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改良肋骨内固定手术治疗前支肋骨骨折

目的 探索胸部损伤浮动胸壁中前支肋骨骨折内固定的有效方法。 方法 回顾性分析2007 年1 月至2009 年12 月广元市中心医院43 例多发性前支肋骨骨折患者采用形状记忆环抱接骨板内固定治疗的临床资料，根据手术方式不同，将43 例分为两组，常规手术组：18 例，其中男16 例，女2 例；年龄（38.5±3.8）岁，采用常规手术方法行肋骨内固定术；改良手术组：25 例，其中男21 例，女4 例；年龄（36.4±5.6）岁；采用改良手术方法行肋骨内固定术。对两种手术方法的难易程度、手术时间和术后效果进行比较。 结果 围术期无死亡，术后两组患者胸廓形状均恢复正常，反常呼吸消失，呼吸困难显著改善，肋骨骨折均达到解剖复位。术后无肺部、胸腔、切口感染和肺不张等并发症发生。改良手术组手术时间[（74.80±9.41） min vs.（91.94±17.42） min，P=0.006] 和术中出血量[（34.20±14.70） ml vs.（83.33±20.72） ml, P=0.000）] 明显短于或少于常规手术组。随访28 例（改良手术组17 例、常规手术组11 例），随访时间1 个月～ 1 年，失访15 例。随访期间两组患者肋骨骨折均愈合，无胸廓畸形和呼吸功能受损，亦未见记忆环抱接骨板脱落、断裂和移位。患者恢复正常生活或工作。 结论 前支肋骨骨折内固定的改良手术操作简单、方便、创伤小、出血少和临床效果好，值得临床推广应用。

不同内径胸腔引流管行胸腔引流的效果比较

Short-term efficacy of improved Bentall operation with "pericardial lining" for aortic root aneurysm

Objective To investigate the feasibility of a "pericardial lining" modified Bentall procedure for the treatment of patients with aortic root aneurysm. MethodsThis was a retrospective study that consecutively enrolled patients treated at the Affiliated Suzhou Hospital of Nanjing Medical University, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, and the First People's Hospital of Guangyuan from January 2023 to February 2024. Preoperative clinical data, imaging findings (including echocardiography and CT scans of the aortic root and the entire aorta), details of coronary artery management, surgical outcomes, and postoperative follow-up results were collected. All patients underwent the "pericardial lining" modified Bentall procedure: the aortic valve was replaced, and an autologous pericardial patch was divided into three equal leaflets based on the circumference of the aortic annulus measured by a valve sizer. These leaflets were then sutured to the aortic annulus. Fenestrations were created in two of the pericardial leaflets for anastomosis with the left and right coronary ostia. The pericardial leaflets were sutured to the wall of the aortic sinuses to form an integrated structure, thereby narrowing the sinus portion. A prosthetic vascular graft was anastomosed to the proximal and distal aorta, and no aortic root-to-right atrium shunt was created. Results A total of 5 patients, aged 37 to 68 years, were included. The preoperative Society of Thoracic Surgeons (STS) risk scores ranged from 2.8% to 3.9%. The diameter of the ascending aorta was 40-73 mm, the left ventricular end-diastolic diameter (LVEDD) was 45-71 mm, and the left ventricular ejection fraction (LVEF) was 47%-64%. Intraoperatively, the aortic cross-clamp time ranged from 85 to 180 min, and the cardiopulmonary bypass time ranged from 110 to 302 min. Postoperative follow-up echocardiography revealed that the ascending aortic diameter was 27-35 mm, LVEDD was 39-57 mm, and LVEF was 43%-61%. All surgeries were completed successfully with satisfactory immediate outcomes and no intraoperative complications. During the follow-up period, there was no mortality or reoperation. Conclusion For patients with aortic root aneurysm, the "pericardial lining" modified Bentall procedure yields satisfactory preliminary results, and the technique is demonstrated to be feasible.