Comparative Study Of Postoperative Pain Between Focal-point Internal Fixation Guided By VATS And Continuous Internal Fixation In The Treatment Of Rib Fracture

Background and objectiveCompared with conventional thoracotomy,VATS has the advantages of less trauma and quicker recovery,which has been widely used in the diagnosis and treatment of various types of benign diseases,the diagnosis of breast malignant diseases and palliative care,and relatively simple injury treatment.With the introduction of FTS,the management and fast rehabilitation of trauma patients have also been included in the scope of the key research.The main contents of FTS include fast-track anesthesia,the best analgesic techniques and effective postoperative nursing.Minimally invasive surgical technique is also included.Minimally invasive surgical technique is applied in VATS and can reduce the damage of trauma patients in the secondary surgery.And the best analgesia technique is based on a patient's pain assessment and management.In the past,a lot of literatures reported the video-assisted thoracic technology on multiple fractured ribs and hemopneumothorax processing applications,but for VATS under multiple fractured ribs and hemopneumothorax pain contrast study is relatively rare.The purpose of this study was to compare the postoperative pain of multiple rib fractures guided by video assisted thoracic surgery(VATS)with multiple rib fractures and internal fixation with single incision.Material and MethodsWe adopted the method of retrospective study and collected the materials about the treatment for conditions of 52 cases of multiple fractured ribs and hemopneumothorax patients from the third military medical university hospital and friendly hospital from September 2013 to July 2016.All patients were treated with internal fixation of rib fracture,and the pain was compared and analyzed.We randomly divided the patients into an experimental group and a control group,and there are 26 cases in each group.The experimental group were treated with the focal-point internal fixation guided by VATS,while the control group used single incision continuous internal fixation.Besides,there is a comparison between the two group as for the main index of incision length,extent and duration of pain,time and dosage,analgesic drug use under the function of exercise time,while comparing the operation time,intraoperative blood loss,complications(pulmonary infection atelectasis),incidence of ventilator cases and time,chest tube and drainage,the number of fixers used and other related indexes.Result52 cases of patients were discharged smoothly.VATS can help make incisions smaller.The length of the small incision in the key internal fixation group was 9.0±2.0 cm.The single incision could be controlled within 3 cm.As for single incisions,the incision in the continuous internal fixation group was 16.1±2.4 cm long.The operation could be finished within 64.4±8.8 minutes,while the control group needed more time(78.7±10.7 minutes).In the experimental group,the blood loss was 96.5±30.6 ml,but that of the control group was 78.7±10.7 ml.The number of the used holders was 3.1±0.7,while that of holders in the control group was 4.7±0.8.The index between the two groups is below 0.01,which is statistically significant.Between the two groups the incidence of lung infection,atelectasis and breathing machine's utilization rate is very low.The index between the two groups is above 0.05,no statistical significance.The patients in the experimental group must stay in bed for 1.9±0.7 days,while the control group need another 2 days.The volume of the closed thoracic drainage respectively is 137.7±64.0 ml and 217.1±81.4 ml.The ratio between the two groups was below 0.01,with statistical significance.The duration of chest tube drainage was 1.9±0.7 days and 2.2±0.9 days.The ratio between the two groups was above 0.05,no statistical difference.After the operation,the experimental group and the control group Pethidine dosage is 10.6 mg ±20.2,78.8±51.3 mg respectively,times were 0.3 ±0.75,2 ±1,P<0.01.According to the comparison between two groups of patients,the difference was statistically significant.During the first 6 days after the operation,pain score(NRS)between two groups were obviously different.The ratio is 0.01 or less.Besides,modified version of facial pain scale(FPS)were significantly different,P< 0.05.Thus we can draw a conclusion that the experimental group were significantly lower than the control group in the following aspects----the key comparison of internal fixation incision length,operative time,blood loss,the number of used holders,the degree of pain,frequency of used analgesic drug and dosage,ambulation time,drainage volume.There was statistical significance(p<0.01).The number of rib fracture,complication rate,frequency and time of ventilators used,duration of chest tube drainage in the experimental group had no difference compared with the control.ConclusionThe key internal fixation of multiple small incisions in the location of the fracture of the rib under the guidance of VATS has the following advantages: small trauma,a little pain,rapid recovery and so on.It accords with modern surgical rapid rehabilitation concept.At the same time,it can also avoid serious secondary surgery injury and make the wounds look beautiful.Thus,the technique is worthy of further promotion in the clinical practice.