Comparison Of Surgical And Non-surgical Treatment Of Multiple Rib Fractures In Non-flail Chest

Objective:To compare the clinical effects of open reduction and internal fixation with nickel-titanium alloy rib embracing device and non-surgical treatment of non-flail chest multiple rib fractures.Methods:A total of 387 cases of non-flail chest patients diagnosed with multiple rib fractures were selected from the thoracic surgery department of our hospital from October 2017 to October 2019,among which 144 cases met the study criteria（AIS≤3）.There were 70 cases in the operation group and 74 cases in the non-operation group.Retrospective analysis was performed on the relevant case data of the surgical treatment group and the non-surgical treatment group,and the reasons of injury,number of fractured ribs,AIS score,ISS score,blood gas analysis（at admission,1 day after treatment,3 days after the treatment of p H value,Pa O₂,Pa CO₂and Pa O₂/Fi O₂）,ward VAS score,hospitalization complications（pleural effusion,late-onset hemopneumothorax,lung infection,atelectasis and end frame shift,etc.）and analgesic time,total hospitalization days and total hospitalization expenses,follow-up of fracture healing,discharge follow-up clinical indexes such as VAS score,data collection and analysis,comprehensive evaluation with open reduction and internal fixation surgery and non-surgical treatment of flail chest clinical curative effect of multiple fractured ribs.Results:1.Comparison of basic clinical data,such as gender,age,body mass index,number of fractured ribs,AIS score and ISS score,between the two groups showed that there were differences between the surgery group and the non-operation group,but there was no statistical significance（P>0.05）;There were no significant differences in the cause of injury and the number of fractured ribs between the two groups（P>0.05）;2.There were differences in pleural effusion,delayed pneumothorax,atelectasis,broken rib displacement and other complications between the two groups during treatment,but the differences were not statistically significant（P>0.05）;The pulmonary infection rate of the surgery group was lower than that of the non-surgery group（8.6%vs 21.6%,P=0.03）,and the difference between the two groups was statistically significant（P<0.05）.3.The surgical group and the non-surgical group were tested by blood gas analysis on admission,on the first day after treatment,and on the third day after treatment.After comparison,the surgical group was tested on admission,day 1 after treatment,and day 3 after treatment.The improvement of p H,Pa O₂,Pa CO₂and Pa O₂/Fi O₂was better than that of the non-surgical group.There were differences in blood gas indexes between the two groups,and the difference was statistically significant（P<0.05）;4.The VAS score of the patients in the surgery group was 6.59±2.06 at admission,the VAS score was 3.85±0.96 one day after treatment,and the VAS score was 1.71±0.43at 3 days after treatment;the VAS score of patients in the non-surgical group was7.10±1.89 at admission,treatment The VAS score was 2.99±0.91 1 day after treatment,and 1.23±0.31 on 3 days after treatment.The time of analgesia in the operation group and non-operation group was（4.58±1.03d vs 6.74±0.65d,P<0.05）.After comparison,the analgesic improvement effect of the surgical group was better than that of the non-surgical group,there were differences between the two groups,and the difference was statistically significant（P<0.05）;5.The total hospital stay in the surgical group was shorter than that in the non-surgical group（9.34±2.56d vs 11.6±3.67d,P<0.05）;the hospitalization cost of the surgical group was higher than that of the non-surgical group（31268±4631￥vs 18652±3542￥,P<0.05）.Both of the two results are different,and the differences are statistically significant（P<0.05）;6.The improvement of follow-up VAS score and fracture healing in the surgical group were better than those in the non-surgical group,there were differences between the two,and the differences were statistically significant（P<0.05）.Conclusion:For the treatment of non-flail chest multiple rib fractures,the use of nickel-titanium alloy embracing device for surgical internal fixation is safe and reliable,blood gas indicators are improved more significantly than non-surgical treatment,and the surgical effect is better than non-surgical treatment,which can reduce the time and improve the use of analgesics VAS score,reduce the rate of pulmonary infection,and at the same time shorten the hospital stay,promote the patient’s early recovery,and obtain a better prognosis,,which has high clinical application value.