Comparison between Video-assisted Thoracoscopic Surgery and Conventional Surgery for Multiple Rib Fractures_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

RENShou-yang ¹ , HUANGJian ¹ , ZHANGXiao-fei ¹ , CHENZu-yao ¹ , WANGYun ²

1. Department of Thoracic Surgery, Dujiangyan People's Hospital, Dujiangyan 611830, Sichuan, P. R. China;
2. Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding?author：

Keywords：

Rib fracture; Video-assisted thoracoscopic surgery; Internal fixation

DOI：

10.7507/1007-4848.20140010

Video：

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Objective To compare clinical outcomes between video-assisted thoracoscopic surgery (VATS) and conventional surgery for the treatment of multiple rib fractures. Methods A total of 173 consecutive patients with multiple rib fractures were admitted to Dujiangyan People's Hospital from January 2010 to December 2012. There were 122 males and 51 females with their age of 19-71 (41.3±7.1) years. According to different treatment strategies, all the patients were divided into 3 groups:conservative treatment group (83 patients with a mean of 4.9±1.3 fractured ribs, including 20 patients with flail chest), conventional surgery group (41 patients with a mean of 5.2±1.1 fractured ribs, including 11 patients with flail chest) and VATS group (49 patients with a mean of 5.3±1.5 fractured ribs, including 14 patients with flail chest). Length of hospital stay, duration of postoperative pain, incision length, operation time, chest drainage duration and morbidity were compared among the 3 groups. Results The incision length (5.2±1.5 cm vs. 8.5±2.3 cm, P=0.031), operation time (1.1±0.3 hours vs. 1.8±0.2 hours, P=0.003), chest drainage duration (0.3±0.0 day vs. 3.2±1.1 days, P=0.007) and length of hospital stay (13.7±1.5 days vs. 17.3±2.3 days, P=0.017) of VATS group were significantly shorter than those of the conventional surgery group. A total of 159 patients were followed up, and chest x-ray was examined at 1, 3 and 6 months after discharge. After 3 months, bone callus formation was evident around the rib fractures in chest x-ray in patients undergoing surgery, while bone union with deformity was shown in some patients of the conservative group. Conclusion With the development of various internal fixation materials, surgical internal fixation has become a trend for patients with multiple rib fractures, and VATS internal fixation is minimally invasive with satisfactory clinical outcomes.

Citation： RENShou-yang, HUANGJian, ZHANGXiao-fei, CHENZu-yao, WANGYun. Comparison between Video-assisted Thoracoscopic Surgery and Conventional Surgery for Multiple Rib Fractures. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2014, 21(1): 33-35. doi: 10.7507/1007-4848.20140010 Copy

1.	Nirula R, Diaz jj jr, Truntey DD, et al.Rib fracture repair.indications, technical issues, and future directions.World J Surg, 2009, 33 (1):14222.
2.	潘鐵成, 殷桂林, 主編.胸心外科急癥和并發癥.北京:人民衛生出版社, 2006.139.
3.	石應康.胸部創傷的診斷治療進展.中華創傷雜志, 1998, 14 (2):65.
4.	陸善偉, 鐘竑, 徐懷陽.電視胸腔鏡聯合形狀記憶環抱接骨板治療多發性肋骨骨折.中國胸心血管外科臨床雜志, 2012, 19 (2):210-212.
5.	Campbell N, Conaglen P, Martin K, et al.Surgical stabilization of rib fractures using Inion OTPS wraps--techniques and quality of Life follow-up.J Trauma, 2009, 67 (3):596-601.
6.	鄧軒庚, 熊小明.多發肋骨骨折手術與非手術治療對照研究.創傷外科雜志, 2011, 13 (2):127.
7.	吳偉敏, 張劍平, 姜敏炎, 等.肋骨爪的鋼板內固定治療外傷性浮動胸壁.中華胸心血管外科雜志, 2005, 21 (1):23.
8.	孔令文, 都定元, 譚遠康, 等.損害控制在嚴重胸部創傷救治中的應用.創傷外科雜志, 2009, 11 (1):8-11.
9.	梁貴友, 牛義民, 劉達興, 等連枷胸的機械通氣治療.中華創傷雜志, 2005, 21 (7):531-534.
10.	任明明, 孔繁義, 宋翔, 等.胸腔鏡輔助爪形接骨板內固定手術治療多發性肋骨骨折24例.中國胸心血管外科臨床雜志, 2012, 19 (5):574-575.
11.	Mohta M, Verma P, Saxena AK, et al.Prospective, randomized comparison of continuous thoracic epidural and thoracic paravertebral infusion in patients with unilateral multiple fractured ribs-a pilot study.J Trauma, 2009, 66 (4):1096-1101.
12.	呂振業, 馮競, 鄒宗望, 等.不剝離骨膜法可吸收肋骨釘內固定治療多發性肋骨骨折的研究.現代實用醫學, 2011, 23 (1):95-96.
13.	Voggemreiter G.Operative chest wall stabilization in flail chest-outcomes of patients with or without pulmonary contusion.J Am Coll Surg, 1998, 187 (2):130-138.
14.	Iwnsaki Y, Kawasaki S, Shinozaki M, et al.Surgial slabilization of multplc rib fraclure and flail chest.Kyobu Ceka, 2006, 59 (11):980-984.
15.	Marasco S, Cooper J, Pick A, et al.Pilot study of operative fixation of fractured ribs in patients with flail chest.ANZ J Surg, 2009, 79 (11):804-808.

1. Nirula R, Diaz jj jr, Truntey DD, et al.Rib fracture repair.indications, technical issues, and future directions.World J Surg, 2009, 33 (1):14222.
2. 潘鐵成, 殷桂林, 主編.胸心外科急癥和并發癥.北京:人民衛生出版社, 2006.139.
3. 石應康.胸部創傷的診斷治療進展.中華創傷雜志, 1998, 14 (2):65.
4. 陸善偉, 鐘竑, 徐懷陽.電視胸腔鏡聯合形狀記憶環抱接骨板治療多發性肋骨骨折.中國胸心血管外科臨床雜志, 2012, 19 (2):210-212.
5. Campbell N, Conaglen P, Martin K, et al.Surgical stabilization of rib fractures using Inion OTPS wraps--techniques and quality of Life follow-up.J Trauma, 2009, 67 (3):596-601.
6. 鄧軒庚, 熊小明.多發肋骨骨折手術與非手術治療對照研究.創傷外科雜志, 2011, 13 (2):127.
7. 吳偉敏, 張劍平, 姜敏炎, 等.肋骨爪的鋼板內固定治療外傷性浮動胸壁.中華胸心血管外科雜志, 2005, 21 (1):23.
8. 孔令文, 都定元, 譚遠康, 等.損害控制在嚴重胸部創傷救治中的應用.創傷外科雜志, 2009, 11 (1):8-11.
9. 梁貴友, 牛義民, 劉達興, 等連枷胸的機械通氣治療.中華創傷雜志, 2005, 21 (7):531-534.
10. 任明明, 孔繁義, 宋翔, 等.胸腔鏡輔助爪形接骨板內固定手術治療多發性肋骨骨折24例.中國胸心血管外科臨床雜志, 2012, 19 (5):574-575.
11. Mohta M, Verma P, Saxena AK, et al.Prospective, randomized comparison of continuous thoracic epidural and thoracic paravertebral infusion in patients with unilateral multiple fractured ribs-a pilot study.J Trauma, 2009, 66 (4):1096-1101.
12. 呂振業, 馮競, 鄒宗望, 等.不剝離骨膜法可吸收肋骨釘內固定治療多發性肋骨骨折的研究.現代實用醫學, 2011, 23 (1):95-96.
13. Voggemreiter G.Operative chest wall stabilization in flail chest-outcomes of patients with or without pulmonary contusion.J Am Coll Surg, 1998, 187 (2):130-138.
14. Iwnsaki Y, Kawasaki S, Shinozaki M, et al.Surgial slabilization of multplc rib fraclure and flail chest.Kyobu Ceka, 2006, 59 (11):980-984.
15. Marasco S, Cooper J, Pick A, et al.Pilot study of operative fixation of fractured ribs in patients with flail chest.ANZ J Surg, 2009, 79 (11):804-808.

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Comparison between Video-assisted Thoracoscopic Surgery and Conventional Surgery for Multiple Rib Fractures

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