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.	潘铁成, 殷桂林, 主编.胸心外科急症和并发症.北京:人民卫生出版社, 2006.139.
3.	石应康.胸部创伤的诊断治疗进展.中华创伤杂志, 1998, 14 (2):65.
4.	陆善伟, 钟竑, 徐怀阳.电视胸腔镜联合形状记忆环抱接骨板治疗多发性肋骨骨折.中国胸心血管外科临床杂志, 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.	邓轩庚, 熊小明.多发肋骨骨折手术与非手术治疗对照研究.创伤外科杂志, 2011, 13 (2):127.
7.	吴伟敏, 张剑平, 姜敏炎, 等.肋骨爪的钢板内固定治疗外伤性浮动胸壁.中华胸心血管外科杂志, 2005, 21 (1):23.
8.	孔令文, 都定元, 谭远康, 等.损害控制在严重胸部创伤救治中的应用.创伤外科杂志, 2009, 11 (1):8-11.
9.	梁贵友, 牛义民, 刘达兴, 等连枷胸的机械通气治疗.中华创伤杂志, 2005, 21 (7):531-534.
10.	任明明, 孔繁义, 宋翔, 等.胸腔镜辅助爪形接骨板内固定手术治疗多发性肋骨骨折24例.中国胸心血管外科临床杂志, 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.	吕振业, 冯競, 邹宗望, 等.不剥离骨膜法可吸收肋骨钉内固定治疗多发性肋骨骨折的研究.现代实用医学, 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. 潘铁成, 殷桂林, 主编.胸心外科急症和并发症.北京:人民卫生出版社, 2006.139.
3. 石应康.胸部创伤的诊断治疗进展.中华创伤杂志, 1998, 14 (2):65.
4. 陆善伟, 钟竑, 徐怀阳.电视胸腔镜联合形状记忆环抱接骨板治疗多发性肋骨骨折.中国胸心血管外科临床杂志, 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. 邓轩庚, 熊小明.多发肋骨骨折手术与非手术治疗对照研究.创伤外科杂志, 2011, 13 (2):127.
7. 吴伟敏, 张剑平, 姜敏炎, 等.肋骨爪的钢板内固定治疗外伤性浮动胸壁.中华胸心血管外科杂志, 2005, 21 (1):23.
8. 孔令文, 都定元, 谭远康, 等.损害控制在严重胸部创伤救治中的应用.创伤外科杂志, 2009, 11 (1):8-11.
9. 梁贵友, 牛义民, 刘达兴, 等连枷胸的机械通气治疗.中华创伤杂志, 2005, 21 (7):531-534.
10. 任明明, 孔繁义, 宋翔, 等.胸腔镜辅助爪形接骨板内固定手术治疗多发性肋骨骨折24例.中国胸心血管外科临床杂志, 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. 吕振业, 冯競, 邹宗望, 等.不剥离骨膜法可吸收肋骨钉内固定治疗多发性肋骨骨折的研究.现代实用医学, 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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