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基于胸腔镜的复位内固定术治疗老年肋骨骨折患者的临床疗效研究

Clinical effect of thoracoscopy-based reduction and internal fixation in treatment of elderly patients with rib fracture

    摘要
  • 摘要:
    目的 探讨基于胸腔镜的复位内固定术对老年肋骨骨折患者康复进程以及功能恢复的影响。
    方法 选取收治的85例老年肋骨骨折患者为研究对象，按照不同治疗方案分为对照组(n=41, 开胸内固定手术)和观察组(n=44, 基于胸腔镜的复位内固定手术)。比较2组手术指标(血氧饱和度恢复时间、呼吸频率恢复时间、机械通气时间、住院时间和骨骼愈合时间)、疼痛评分、肺功能指标第1秒用力呼气容积(FEV1)、用力肺活量(FVC)和最大呼气峰流速(PEF)、血气指标动脉血氧分压pa(O2)、动脉血二氧化碳分压pa(CO2)、临床疗效及并发症发生率。
    结果 观察组的血氧饱和度恢复时间、呼吸频率恢复时间、胸腔引流管留置时间和住院时间及骨折愈合时间短于对照组，胸管引流量少于对照组，差异有统计学意义(P < 0.05)。术后7 d, 2组视觉模拟评分法(VAS)评分、pa(CO2)水平低于术前，且观察组低于对照组，差异有统计学意义(P < 0.05)。术后7 d, 2组FEV1、FVC、PEF、FEV1/FVC水平及pa(O2)水平高于术前，且观察组高于对照组，差异有统计学意义(P < 0.05)。观察组临床总有效率为93.18%, 高于对照组的78.05%, 差异有统计学意义(P < 0.05)。观察组并发症总发生率为4.55%, 低于对照组的19.51%, 差异有统计学意义(P < 0.05)。
    结论 基于胸腔镜的复位内固定手术治疗老年肋骨骨折患者的临床疗效显著，可有效缩短康复进程，缓解患者疼痛，促进其肺功能恢复，且安全性高。

     

    Abstract:
    Objective To investigate the effects of thoracoscopy-based reduction and internal fixation in the rehabilitation process and functional recovery of elderly patients with rib fracture.
    Methods Eighty-five elderly patients with rib fracture were selected as the study objects, and divided into control group (n=41, thoracotomy and internal fixation) and observation group (n=44, thoracoscopy-based reduction and internal fixation) according to different treatment plans. The surgical indexes (oxygensaturation recovery time, respiratory rate recovery time, mechanical ventilation time, hospital stay and bone healing time), pain scores, lung function indexesforced expiratory volume in one second (FEV1), forced vital capacity (FVC) and peak expiratory flow rate (PEF), blood gas indexes arterial partial pressure of oxygenpa(O2) and arterial partial pressure of carbon dioxide pa (CO2), clinical efficacy and complication rate were compared between the two groups.
    Results The blood oxygen saturation recovery time, respiratory rate recovery time, thoracic drainage tube indwelling time, hospital stay time and fracture healing time in the observation group were significantly shorter than those in the control group, and the chest tube drainage volume was significantly less than that in the control group (P < 0.05). At the 7 days after operation, visual analogue scale (VAS) score and pa (CO2) level in the two groups were significantly lower than before surgery, and the observation group was significantly lower than the control group (P < 0.05). At 7 days after surgery, the levels of FEV1, FVC, PEF, FEV1/FVC and pa(O2) in the two groups were significantly higher than before surgery, and the observation group was significantly higher than the control group (P < 0.05). The total effective rate of the observation group was 93.18%, which was significantly higher than 78.05% of the control group (P < 0.05). The incidence of complications in the observation group was 4.55%, which was significantly lower than 9.51% in the control group (P < 0.05).
    Conclusion Thoracoscopy-based reduction and internal fixation in treatment of elderly patients with rib fracture has significant clinical efficacy, which can effectively shorten the rehabilitation process, relieve the pain of patients, and promote the recovery of lung function, with high safety.

     

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