The Clinical Application Of Video-Assisted Thoracoscopic Surgery For Internal Fixation Of Multiple Fractured Ribs

BackgroundThere are many injuries caused by several reasons.Chest trauma is a fairly significant one.Multiple fractured ribs are very common,which destroy the continuity of normal thorax.For such patients,conservative treatment is often used by thoracic surgeons.It can cure some patients though,but can also cause an array of complications and sequelae such as abnormalities in the thorax which affect human body’s contour artistically,respiratory dysfunction and chronic pain which result in the serious decline of life quality after the recovery.With the development of technology and social progress,thoracoscopy and its supporting equipment are becoming more and more perfect,not only for the diagnosis of extra-thoracic diseases,but also for complex surgical treatment.It is of certain clinical value to compare two techniques of the treatment of multiple rib fractures,namely,assisted thoracoscopic surgery and traditional open thoracotomy,so as to explore the difference of curative effects between these two.ObjectiveThe main purpose is to compare the curative effects of thoracoscopic rib internal fixation surgery and traditional open internal fixation surgery on patients with multiple rib fractures who meet the inclusion criteria of the experimental group;the secondary purpose is to compare the therapeutic effects of surgical treatment and conservative treatment on patients with multiple rib fractures.MethodsAccording to the purpose of this study,researchers will check the general and clinical information of patients,including gender,age,injury factors,fracture types,the presence of combined injuries,the presence of severe limbs injury,extra-vertebral injury and head and abdomen injury,as well as the formulation of detailed inclusion and exclusion criteria.Patients who meet the criteria and agree to surgery are randomly divided into two groups by random number table.Different groups receive different surgical schemes,including assisted thoracoscopic exploration plus nickel-titanium memory alloy rib internal fixation for assisted thoracoscopic surgery group,open-vision thoracic exploration plus nickel-titanium memory alloy rib internal fixation for traditional surgery group.Then the intra-operative and post-operative indicators of patients in different treatment groups are summarized and compared,which involve operation time,intra-operative bleeding volume,post-operative drainage,post-operative pain,post-operative complications,total hospitalization time and so on.Through quantitative comparison of indicators,the clinical efficacy of different surgical options will be analyzed.Conservative treatment should be carried out for those who meet the standard but do not agree with the operation.Comparing the hospitalization time,pulmonary infection,atelectasis,coagulated hemothorax,pressure sore and pain duration between conservative treatment group and other two surgical groups,the analysis of clinical efficacy of conservative treatment and surgical treatment will be the secondary objective of this study.The research plan has been approved by the Ethics Committee of the author’s work unit.ResultsThe bleeding volume and drainage volume of patients recieved traditional thoracotomy were significantly increased than those treated by assisted thoracoscopy(P < 0.05);the operation time of traditional thoracotomy is significantly longer than that of assisted thoracoscopy;the difference between these two groups was statistically significant(P < 0.05).The pain time,ambulation time and hospitalization time of patients who undergo video-assisted thoracotomy were significantly shorter than those who undergo traditional thoracotomy(P < 0.05),with statistical significance;the incidence of complications of patients who undergo assisted thoracoscopic surgery was significantly lower than that of patients who undergo traditional thoracotomy(P < 0.05),with statistic significance.Comparing the prognosis of conservative treatment group and operation group(including control group and observation group),the hospitalization time and pain time of operation group were shorter than that of conservative treatment group,the difference was statistically significant(p < 0.05);the incidence of pulmonary infection in operation group was lower than that in conservative treatment group,the difference was also statistically significant(p = 0.038).There was no significant difference in the incidence of coagulated hemothorax,atelectasis and pressure sore between these two groups(p > 0.05).ConclusionThe clinical effect of assisted thoracoscopic surgery for patients with multiple rib fractures is remarkable.It can accurately locate the surgical incision approach,reduce surgical trauma,and control pain and complications,and finally reduce the overall treatment time.Compared with conservative treatment,surgical treatment of multiple rib fractures is more effective.