Objective Summarize and analyze surgical treatment experience and clinical application value for severe chest trauma with multiple rib fractures (which has a positive rate of occurrence),the treatment method is to surgically fix titanium plate to ribs at the early stage of the fractures.Methods Adopted 161 severe chest trauma cases require thoracotomy from June,2007 to June,2012.The patients were arranged as two groups according to the doctor's requirements by our fulltiem horses.79 cases of normal thoracotomy operations were recorded as control group ; at the same period 82 cases thoracotomy operation with ribs internally fixed treatment were recorded as the group of internal plate fixing treatment group.Then compare the results of postoperative paradoxical respiration,oxygen concentration,lung function,chest drainage,length of stay and others after operations.Results The treatment results include oxygen saturation of blood,lung function,and length of stay,the complication rate and death rate.The results of ribs intemafly fixed group are better than the control group on average.Conclusion Apply internal plate fixing operation to ribs during the thoracotomy will effectively control thoracic paradoxical respiration and prevent respiratory failure,improve lung function,reduce death rate of chest trauma and the complication and be helpful for rapid recovery.

Objective To evaluate the efficacy and safety of using double thin tube drainage after single-port thoraco-scopic pulmonary bullae resection in the treatment of primary spontaneous pneumothorax ( PSP) in teenager.Methods From January 2015 to January 2018, 81 PSP teenage patients were prospectively enrolled and randomly divided into two groups ac-cording to the different indwelling drainage tubes.One group was drained by double thin tube( 6F, 16F )(41 cases) and the other group was drained by single 28F thick tube(40 cases).The postoperative recovery and pain scores and other indicators of the two groups were compared.Results The time of keeping drainage tube, length of hospital stay, poor healing of incision and the number of second puncture cases, rest and movement pain scores within 5 days in the double thin tube drainage group were all better than those in the single thick tube group, the difference was statistically significant(P<0.05).Conclusion Double thin tube drainage after single-port thoracoscopic pulmonary bullae resection in teenage PSP patients is more helpful to relieve postoperative pain than single thick tube drainage , and is more conducive for enhanced recovery after surgery .

Objective: To evaluate the analgesic effect of a new combined analgesic mode in the early stage of non-operative treatment of adult traumatic rib fractures. Methods: A total of 93 patients with rib fractures who did not receive surgical treatment from January 2014 to January 2018 were prospectively included, and randomly divided into the traditional analgesia group, subcutaneous analgesia group and combined analgesia group(31 cases each). There were 56 males and 37 females totally with a median age of(47.3±13.2)years. All patients have moderate to severe pain with VAS scores greater than 5. Traditional analgesia group: lornoxicam 8 mg intravenous injection twice daily. Subcutaneous analgesia group: only subcutaneous self-controlled analgesia pump was used for treatment. Combined analgesia group: on the basis of the traditional analgesia group, subcutaneous self-controlled analgesia pump was added for treatment, and the dosage of the pump drug was the same as that of subcutaneous analgesia group. The VAS scores at tranquillization and cough were compared before analgesia treatment(T1), 24 h(T2), 48 h(T3) and 72 h(T4) after analgesic treatment in each group during bed brake within 3 days after injury. The VAS scores after 78 hours of analgesic treatment during ambulation were compared. When sudden pain with VAS score greater than 7 occurred within 72 hours of bed staying treatment in each group, the average daily use times of bucinnazine hydrochloride 100mg remedial analgesia were compared. The number of adverse reactions such as nausea and pneumonia in each group was compared. Results: The VAS scores of resting pain and cough pain at the observation time point(T2-T4) in the combined analgesia group were better than those in the subcutaneous analgesia group and the traditional analgesia group, showing a significant difference(P<0.05). When getting out of bed, there were significant differences in pain scores among the three groups, and the pain score of the combined analgesia group was the lowest. There was a significant difference among the three groups in the number of daily additions of bucinnazine hydrochloride during remedial analgesia(P<0.05), the combined analgesia group was the least. Between the two groups of patients using analgesic pump, the number of self-compressions in the combined analgesia group was lower than that in the subcutaneous analgesia group(P<0.05). The incidence of pneumonia in the combined analgesia group was lower than that in the other two groups and the incidence of other adverse reactions such as nausea was lower than that in the simple analgesia group. Conclusion In the early stage of non-operative treatment of traumatic rib fractures in adults, the multi-mode analgesic effect of traditional intravenous intermittent administration combined with subcutaneous continuous administration is superior to the single analgesic mode of traditional intravenous or subcutaneous administration with no obvious adverse reactions.