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COMPARISON OF SEVERAL RIB RINGS WITH INTERCOSTAL MUSCLES FOR TRACHEAL REPLACEMENT IN DOGS

OBJECTIVE: To compare the effect of several types of rib rings with intercostal muscles for the replacement of trachea in thorax. METHODS: The surface layer of the third rib of dogs were ripped off and curved into triangular, quadrilateral and polygonal form. These three types of rib rings with intercostal muscles were used to replace a segment of trachea in thorax. RESULTS: The stability of triangular rib ring was very well, but stricture of ring were often happened because of its smaller internal diameter. These stability of quadrilateral rib ring was the worst. The polygonal rib ring presented the biggest diameter and good stability compared to the other two kinds of rings. If silicone tube was supplemented in the polygonal rib ring, the quality of artificial trachea was excellent. CONCLUSION: The rib rings with intercostal muscles are successfully used for replacing the defect of trachea in canine thorax. The polygonal rib rings have the best quality in the three types of rib ring for tracheal replacement.

可吸收髓内钉在多发性肋骨骨折内固定中的应用

【摘 要】 目的 回顾分析可吸收髓内钉在多发性肋骨骨折内固定中的应用方法、指征和疗效。 方法 2005 年9 月－ 2007 年2 月，使用可吸收髓内钉行内固定治疗16 例多发性肋骨骨折患者。男12 例，女4 例；年龄18 ～ 43 岁。患者均有3 根以上肋骨骨折，均合并血胸，其中10 例为血气胸；11 例合并肺挫伤；9 例合并脾破裂、锁骨骨折、骨盆骨折等其他部位的损伤。病程30 min ～ 7 d。手术均采用全身麻醉，健侧卧位，经标准外侧位切口进行。术后定期随访，观察骨折愈合情况。 结果 患者均获随访6 ～ 20 个月。除1 例因切口感染行二期缝合外，余患者均Ⅰ期愈合，未发生脓胸等并发症。胸廓塌陷畸形纠正，完整性良好，外观饱满。术后6 个月骨折端全部达骨性愈合。 结论 可吸收髓内钉具有良好的组织相容性，可自行降解吸收无需二期手术取出，手术操作简便，创伤小、愈合时间短，是一种理想的方法。

"Z"字形断肋保留肋骨的开胸术

目的 为行肺、食管等开胸术时保留肋骨,以保持胸廓的完整性.方法 采用"Z"字形断肋的方法行肺手术10例,食管手术4例.结果 全组病例术后恢复良好,切口疼痛明显减轻.胸部X线片示:各肋骨排列完整,断肋对合好.均痊愈出院.结论 该术式开胸时可快捷进胸、损伤小、出血少、切口暴露好;关胸时断肋对合严密,不易松脱;操作简单、方便、易掌握.

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。

SU,s全胸腔镜下肋骨骨折骨板骨钉胸腔内植入固定技术的临床应用

目的　探讨全胸腔镜下肋骨骨折骨板骨钉胸腔内植入固定技术的操作方法及适应证。 方法　2009年10月至2011年10月赤峰学院附属医院3例有移位的肋骨骨折患者，其中男2例、女1例，平均年龄36岁；采用SU , s全胸腔镜下肋骨骨折骨板骨钉胸腔内植入固定技术进行手术，3例均有胸腔内活动性出血和胸内凝血块，术中应用自主设计专利器械进行操作，针对如何控制肋间血管出血、游离显露肋骨断端、牵开骨折断端、对位固定、腔镜下肋骨板内植入等阶段设计了全新的手术方法。 结果　采用胸腔镜下内植入式镍钛记忆合金肋骨板胸腔内植入1例，固定肋骨1根，手术时间125 min；采用可吸收肋骨钉固定2例，1例固定2根肋骨，手术时间110 min；1例固定1根肋骨，手术时间90 min。 3例患者手术顺利，恢复良好，无并发症发生，痊愈出院，随访3个月骨折无移位。结论　SU , s全胸腔镜下肋骨骨折骨板骨钉胸腔内植入固定技术从技术角度在部分选择的患者中可行，但还不能取代在重症复合胸外伤常规开胸手术，还需进一步改进。

CLINICAL APPLICATION OF RIB AUTOGRAFT FOR ILIAC CREST RECONSTRUCTION BY ANTERIOR APPROACH OF THORACIC AND LUMBAR VERTEBRAE

Objective To explore the cl inical appl ication of rib autograft for reconstructing il iac crest by anterior approach of thoracic and lumbar vertebrae, and to observe the short-term and long-term effects. Methods From September 2004 to September 2007, 54 cases of thoracic and lumbar injuries were treated by the surgery of anterior approach of thoracic and lumbar vertebrae.There were 39 males and 15 females with an average age of 42 years old (range, 27-59 years old), including 4 cases of tuberculosis of spine and 50 cases of thoracic and lumbar vertebrae bursting fracture. All cases underwent the surgery of anterior approach of thoracic or lumbar and il iac crest was used as autograft. Fifty-four patients wererandomized into the reconstruction group (RG, n=25) and the non-reconstruction group (NRG, n=29). The patients of RGgroup were treated with rib autograft for reconstructing il iac crest. There were no statistically significant differences in general data between two groups (P gt; 0.05). The visual analogue scores (VAS) was used to estimate pain degree of treated hip after 2 weeks, and 3, 12 months. The extenion satisfaction grade of il iac crest and the comfort degree of action while bundl ing waist belt were estimated after 12 months. It was observed whether or not anterior superior il iac spine avulsion fracture occurred on the premise of non-accidental trauma within 1 year. The occurrence of fracture and the union status of reconstructed il iac crest were observed by X-ray after 1 year. Results All wounds achieved primary heal ing. No compl ication was found at early stage. All patients were followed up 1 year. There was no significant difference in the VAS of the treated hip under conditions of cl inostatism rest between two groups after 2 weeks and 3 months (P gt; 0.05). But there was significant difference in the VAS under conditions of action after 2 weeks and 3 months, under conditions of cl inostatism rest after 12 months (P lt; 0.05), and the VAS of RG was lower than that of NRG. The exterior satisfaction grade of il iac crest and comfort degree of action while bundl ing waist belt in RG were higher than those in NRG after 1 year, showing significant differences (P lt; 0.05). No anterior superior il iac spine avulsion fracture occurred after 1 year. And in RG group no fracture of reconstructed il iac crest occurred after 1 year. The X-ray film showed that the two ends of rib reconstructed by il iac crest were blur, and that the rib healed well with il iac bone. Conclusion Rib autograft for reconstruction of il iac crest by anterior approach of thoracic and lumbar vertebrae was economic and convenient. It could improve local appearance, reduce the local pain, and improve patients’ l ife quality.

Electronic Bronchoscope Lavage Lung Segment for Traumatic Atelectasis Caused By Rib Fractures

目的探讨肋骨骨折导致的创伤性肺不张治疗中应用电子支气管镜肺段灌洗治疗的效果 方法回顾性分析新疆医科大学第六附属医院2009年10月至2013年4月肋骨骨折导致创伤性肺不张73例行电子支气管镜肺段灌洗治疗患者的临床资料，其中男52例、女21例，年龄29～83（36± 5）岁。按治疗方式将患者分为两组：灌洗组（37例）行电子支气管镜肺段灌洗，对照组（36例）采用肺不张的常规治疗。比较两组临床效果。 结果灌洗组呼吸频率及心率减慢，动脉血氧饱和度升至95%以上，肺复张明显好于对照组，差异有统计学意义（P < 0.05）。 结论电子支气管镜肺段灌洗治疗肋骨骨折导致的创伤性肺不张直视下诊断明确，起效快，创伤小，疗效确切。

Choice of Surgical Pathway and Incision for Multiple Fractured Ribs

目的探讨多发性肋骨骨折切口及手术入路选择 方法回顾性分析赤峰学院附属医院2000年6至2013年12月手术治疗58例多发性肋骨骨折患者的临床资料，其中开胸组46例，胸腔镜组12例，男43例、女15例，年龄36（15～61）岁。 结果开胸手术组平均手术时间152 min，平均住院时间16 d；腔镜镜手术组平均手术时间125 min，平均住院时间12.5 d。46例开胸手术患者中44例术后胸壁稳定，自主呼吸排痰良好，16例肺挫伤较重有呼吸综合征（ARDS）倾向，术后经12～148 h呼吸机支持后恢复，1例死于合并食管下段破裂，术后第3 d突发腹腔大出血，分析为外伤性腹主动脉瘤破裂。3例患者切口部分裂开，均为环抱器骨板，1例胸骨骨折胸大肌皮瓣拉拢缝合治愈，另2例中1例取出裸露骨板，1例换药及二期缝合治愈。45例患者返院及电话随访6个月至3年，开胸组39例胸壁稳定，胸部X线片固定处均有骨伽形成，全组无难以耐受的肋间神经痛，腔镜手术组切口及固定肋骨处愈合良好。 结论实际操作中可根据骨折形态特点以后外侧“～”切口及垂直切口为基础做多种变形。胸腔镜下手术切口设计时要根据骨折断端位置，可能出现的胸内脏器血管损伤，综合考虑切口布局；最好操作孔及进镜孔处有骨折断端，方便内外结合固定，节省手术时间；同时要考虑出血脏器损伤的部位，方便止血修补或中转开胸；操作孔可以3～5个。

中断肋骨后外侧开胸切口施行食管、贲门癌切除术

目的 为了减小开胸手术切口的创伤，获得良好的手术视野，探讨中断肋骨后外侧开胸切口的临床效果。方法 采用中断肋骨后外侧开胸方法施行食管、贲门癌切除、淋巴结清扫术126例；介绍该技术的要点，比较中断肋骨开胸切口法与其他保留肋骨方法的显露面积、创伤大小及手术效果。结果 本组无1例发生术后肺不张和胸壁切口出血而需再次开胸止血，患者均恢复良好。结论 中断肋骨开胸切口方法手术操作简单，手术视野显露好，且手术创伤小。

3D 打印定制人工胸骨带肋骨假体植入修复胸壁缺损一例