Effect of thoracoscopy combined with puncture-positioned internal fixation of multiple rib fractures accompanied with hemopneumothorax / 中华创伤杂志

ABSTRACT

Objective:To investigate the clinical effect of thoracoscopy combined with puncture-positioned internal fixation of multiple rib fractures accompanied with hemopneumothorax.Methods:A retrospective case-control study was used to analyze the clinical data of 68 patients with multiple rib fractures accompanied with hemopneumothorax admitted to Fujian Provincial Hospital from September 2016 to December 2018, including 49 males and 19 females, aged 25-86 years [(47.3±7.4)years]. There were 55 patients with unilateral lung contusion and laceration, and rest 13 patients with bilateral lung contusion and laceration. A total of 36 patients were treated by thoracoscopy combined with puncture-positioned internal fixation (thoracoscopy group) and 32 patients by open reduction group (open reduction group). The incision length, operation time, intraoperative blood loss, chest tube drainage time, ICU hospitalization time, total hospitalization time, and complications were recorded. Numeric rating scale (NRS) score was assessed at postoperative 1, 2, 3, 7 days. The MOS 36-item short-form health survey (SF-36) was conducted at the latest follow-up.Results:All patients were followed up for 8-34 months [(18.9±4.3)months]. Thoracoscopy group showed incision length of (4.3±1.3)cm, operation time of (66.3±12.1)minutes, intraoperative blood loss of (86.5±23.4)ml, chest tube drainage time of (5.3±1.1) days, ICU hospital stay of (2.3±0.8)days, total hospital stay of (6.8±1.7)days, and total complication rate of 8%, showing significant differences compared to open reduction group [(11.6±2.2)cm, (105.9±19.4)minutes, (191.4±35.6)ml, (8.1±1.6)days, (4.7± 1.4)days, (10.6±2.1)days, 29%] ( P<0.05 or 0.01). In thoracoscopy group, the NRS scores at day 1, 2, 3, and 7 were respective (6.6±1.2)points, (5.9±1.0)points, (4.4±0.9)points and (2.7±0.7)points, significantly lower than those in open reduction group [(7.3±1.2)points, (7.0±1.1)points, (5.7±1.0)points and (3.9±0.8)points] ( P<0.05 or 0.01). The SF-36 score in thoracoscopy group was (86.4±12.1)points, significantly higher than that in open reduction group [(75.6±11.5)points] ( P<0.01). Conclusions:Compared with open reduction and internal fixation, thoracoscopy combined with puncture-positioned internal fixation for multiple rib fractures has the advantages of smaller surgical incision, shorter operation time, less intraoperative bleeding, shorter chest tube drainage time, shorter ICU hospital stay, shorter total hospital stay, and less postoperative complications. The technique can also reduce the postoperative pain and improve the patients' quality of life.