本文關(guān)鍵詞： 胸腔鏡 肋骨骨折固定 捆綁肋間血管 神經(jīng)　出處：《大連醫(yī)科大學(xué)》2017年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：目的:電視胸腔鏡手術(shù)已經(jīng)廣泛應(yīng)用于胸外科的各領(lǐng)域。胸腔鏡(輔助)肋骨骨折固定手術(shù)成為近年來(lái)治療重癥胸部創(chuàng)傷的熱點(diǎn),手術(shù)方法仍在探索階段,手術(shù)的關(guān)鍵和難點(diǎn)主要是如何在狹小的空間將骨折牽開(kāi)對(duì)位并牢固放置固定材料,目前常用的方法是應(yīng)用可吸收線分別捆綁骨折肋骨兩側(cè)斷端,前期進(jìn)行牽引對(duì)位,不占用手術(shù)操作空間,使骨折固定物安放更加快捷,而后編織捆綁局段肋骨使骨折固定更加牢固,防止固定物移位、脫落。在肋骨捆綁過(guò)程中肋間血管、神經(jīng)能否與肋骨共同捆綁尚無(wú)定論,本研究通過(guò)對(duì)比胸腔鏡(輔助)肋骨骨折固定術(shù)中肋間血管、神經(jīng)與肋骨共同捆綁組(捆綁組)與剝離肋間血管、神經(jīng)后單純捆綁肋骨組(剝離組)圍手術(shù)期及隨訪數(shù)據(jù)的統(tǒng)計(jì)分析,探討肋間血管、神經(jīng)與肋骨共同捆綁對(duì)圍術(shù)期及預(yù)后的影響,為手術(shù)方法的進(jìn)一步探索提供循證依據(jù)。方法:單中心隨機(jī)對(duì)照前瞻性研究。病例選擇胸外科病房收治的胸外傷患者,年齡介于20-60歲之間,多發(fā)多段肋骨骨折——鏈枷胸或肋骨骨折合并嚴(yán)重肺裂傷、活動(dòng)性血胸等需要行胸腔鏡(輔助)探查手術(shù)者,排除頭部、腹部、心臟及脊柱四肢骨骼嚴(yán)重?fù)p傷,無(wú)凝血功能障礙,無(wú)器官臟器功能衰竭等原發(fā)疾病。將入選患者先后順序隨機(jī)分入2個(gè)治療組,肋間血管、神經(jīng)與肋骨共同捆綁組(捆綁組)、剝離肋間血管、神經(jīng)后單純捆綁肋骨組(剝離組)。二組均給予常規(guī)治療,即吸氧、氣道濕化、抗感染、補(bǔ)液、支持等綜合治療。統(tǒng)計(jì)二組患者的一般特征:性別、年齡、身高、體重、肋骨骨折數(shù)量、胸部合并傷等。對(duì)二組患者的術(shù)中出血量、平均單處肋骨固定時(shí)間、切口長(zhǎng)度、術(shù)后引流量、拔引流管時(shí)間、大于6分疼痛時(shí)間、術(shù)后鎮(zhèn)痛藥物劑量、并發(fā)癥、住院時(shí)間、隨訪術(shù)后3周、5周及3月疼痛評(píng)分、骨折愈合、肺功能變化情況等相關(guān)數(shù)據(jù)進(jìn)行統(tǒng)計(jì)分析。結(jié)果:兩組患者一般特征無(wú)顯著性差異,捆綁組手術(shù)時(shí)間短,切口小,術(shù)中出血量、術(shù)后引流量、拔引流管時(shí)間、大于6分疼痛時(shí)間、鎮(zhèn)痛藥物劑量、并發(fā)癥率、住院時(shí)間及隨訪疼痛評(píng)分、肺功能、骨折愈合情況無(wú)顯著差異性。結(jié)論:胸腔鏡(輔助)肋骨骨折固定手術(shù)中肋間血管、神經(jīng)與肋骨共同捆綁,不會(huì)造成患者術(shù)后疼痛加重,并發(fā)癥增多,與剝離肋間血管、神經(jīng)后單純肋骨捆綁相比具有手術(shù)時(shí)間縮短,切口更小的優(yōu)點(diǎn),適合應(yīng)用于手術(shù)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.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R655

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