Comparison Of 60 Multiple Fractured Ribs Patients Treate With Surgical And Non-surgical Treatment

Objective:To study the manifestations of multiple rib fractures, to further clear preoperative diagnosis, assessment of disease prognosis and guide clinical treatment. And comparing the curative effect of surgical with non-surgical treatment for fractures. According to the different performance to assess the advantage and disadvantage of operative treatment and traditional therapy,whether deserve the clinical expansion. Methods:Retrospective analysis 60 cases of multiple rib fractures clinical data from August 2011 to September 2013 in(general thoracic surgery of) our hospital, 41 males and 19 females with an average age of 50.6+10.0 years(16~55 years) and hospitalization time of 21.7+6.8 days(10~35 days). Among them 23 cases derived from traffic accident, 7 cases came from crash of heavy object, 23 cases sustained falls, 5 cases of falling from high altitude, fight and machine extrusion injury were 1case. By preoperative X-ray, CT and 3D(three dimensional reconstruction) of all the 60 examples images, multiple and severe displacement of rib fractures, left rib fractures for 34 cases, right for 31 cases, bilateral for 5 cases. And all merges different degree of lung bruises. As possible to meet the needs of comparison, cases required: ?More than at least 3 rib fractures of 3D reconstruction of Chest, non-significant open fracture; ?No obvious hemothorax caused by pulmonary contusion or other special treatment of the associated injury; ?To exclude eld patients who over 70 years; ④Have clear consciousness and independent expectoration; ⑤Without thoraco-abdominal injuries, intracranial hemorrhage, humeral fracture or other operation and diagnosis treatment about associated department, neither continue therapy at a local hospital. According to the causes, clinical symptoms, signs and image performance, preoperative diagnosis was assured as multiple rib fractures. In the process, informed patients and their families about various therapeutic schemes with its advantages and disadvantages, fully respected their choose of treatment method and selected the patients according to the above set standards. Among them, treatment of multiple fractured ribs by Ti-Ni shape memory alloy embracing fixator(Ti-Ni Embracing Compressive Connector, Lan zhou Seemine SMA Co.,Ltd) in 30 cases which were randomly selected as the study group. 30 cases in control group received routine treatment that took compressive external fixation with the chest bandage or the adoption of chest backplate external fixation in recent years. Meanwhile, anti-inflammation, sputum excretion, analgesic and intensive care of respiratory tract. The operation used combined or general anesthesia. According to the 3D, preoperative marked the shape of fracture site and selected proper incision. To avoid injury of intercostal nerves and vascular while free periosteum from broken ends of fractured bones. Then, picked the suitable Ti-Ni alloys, moulding and installation. By intuitive understanding of the multiple fractures to get further corresponding with 3D image. Evaluation and comparison of two groups about the illness mainly based on the following aspects: hospitalization time, Visual Analogue Scale(VAS), the time of active out of bed, hospitalization expenses, degree of thracoplasty and pulmonary ventilatory function. Visual Analogue Scale(VAS) scores were used: 0 points: no ache; 3 points or less: mild ache that can endure; 4~6 points: obvious ache and influence sleep but still can endure; 7~10 points: Gradually strong pain, cannt tolerate, influence or appetite and sleep. Preoperative VAS score recorded by the day before surgery, postoperative score was the average value of self assessment, recorded at the sixth day after the operative day. Compared the decreasing degree of the two groups’ VAS score. The criteria for the treatment of rib fractures: Excellent: chest-wall with no pain, normal respiration, ribs anatomical reduction by radiological examination, symmetry in bilateral thoracic; Good: non-anatomical reduction compared with the excellent parameters, displacement within 2 mm, basic symmetry in bilateral thoracic; Fair: slight pain of chest-wall, poor reduction of few ribs by imaging examinations, but displacement within 3mm, thoracic slightly collapse or asymmetry; Poor: obviously pain of chest-wall, displacement above 3mm. All date analysis using SPSS 13.0 software, measurement data to mean + standard( ±CS)deviation, comparison between groups using matching test. Comparison between enumeration data using c 2 test and rank sum test. Comparison of two groups is based on 5 clinical parameters: hospitalization time, decreasing degree of postoperative pain, the time of active out of bed, pulmonary function and reexamination the reduction effect of ribs fractured after one month. The difference was statistical significant( P<0.05). Results:The group of 60 patients were followed up for 1~2 months by reexamining chest X-ray of the reductive situations in our hospital. For further comparison of the therapeutic effects about operative and non-operative treatment. Found that according to the comparison of hospitalization time, decreasing degree of postoperative pain and the time of active out of bed, the observation group were much better than the control group. But as to the hospitalization expenses, the observation group was significantly higher. There was significant difference between the two groups. Patients, both the two groups had their pulmonary function test when admission, at the same time on the seventh day after operative of the observation group and the traditional therapy of the control group retested the pulmonary function by the indexes of maximal voluntary ventilation(MVV) and forced expiratory volume in one second/forced vital capacity%( FEV1.0/FVC%). There was no significant difference between the two groups on admission. 7 days after the treatment retest: the observation group obvious better than the control group in recovery of MVV, but no obvious change in FEV1.0/FVC% to consider that lung restrictive ventilation caused by trauma had no effect on it. There was significant difference between the two groups. Observation of healing condition of ribs fractured and thoracic shape by out-patient service. There was significant difference between the two groups. ConclusionsThrough the comparison of the patients and postoperative followed-up, it makes us further comprehensively understanding of the clinical characteristic on multiple rib fractures. Under operation has clear and overall view, directly faced the fracture position to deal with fractures. Rib surgery can be targeted to treatment, surgical cure results was satisfied, and the effect of reduction good. Overall, the operative group were more satisfied in terms of hospitalization time, decreased of pain index and satisfaction degree of therapy, but the expenses was higher. It can be said that operative reduction and internal fixation has important application value for the treatment.