| Flail chest refers to bone fractures either one rib or many ribs caused bysevere chest injury, resulting in chest wall softening, often associated withrespiratory failure, heart and lung contusion, pneumothorax, hemorrhagicshock, etc,even with acute or even life-threateningIt has become a trend to use internal fixation devices for surgical fixation.In the treatment of flail chest, internal surgical fixation plays a significant rolein reducing the time of mechanical ventilation, ICU time and complicationscaused by mechanical ventilation. Flail chest is also accompanied by lungdamage, thus, using conventional thoracotomy to fix the chest wall and repairthe chest injury causes more trauma to the patients. Therefore, how to beminimally invasive in the treatment of chest injury is a hard nut for theclinicians to crack. This study probes into this topic.Objective: Different types of rib blade plates and fixation equipmentswas designed, so that they can be properly applied to thoracoscopic internalfixation. The best fixing plate was choose to simulate thoracoscopic fixation,clarify the the feasibility of a bone plate, as well as its convenience foroperation. After selecting the best bone plate for internal fixation, build themodel of flail chest and then carry out experimental study on dogs. Finally,discuss the feasibility and therapeutic effects of internal fixation by way ofobserving and comparing the monitored values of dogs' vital signs.Methods:This study can be divided into two parts:Part I The design of the bone plate for flail chest ribs:1. Fixed screwwith contact plate and fixation devices.2. Wrap around of the contact plateand its fixation devices3."Titanium clamp" fixed-type contact plate and its fixation devices. Take both animal ribs and human ribs for thoracoscopicsimulations of internal fixation experiments with three plate types respectively,examining whether the direction into board is appropriate, as well as itsfirmness and operability.Part II Dogs flail chest with the production model and experimental studyof ribs fixed under the VATS. Fifteen healthy mongrel dogs were divided intoGroup A (5dogs for control treatment), Group B (3for operation externalfixation)and(5dogs for fixation during the operation). Establish a large area(15cm2/kg) floating chest wall model. Monitor and observe the changes of thedogs' respiratory rate (RR), arterial oxygen tension (PaO2), arterial carbondioxide tension (PaCO2), arterial oxygen saturation (SaO2), heart rate (HR),etc. by way of blood gas analysis and ECG. Compare the effects as well asoperabilities among conservative treatment, conventional external fixation andinternal surgical fixation.Results:Part I1.Fixed screw with contact plate and fixation devices. Advantages:ribs can be strongly fixed by them and won't fall off easily after fixation.Disadvantages: The thoracoscopic operability is not very good. The screwsmay fall off easily after put into the chest. It is inadequate to use universalpunch to fix screws without difficulty.2. wrap around of the contact plate and its fixing equipments. Advantages:the access to the chest is easy and favorable, so is the operability. into thechest smoothly. Disadvantages: it is difficult to fix, and may fall off easilyafter fixation, besides, it can not grasp the plate well.3."Titanium clamp" fixed-type contact plate and its fixation devices.Advantages: it is easy to enter the chest, convenient to operate, and stable tofix. It won't fall off easily while using grasping tools to put the equipmentsinto the chest and fix them. Disadvantages: the fixations on the ribs of anteriorchest wall and posterior chest wall are fairly good, but the ones on those oflateral of chest wall have a certain degree of difficulty. It is not easy to adjustthe direction and the fixation is not very strong. After comparing and summarizing the three types of blade plates, we canconclude that the third type, that is, the combination of "Titanium clamp"fixed-type contact plate and its fixation devices., is not only reasonable butalso easy to operate.Part II1. After the flail chest with anterior wall model was completed,abnormal breathing appeared. An hour later,The RR was33±2.5bp/minandHR was121±9.9bp/min, with a significant increase (P<0.01).Pa02was6.96±0.41kPa, with a decrease (P<0.05). PaC02was4.10±0.35kPa, Sa02was83.8±1.8%, with a significant decrease (P<0.01).2. Three hours later,And A group of comparison, HR group B (P<0.01),PaO2, PaCO2SaO2, there were no statistically significant, RR (P>0.05);And Agroup of comparison, PaO2,PaCO2, SaO2in group C significantly increased(P<0.01), RR significantly reduce (P<0.01), HR was statistically significant(P>0.1).And B group of comparison,PaO2,PaCO2, SaO2in group Csignificantly increased (P<0.01), RR significantly reduce (P<0.01), HR wasstatistically significant (P>0.1).3. The rib fixation surgery was completed well by blade plate, and theinternal fixation was firmly doneConclusion:1. The model of "Titanium clamp" fixed-type contact plate and itsfixation devices as well as its fixation equipments is feasible during theapplication of the three types of rib blade plates and their equipments.2.Thoracoscopic flail chest fixation has more advantages thanconservative treatment and conventional surgical fixation in that, theintraoperative and postoperative vital signs change less significantly, smalltrauma to the body and the postoperative recovery is quicker, too.3. Thoracoscopic rib plate adjuvant treatment of multiple rib fractures isminimally invasive, stable to fix, and convenient to operate. Thus, it is anideal method of treating multiple rib fractures. |
PDF Full Text Request