胸腔镜辅助肋骨固定与传统手术病例对照研究

目的:探讨胸腔镜辅助（video-assisted thoracoscopy, VATS）下使用记忆合金环抱器进行肋骨内固定术治疗多根多处肋骨骨折的应用价值。方法:回顾性纳入2010年6月至2020年5月深圳市人民医院急诊中心收治的多根多处肋骨骨折。根据内固定术中是否采用VATS，分为VATS组（胸腔镜定位切口）和传统组（CT定位切口）。主要结局指标为并发症发生风险，次要结局指标包括术后疼痛、切口长度、手术时间和机械通气率等。计量和计数资料比较分别采用LSD- t和 χ2检验，重复测量方差分析疼痛评分变化，logistic回归分析并发症发生的影响因素。 结果:共纳入221例患者，其中VATS组128例，传统组93例。两组性别、年龄和ISS评分等基线资料具有可比性（ P>0.05）。VATS组切口长度、术中出血量、手术时间、术后机械通气占比、通气时间、胸管留置时间、ICU住院和总住院时间、住院费用均优于传统组（均 P<0.05）。重复测量方差分析显示，VATS组比传统组术后疼痛缓解更快速、更明显（ F=3 517.808, P<0.01）。Logistic回归分析显示，VATS是减少术后并发症的独立保护因素（ OR=0.225，95% CI：0.121~0.416， P<0.01）。 结论:胸腔镜辅助肋骨内固定手术视野开阔，定位准确，能减少术中损伤，缩减手术时间，快速缓解疼痛，减少并发症，有利于患者快速恢复。;Objective:To compare the effects between video-assisted thoracoscopic surgery (VATS) and conventional surgery in internal fixation of multiple rib fractures.Methods:Patients with multiple rib fractures, who were admitted to Emergency Center of Shenzhen People's Hospital from June 2010 to May 2020, were included. Patients were divided into the VATS group (incision positioning with VATS) and the conventional group (incisionpositioning with CT scan). The primary outcome measures was the risk of complications, and the secondary outcome measures included postoperative pain, incision length, operation time, and mechanical ventilation rate. Continuous and categorical variables were compared using LSD- t test and Chi-square test. Repeated measures analysis of variance was performed to assess the trend of postoperative pain over time. A logistic regression analysis was used to explore the association of VATS with postoperative complications. Results:A total of 221 patients, including 128 patients in the VATS group and 93 patitents in the conventional group, were enrolled. Baseline characteristics were identical between the two groups ( P>0.05). In the VATS group, the length of incision, intraoperative blood loss, operation time, mechanical ventilation rate after operation, ventilation time, thoracic tube indwelling time, ICU and total length of stay, and medical costs were better than those in the conventional group (all P<0.05). Repeated measures analysis of variance showed that pain relief was faster and more profoundly in the VATS group than in the conventional group ( F=3 517.808, P<0.01). Logistic regression analysis indicated that VATS was an independent protective factor for reducing postoperative complications ( OR=0.225, 95% CI:0.121-0.416, P<0.01). Conclusions:During internal fixation of multiple rib fractures, VATS is an effective approach to reduce postoperative pain and complications. Moreover, video-assisted technique is associated with a rapid recovery for patients, resulting in shorter length of hospital stay and less medical costs.