The Clinical And Anatomy Research Of Ribs Fracture Treatment

Part one The anatomy research of ribs fracture treatmentObjective On the basis of ribs anatomy partition, muscles and its dominating nerves, nutrient vessels involved in each partition were measured . Alleviating the side effects by designing different incisions for different partitions and avoiding major nerves and blood vessels.Methods Select 8 adult -cadaver samples(4 men, 4women) and observe the generally form of the samples , line feed of the intercostal muscles and intercostal nervus vessels .Divide the ribs into five parts from the junction of the shoulder blades ,ribs and the costicartilages.Ⅰ: cartilage partition;Ⅱ: scapular partition;Ⅲ: the partition before the scapular;Ⅳ: the partition under the scapular ;Ⅴ: Rachis side district. Through general anatomy of four -cadaver samples ,observing the terminal and features of the line feeds of the muscles involved in each partition .Observing and measuring the line feeds features of the major vessels and nerves in each partition. Find a osseous reference and measure the distance between the blood vessels and nerves ,their outer diameters, the relationship between the important anatomic structure and ribs, determine the safe scope of the surgical incision. Designing the surgical incision and passage on the other four -cadaver samples, determining the scope of stripping muscles , major vessels and nerves is to minimize the damage on muscles of the designed surgical passage and avoid the scope of the major vessels and nerves.Result (1)Make a longitudinal incision of more than 20mm on partitionⅠfrom the outside of the sternum .(2)Make a large 'S' incision on partitionⅡblow the backward of the shoulder blade .(3) Make an arc incision on partitionⅢalong the outside of the pectoralis major muscles. (4)Make a longitudinal or arc incision on partitionⅣbetween the alar line and the vertical line under the scapular.(5) The partitionⅤis the rachis side distract and subdivided into up rachis side distract and underneath rachis side distract. Make a longitudinal incision on up rachis side distract in the center of the spinal margin line and the margo vertebralis scapulae.If the fracture of underneath rachis side distract is near the vertical line under the scapular , we can make a parallel incision near the vertical line under the scapular . If the fracture is near the paravertebral line , we can take a longitudinal incision from the paravertebral line for about 10 cm .Conclusion (1) This study is based on the ribs surgery and imaging division research. According to the study of anatomy, ribs are divided into five partitions,Ⅰ: cartilage partition;Ⅱ: scapular partition;Ⅲ: the partition before the scapular;Ⅳ: the partition under the scapular ;Ⅴ: Rachis side district. (2) Through anatomical experiments, we can find that the partitionⅠinvolves some muscles as follows: pectoralis major muscle, rectus abdominis , external intercostals, internal intercostals, intercostals intimi, rib horizontal muscle, subcostales. The partitionⅡincludes : joint of the scapular , serratus anterior muscle, the anchor of latissimus dorsi muscle, external intercostals, internal intercostals. The partitionⅢincludes pectoralis major muscle, pectoralis minor muscle, external intercostals, internal intercostals. The partitionⅣincludes serratus anterior muscle, latissimus dorsi muscle, obliquus externus abdominis muscle, external intercostals, internal intercostals. The partitionⅤincludes trapezius, latissimus dorsi muscle, rhomboideus, serratus posterior superior, serratus posterior inferior, erector spinae muscle, external intercostals, internal intercostals , intercostals intimi. (3) Design different incisions according to the study of ribs anatomical partition. Make a longitudinal incision of more than 20mm on partitionⅠfrom the outside of the sternum . Make a large 'S' incision on partitionⅡblow the backward of the shoulder blade . Make an arc incision on partitionⅢalong the outside of the pectoralis major muscles. Make a longitudinal or arc incision on partitionⅣbetween the alar line and the vertical line under the scapular. Make a longitudinal incision along the fractures line .Part two The prospective study of the surgical treatment on ribs fractureObjective According to the results of the incision designing research ,take operations on the patients of ribs fracture. Comparing the efficacy of operation on ribs fracture and the conservative treatment to provide the basis for clinical treatment on ribs fracture.Methods Collection includes the patients with ribs fracture from January 2009 to July 2010 in Hebei United University Affiliated Hospital. According to the selecting criteria and exclusion criteria ,117 patients were involved. They were randomly divided into steel group and conservative group, including 61 steel groups and 56 conservative groups. Observe the oxygen partial pressure of the two groups within 7 days ( PaO₂), blood oxygen saturation (SaO₂) and the change of pain degree. Records the time from hospitalization to independent activities ,the length of hospitalization ,the healing time of the fracture and the length of restoring original work of the two- group patients. Assuring up office visit every week for the patients of steel group and conservative group until 3 months after discharge. Take an X-ray and check the healing of the bones and internal fixation.Result (1) Comparing the gender, age, fractured ribs and the anatomical partition of the two groups. The difference has no statistical significance, but comparable. (2)The difference between the PaO₂ and SaO₂ before admission has no statistical significance. After admission the PaO₂ and SaO₂ at different time are rising. Especially the growth of the steel group is larger than that of the conservative group. The difference has the statistical significance (P< 0.05). The degree of the pain is highest when taking a rest and having a cough. The comparisons is P> 0.05 between the two groups, but has no significant difference. 24 hours after admission or 10 hours after the operation, the pain of the steel-group patients caused by the surgical incision decreased unobviously compared with the conservative group, but it has no statistical significance. The degree of pain when taking a rest and having a cough after the 48,72,168 hours is lower gradually than it before admission. And the decrease of the steel group is obvious, P< 0.05. The grades of the VAS at different time points are higher than static state when giving mandatory breathing to the patients of the two groups. The time from hospitalization to independent activities ,the length of hospitalization ,the healing time of the fracture and the length of restoring original work of the steel group is shorter than that of the conservative group. The statistical inspection is P< 0.05 and there is significant differences. (3)Assuring up office visit every week for 61 patients in steel group and 56 patients in conservation group every week until 3 months after discharged. The average healing time of the steel group is 8.05±0.96. The dynamic chest radiograph shows the fixation of the rib conjunction is well, finding no shifting of the bone conjunction and no transparent bands formation, the internal fixation is firm. There is no broken, loose, slip, ecclasis phenomenon of the interior fixation. None of the patients suffered chest wall deformity.Conclusion (1) The study found: the comparison of PaO₂ and SaO₂ between the steel group and conservative group in different time points after admission, the VAS comparison when taking a rest and having a cough,the comparison of the length of the treatment, the efficacy of operation on ribs fracture and the conservative treatment are significantly different. (2) According to different anatomy partitions, the study adopts different surgical incisions and surgical position. PartitionⅠadopts the supine posture. Make a longitudinal incision of more than 20mm from the outside of the sternum. PartitionⅡadopts the health side-lying position. Make a large 'S' incision blow the backward of the shoulder blade . PartitionⅢadopts the supine. Make an arc incision along the outside of the pectoralis major muscles. PartitionⅣadopts the health side-lying position. Make a longitudinal or arc incision between the alar line and the vertical line under the scapular. PartitionⅤadopts the prostrate position. Make a longitudinal incision along the fractures line . Therefore, this study approves the surgical experiment is more advantageous to the recovery of patients and can reduce complications. The postoperative function of the patients recovered well and the satisfaction of the patients is high . It is worth promoting in clinical operation.