▲P < 0.05 -
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