Efficacy and Safety of Internal Rib Fixation for Multiple Rib Fractures: A Randomized Controlled Trial_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANGLi , Barbie , KANGDi , Elham ,  DUPing

Department of Thoracic Surgery, Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi 830002, Xinjiang, P. R. China;

Corresponding?author：

DUPing, Email: goldw@126.com

Keywords：

Multiple rib fracture; Internal fixation surgery; C-reactive protein; Efficacy; Safety

DOI：

10.7507/1007-4848.20140066

Video：

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Objective To investigate the efficacy and safety of internal rib fixation for patients with multiple rib fractures. Methods A total of 141 patients with multiple rib fractures who were admitted to Department of Thoracic Surgery of the Sixth Affiliated Hospital of Xinjiang Medical University between January 2010 and January 2013 and whose chest trauma score (AIS-ISS) was 9-20 (16±2) were recruited in this study. Using the random number generator of SPSS, all the patients were randomly divided into an internal fixation group [69 patients including 41 males and 28 females with their age of 25-61 (37±4) years] who underwent internal rib fixation, and a control group [72 patients including 43 males and 29 females with their age of 24-63 (35±5) years] who received conservative therapy. Plasma C-reactive protein (CRP) patients' satisfaction degree with thoracic appearance,incidence of lung infection,pain-relieving efficacy,postoperative chest drainage duration and length of hospital stay were compared between the 2 groups. Results Plasma CRP levels of the internal fixation group were not statistically different from those of the control group in 1-3 days after injury (P>0.05) but were significantly lower than those of the control group in 4-12 days after injury (P<0.05). Patients' satisfaction degree with thoracic appearance (97.1% vs. 48.6%,P<0.05) and pain-relieving efficiency (91.3% vs. 68.1%,P<0.05) of the internal fixation group were significantly higher than those of the control group. Incidence of lung infection of the internal fixation group was significantly lower than that of the control group(11.6% vs. 37.5%,P<0.01). Postoperative chest drainage duration [(3±2) d vs. (7±4) d,P<0.05] and length of hospital stay [(9±4) d vs. (15±7) d,P<0.05] of the internal fixation group were significantly shorter than those of the control group. Conclusions For patients with multiple rib fractures and stable vital signs,internal fixation surgery is helpful to shorten length of hospital stay, relieve chest pain and improve thoracic appearance. It can also reduce lung inflammation and increase surgical safety so as to improve treatment outcomes of multiple rib fractures.

Citation： WANGLi, Barbie, KANGDi, Elham, DUPing. Efficacy and Safety of Internal Rib Fixation for Multiple Rib Fractures: A Randomized Controlled Trial. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2014, 21(2): 228-232. doi: 10.7507/1007-4848.20140066 Copy

1.	?王立,張淼,賁曉松,等.對多發性肋骨骨折行經胸腔鏡探查+內固定手術的探討.實用醫學雜志,2013,29 (10):1714-1715.
2.	張業強,胡濤,高小見,等.爪形肋骨接骨板在多發性肋骨骨折內固定手術中的應用.中國胸心血管外科臨床雜志,2012,19 (5):533.
3.	吳圣賢,蔣良鐸,王建云.益氣解毒活血法對動脈粥樣硬化進程中高敏C反應蛋白及相關促炎因子的影響.北京中醫藥大學學報,2011,9 (34):627-631.
4.	郁秀莉,何元兵,夏宇,等.血清降鈣素原及C反應蛋白在社區獲得性肺炎和肺結核中的診斷價值.中國呼吸與危重監護雜志,2013,12 (2):190-193.
5.	Bottlang M,Helzel I,Long WB,et al.Anatomically contoured plates for fixation of rib fractures.J Trauma,2010,68 (3):611-615.
6.	王洪斌,張明,劉海林,等.微創小切口肋骨內固定術治療多根多處肋骨骨折及連枷胸.中國胸心血管外科臨床雜志,2012,19 (4):449-450.
7.	Nirula R,Diazz JJ Jr,Trunkey DD,et al.Rib fracture repair:indications,technical issues,and future directions.World J Surg,2009,33:14-22.
8.	楊仁榮,曹金林,鄭海燕,等.損傷控制外科新理念在肺創傷急救中的臨床應用.中國胸心血管外科臨床雜志,2012,19 (1):98-100.
9.	Mayberry JC,Kroeker AD,Ham LB,et al.Long-termmorbidity,pain,and disability after repair of severe chest wall injuries.Am Surg,2009,75 (5):389-394.
10.	王立,邊拜,康迪.無痛支氣管灌洗在創傷性肺不張的應用.中華創傷雜志,2010,26 (4):342-343.
11.	陸善偉,鐘肱,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.
12.	Lotfipour S,Kaku SK,Vaca FE,et al.Factors associated with complications in older adults with isolated blunt chest trauma.West J Emerg Med,2009,10 (2):79-84.
13.	李春光,陳和忠,李志剛,等.膨體聚四氟乙烯補片在胸壁重建中的應用.中國胸心血管外科臨床雜志,2012,19 (3):248-250.
14.	韋春暉,譚勇明,鄧濱,等.應用可吸收肋骨固定釘治療多根多段肋骨骨折20例報告.中國微創外科雜志,2010,10 (6):551-553.
15.	范興龍,李冬德,艾合買江,等.多根多段肋骨骨折的外科治療經驗.中國胸心血管外科臨床雜志,2012,19 (2):219.

1. ?王立,張淼,賁曉松,等.對多發性肋骨骨折行經胸腔鏡探查+內固定手術的探討.實用醫學雜志,2013,29 (10):1714-1715.
2. 張業強,胡濤,高小見,等.爪形肋骨接骨板在多發性肋骨骨折內固定手術中的應用.中國胸心血管外科臨床雜志,2012,19 (5):533.
3. 吳圣賢,蔣良鐸,王建云.益氣解毒活血法對動脈粥樣硬化進程中高敏C反應蛋白及相關促炎因子的影響.北京中醫藥大學學報,2011,9 (34):627-631.
4. 郁秀莉,何元兵,夏宇,等.血清降鈣素原及C反應蛋白在社區獲得性肺炎和肺結核中的診斷價值.中國呼吸與危重監護雜志,2013,12 (2):190-193.
5. Bottlang M,Helzel I,Long WB,et al.Anatomically contoured plates for fixation of rib fractures.J Trauma,2010,68 (3):611-615.
6. 王洪斌,張明,劉海林,等.微創小切口肋骨內固定術治療多根多處肋骨骨折及連枷胸.中國胸心血管外科臨床雜志,2012,19 (4):449-450.
7. Nirula R,Diazz JJ Jr,Trunkey DD,et al.Rib fracture repair:indications,technical issues,and future directions.World J Surg,2009,33:14-22.
8. 楊仁榮,曹金林,鄭海燕,等.損傷控制外科新理念在肺創傷急救中的臨床應用.中國胸心血管外科臨床雜志,2012,19 (1):98-100.
9. Mayberry JC,Kroeker AD,Ham LB,et al.Long-termmorbidity,pain,and disability after repair of severe chest wall injuries.Am Surg,2009,75 (5):389-394.
10. 王立,邊拜,康迪.無痛支氣管灌洗在創傷性肺不張的應用.中華創傷雜志,2010,26 (4):342-343.
11. 陸善偉,鐘肱,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.
12. Lotfipour S,Kaku SK,Vaca FE,et al.Factors associated with complications in older adults with isolated blunt chest trauma.West J Emerg Med,2009,10 (2):79-84.
13. 李春光,陳和忠,李志剛,等.膨體聚四氟乙烯補片在胸壁重建中的應用.中國胸心血管外科臨床雜志,2012,19 (3):248-250.
14. 韋春暉,譚勇明,鄧濱,等.應用可吸收肋骨固定釘治療多根多段肋骨骨折20例報告.中國微創外科雜志,2010,10 (6):551-553.
15. 范興龍,李冬德,艾合買江,等.多根多段肋骨骨折的外科治療經驗.中國胸心血管外科臨床雜志,2012,19 (2):219.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Efficacy and Safety of Internal Rib Fixation for Multiple Rib Fractures: A Randomized Controlled Trial

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