本文選題：連枷胸 + 胸腔鏡�。� 參考：《河北醫(yī)科大學(xué)》2012年碩士論文

【摘要】：連枷胸是由于嚴(yán)重的胸部損傷導(dǎo)致的多根多處肋骨骨折，引起胸壁軟化，常合并有急性呼吸衰竭、心肺挫傷、血?dú)庑�、失血性休克等，甚至危及生命�?在連枷胸的治療中,采用內(nèi)固定器械進(jìn)行手術(shù)固定已成為趨勢(shì)。手術(shù)內(nèi)固定在減少連枷胸的機(jī)械通氣時(shí)間、ICU時(shí)間和機(jī)械通氣而導(dǎo)致的并發(fā)癥等方面有明顯作用。由于連枷胸同時(shí)伴有肺部的損傷，常規(guī)開(kāi)胸手術(shù)在進(jìn)行修復(fù)胸內(nèi)損傷、固定胸壁時(shí)給患者帶來(lái)更大的創(chuàng)傷。如何使胸部損傷治療微創(chuàng)化是擺在臨床醫(yī)師面前急待解決的問(wèn)題。本課題在此方面進(jìn)行了探討。 目的：設(shè)計(jì)不同類型的肋骨接骨板及固定器械使之能夠合理應(yīng)用于胸腔鏡下內(nèi)固定。選擇最佳固定板進(jìn)行模擬胸腔鏡內(nèi)固定，明確接骨板的可行性及操作的便捷性。選定最佳的內(nèi)固定接骨板后建造連枷胸模型并進(jìn)行犬的實(shí)驗(yàn)研究，通過(guò)觀察犬的生命體征及相關(guān)監(jiān)測(cè)指標(biāo)來(lái)討論內(nèi)固定的可行性及其治療效果。 方法：本研究分兩部分 第一部分：連枷胸肋骨接骨板的設(shè)計(jì)：1、螺絲釘固定式接骨板及其固定器械。2、環(huán)抱式接骨板及其固定器械。3、“鈦夾”固定式接骨板及其固定器械。取動(dòng)物肋骨及人肋骨分別對(duì)三種接骨板進(jìn)行模擬胸腔鏡下固定實(shí)驗(yàn)，判斷進(jìn)板方向是否合適，固定后是否牢固等實(shí)驗(yàn)內(nèi)容。 第二部分：犬連枷胸模型制作及胸腔鏡下肋骨固定的實(shí)驗(yàn)研究。健康雜種犬15只,分為三組，A組(對(duì)照組)、B組(常規(guī)內(nèi)固定組)和C組(胸腔鏡下內(nèi)固定組)，每組5只。首先，建立大面積(15cm2/kg)連枷胸動(dòng)物摸型。對(duì)模型進(jìn)行三種方式內(nèi)固定手術(shù)治療。通過(guò)血?dú)夥治�、心電監(jiān)護(hù)儀等觀察犬呼吸頻率(RR)、動(dòng)脈血氧分壓(PaO2)、動(dòng)脈血二氧化碳分壓(PaCO2)、動(dòng)脈血氧飽和度(SaO2)、心率（HR）等變化。比較常規(guī)內(nèi)固定治療和胸腔鏡內(nèi)固定的治療效果及可操作性。 結(jié)果： 第一部分： 1、螺絲釘固定式接骨板及其固定器械。優(yōu)點(diǎn)：可以很好的對(duì)肋骨進(jìn)行有力的固定，固定完成后不易脫落。缺點(diǎn)：胸腔鏡下操作性不佳，，螺絲在進(jìn)入胸腔后容易脫落，使用萬(wàn)向鉆力度不夠，不易固定螺絲。 2、環(huán)抱式接骨板及固定器械。優(yōu)點(diǎn)：容易進(jìn)入胸腔，好操作，進(jìn)入胸腔過(guò)程順利。缺點(diǎn)：不易固定，固定后易脫落，不能對(duì)接骨板進(jìn)行較好的抓持。 3、“鈦夾”固定式接骨板及其固定器械。優(yōu)點(diǎn)：容易進(jìn)入胸腔，操作簡(jiǎn)便，固定牢靠，不易脫落，使用抓持工具送入胸腔及固定時(shí)不易滑落。缺點(diǎn)：目前對(duì)前胸壁和后胸壁肋骨的固定有很好的效果。但是對(duì)側(cè)胸壁肋骨的固定有著一定的難度，主要是方向不易調(diào)整，固定不是很牢固。 對(duì)三種接骨板進(jìn)行比較總結(jié)，第三種接骨板“鈦夾”固定式接骨板的模式是既合理又易操作的，同時(shí)需進(jìn)一步改進(jìn)。 第二部分： 1、連枷胸模型完成后，均出現(xiàn)反常呼吸。術(shù)后1小時(shí)RR為33±2.5次/分，HR為121±9.91次/分，術(shù)前術(shù)后差異有顯著性(P0.01)。PaO2為6.96±0.41kPa，術(shù)前術(shù)后差異有顯著性(P0.05)。PaCO2為4.10±0.35kPa、SaO2為83.8±1.8%，術(shù)前術(shù)后差異有顯著性(P0.01)。 2、對(duì)照組及手術(shù)固定組3小時(shí)后，B組與A組比較, HR顯著升高，差異有顯著性(P0.01), PaO2、PaCO2、SaO2、RR差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。C組與A組比較，PaO2、SaO2顯著升高，差異有顯著性(P0.01),PaCO2、RR顯著減少，差異有顯著性(P0.01), HR變化不大，差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.1)。C組與B組比較，C組PaO2、SaO2顯著升高，差異有顯著性(P0.01), PaCO2、RR顯著減少，差異有顯著性(P0.01)，HR差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.1)。 結(jié)論： 1、三種肋骨接骨板及其器械的應(yīng)用中“鈦夾”固定式接骨板及其固定器械的模式是較為可行的。 2、胸腔鏡下連枷胸內(nèi)固定組較對(duì)照組及常規(guī)內(nèi)固定治療組術(shù)中及術(shù)后生命體征變化小，機(jī)體影響小，術(shù)后恢復(fù)快。 3、胸腔鏡下肋骨接骨板輔助治療多發(fā)性肋骨骨折具有微創(chuàng)、固定可靠、操作方便等優(yōu)點(diǎn)，是一種治療多發(fā)性肋骨骨折較理想的方法。
[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錛

本文編號(hào)：1835114