Comparison on clinical effects of operative versus non-operative treatment for traumatic flail chest combined with sternal fracture
10.3760/cma.j.issn.1001-8050.2015.03.010
- VernacularTitle:手术与非手术治疗创伤性连枷胸合并胸骨骨折的疗效比较
- Author:
Yu CHEN
;
Qing ZHAO
;
Yun SHI
;
Xiaobo CHEN
;
Kun ZHU
- Publication Type:Journal Article
- Keywords:
Flail chest;
Fracture fixation,internal;
Treatment outcome
- From:
Chinese Journal of Trauma
2015;31(3):224-227
- CountryChina
- Language:Chinese
-
Abstract:
Objective To compare the efficacy of internal fixation with non-operative treatment of traumatic flail chest combined with sternal fracture.Methods A retrospective review was made on 102 patients with traumatic flail chest combined with sternal fracture treated from January 2007 to January 2014.There were 71 patients in operation group and 31 patients in non-operation group.Operation group was allocated to pure titanium rib plating (Group Ⅰ,22 cases),porous titanium screw fixation (Group Ⅱ,20 cases),and nickel-titanium memory alloy sternal rib plating (Group Ⅲ,29 cases).Rib traction was performed in non-operation group.Clinical results and incidence of complications were compared between the two groups.Results At 24 and 72 hours,operation group was superior over non-operation group with regard to HR [(100.4 ± 9.5) times/min vs (105.2 ± 10.1) times/min,(92.1 ± 9.9) times/min vs (102.1 ± 9.2) times/min],MAP [(97.7 ± 14.5) mmHg vs (91.0 ± 13.3) mmHg,(112.5 ± 15.2) mmHg vs (93.1 ± 13.8)mmHg] and CVP [(7.8 ±3.7)cmH2O vs (9.4 ±3.8)cmH2O,(6.2 ±2.9)cmH2O vs (9.1 ±3.2) cmH2 O] (P ＜ 0.05).Duration in ICU [(5.1 ± 0.8) days vs (9.3 ± 1.1) days],ventilation time [(4.5 ±1.0)days vs (8.2 ± 1.4)days],hospitalization time [(14.6 ±3.5)days vs (23.3 ±4.4)days] and incidence of complications were significantly lower in operation group than in non-operation group (P ＜ 0.05).Two months after discharge,tidal volume (VT) [(0.52 ±0.04)L vs (0.40 ±0.03)L],inspiratory capacity (IC)[(1.99 ±0.45)L vs (1.22 ±±0.33)L],forced vital capacity (FVC) [(3.52 ±0.51)L vs (2.44 ±0.42)L],total lung capacity (TLC) [(5.41 ±0.82)L vs (3.72 ±0.56)L] and forced expiratory volume in one second (FEV1) [(2.80 ± 0.43) L vs (1.95 ± 0.50) L] showed significantly better results in operation group than in non-operation group (P ＜ 0.05).Operation time,intraoperative bleeding and daily drainage volume were (38.8 ±9.2)min,(43.5 ±7.6)ml and (10.9 ± 1.1)ml in Group Ⅱ versus (62.5 ± 10.1)min,(100.0 ± 10.5) ml and (26.8 ±3.1)ml in Group Ⅰ and (49.3 ±9.6)min,(61.4 ±8.3)min and (19.8 ±1.6)ml in Group Ⅲ (P ＜ 0.01).Conclusion For traumatic flail chest combined with sternal fracture,the internal fixation should be done as early as possible so as to reduce incidence of complications.Relatively,porous titanium screw fixation has better clinical outcome.
