Comparison Of The Therapeutic Effect Between Anatomical Plates And Claw-type Bone Plates In Fixation Of Flail Chest And The Clinical Curative Effect Of Artificial Pulmonary Dilatation After Operation

Objective1.To compare the therapeutic effect of claw-type bone plates and Anatomical plates in fixation of traumatic multiple rib fractures.2.To investigate the clinical curative effect of artificial pulmonary dilatation after operation.Methods1.Clinical data of 97 patients with traumatic multiple rib fractures treated surgically between January 2016 and September 2018 was analyzed retrospectively.Based on the treatments,the patients were assigned to two groups:claw-type rib bone plates（n=44）and Anatomical plates（n=53）.A comparison was done on the variables including PaO₂,PaCO₂,alveolar-arterial blood oxygen partial pressure,intrapulmonary shunt rate,Operation time,Intraoperative blooding,Postoperative thoracic hemorrhage rate,Wound drainage,Plate loosening and breakage and Postoperative chest pain.Using SPSS21.0 statistical software,t test was used to compare the measurement data,andχ² test was used to compare the counting data.2.Based on the patients collected from the former,patients with pulmonary atelectasis and pleural effusion before operation were divided into two groups.At the end of the internal fixation operation,the VCM group was expanded by artificial lung expansion,while the NVCM group did not do any treatment.A comparison was done on the variables including PaO₂,PaCO₂,alveolar-arterial blood oxygen partial pressure,intrapulmonary shunt rate,The retention time of the postoperative thoracic drainage tube,the separation time of the ventilator,the FEV1%and so on.Using SPSS21.0 statistical software,Mann-Whitney U test was used to compare the measurement data,and Fisher exact probability was used to compare the counting data.Results1.According to different groups of internal fixation,there was no significant difference in PaO₂,PaCO₂,alveolar-arterial blood oxygen pressure difference and intrapulmonary shunt rate between the two groups（P>0.05）.The operation time after the full exposure of fractures were recorded.Operation time for each fracture [（11.66±.182）min（:12.32±0.67）min],intraoperativebleeding[（110.48±20.11）m l（:100.76±24.03）ml]and wound drainage [（110.14±27.31）m l（:100.74±13.92）ml]in the claw-type rib bone plates fixation group were statistically significant different compared with the anatomical plates fixation group（P<0.05）.There were 1 case of screw abscission in the anatomical plates fixation group（suffering from osteoporosis）and 2 cases in the claw-type bone plates fixation group（without osteoporosis and other complications）.Two cases suffered from chest pain and 2 cases suffered from massive hemorrhage in the chest in the claw-type bone plates fixation group,with secondary operation removing internal fixations.2.There was no significant difference between the experimental group and the control group in PaO₂,PaCO₂,alveolar-arterial blood oxygen pressure difference and pulmonary shunt rate（P>0.05）.The indwelling time of thoracic drainage tube and the time of ventilator detachment were significantly shorter in the experimental group after operation（P<0.05）.There was no significant difference in FEV1%between the two groups（P>0.05）.Conclusion1.The two kinds of internal fixation have their own advantages and disadvantages.The claw-type bone plates fixation is cheaper,easier to shape and has shorter operation time.Although the anatomical plates fixation is more expensive than claw-type bone plates fixation,the anatomical plates fixation on multiple fractured ribs has less postoperative blood loss,lower postoperative thoracic hemorrhage rate.2.At the end of the operation,the airway pressure reaches to 40cmH₂O and maintained for seven to eight seconds,which is beneficial to the sufficient drainage of pleural effusion and has little effect on pulmonary function.