The Study On The Effect Of Binding Intercostal Vessels And Nerve In Video-assisted Thoracoscope Surgery Rib Fracture Fixation Surgery

Objective: Video-assisted Thoracoscope Surgery(VATS)in the thoracic surgery is widely applied in various fields.In recent years,VATS rib fracture fixation surgery is becoming a hot topic of treatment of severe chest trauma.It is the key of the surgery to open and align the fracture and then place the fixation materials firmly in narrow space.At present,the most commonly used method is to apply absorbable threads to bind the bilateral broken ends of the fractured ribs,to conduct traction counterpoint,which does not take up surgery space and makes fracture fixation materials be placed more quickly and conveniently.Then weave and bind fractured ribs to make them fixed more firmly.In the process of rib binding,it is inconclusive whether intercostal vessels and nevus can bind ribs or not.The study explores what effects the intercostal vessels and nevus bind ribs together have through comparing intercostal vessels and nevus bind ribs together(binding group)with just binding ribs after detaching intercostal vessels and nevus(detaching group)to analysis perioperative period and follow-up data by statistics.And make sure which method is more suitable for surgery.Methods:Single center randomized controlled prospective study.From August 2013 to October 2016,64 chest trauma patients,whose ages range from25-60,were admitted to thoracic surgery ward.The patients who suffer from Multiple rib fractures-Flail chest or Rib fracture with severe laceration of lung and Activity hemothorax etc.need to be underwent VATS exploration to exclude severe injuries to the head,abdomen,heart and spine,coagulation defects and organs failure and so on.The chosen patients were randomly divided into 2 treatment groups according to hospitalized sequence.The intercostal vessels and nevus bind ribs together(binding group)as well as just binding ribs after detaching intercostal vessels and nevus(detaching group).Both groups were given conventional treatments,namely Oxygen inhalation,Airway humidification,Anti infection,Fluid infusion,support and other comprehensive treatments.The general characteristics of the two groups were statistically analyzed including age,sex,height,weight,the number of rib fractures,thoracic complicated injuries etc.Statistical analysis of the related data in the two patients groups contain hemorrhage volume during surgery,average fixation time for single rib,incision length,amount of postoperative drainage,drainage tube exelcymosis time,the removal time of drainage tube,pain time more than 6mins,postoperative analgesic dose and the length of hospital stay and follow-up patients after surgery for 3weeks,5weeks and 3months for pain score,fracture healing and changes of pulmonary function.Result: There was no significant difference between the two groups in general characteristics.The binding group is in short operation time and small incision.There is no difference in hemorrhage volume during surgery,amount of postoperative drainage,drainage tube exelcymosis time,more than 6mins' pain time,postoperative analgesic dose and the length of hospital stay as well as in pain score,fracture healing and changes of pulmonary function.Conclusion: The intercostal vessels and nerve bind ribs together in VATS,which does not lead postoperative pain and complication increased.Compared with only binding ribs after striping intercostal vessels and nerve.It can shorten operation time,make incision smaller,and be suitable for surgery.