| Objective:To explore the effect of rib internal fixation timing on the early curative effect of flail chest patients.Methods:A total of 66 patients who were diagnosed as flail chest and did rib fracture internal fixation surgery in the Department of Thoracic Surgery of the Affiliated Hospital of Zunyi Medical University from January 2016 to December 2019 were taken as the research object to retrospectively analyze the postoperative recovery of the patients;According to the time interval from injury to rib internal fixation surgery,patients were divided into early surgery group(A group:the interval time from injury to rib internal fixation surgery?3 day),late surgery group(B group:the interval time from injury to the rib internal fixation surgery>3 day),both groups of patients underwent open reduction and internal fixation surgery for rib fracture;Record and compare the basic conditions of the two groups before operation including age,sex,rib fracture site,number,flail segment number of ribs,whether there were complications such as blood pneumothorax,pulmonary contusion,atelectasis,myocardial contusion,etc.The interval time from injury to rib internal fixation operation,the time of postoperative ventilator-assisted ventilation,the incidence of postoperative pulmonary infections,atelectasis,and other complications,the amount of painkillers in the first 3 days after surgery,and the total amount of thoracic drainage after surgery,the postoperative thoracic tube indwelling time,postoperative hospital stay time and other related indicators are used to comprehensively evaluate the effect of surgical treatment timing on the early internal fixation effect of flail chest patients.Results:1.Compared with the patients in the early surgery group and the late surgery group,there were no difference in age,gender composition,number of rib fractures,number of flail segments,lung contusion,blood pneumothorax,atelectasis,myocardial contusion and other complications,(P>0.05).There was a statistically significant difference in the time from injury to surgical treatment between the two groups(2.32±0.83)d vs(7.74±1.79)d,P<0.001.2.In terms of postoperative ventilator-assisted time,the postoperative ventilator-assisted ventilation time in the early surgery group was(34.18±10.98)h,which was shorter than that in the late surgery group(82.72±20.60)h.The difference was statistically significant(P<0.001).3.In terms of post-recovery indicators,the postoperative lung infection rate in the early surgery group was significantly lower than that in the late surgery group 16.1%(5/31)vs42.9%(15/35),P=0.018,the incidence of postoperative atelectasis in the early surgery group was also lower than the late surgery group 12.9%(4/31)vs 31.4%(11/35),P=0.073,but the difference was not statistically significant,the amount of analgesic drugs(di zuo xin)in the early surgery group and the late group were(15.97±6.88)mg vs(14.71±4.01)mg,P=0.363,(15.32±6.94)mg vs(13.57±4.30)mg,P=0.217,(14.52±6.87)mg vs(13.14±3.66)mg,P=0.307,there is no statistically difference(P>0.05),The WBC count on the 3rd day after operation in the early operation group was significantly lower than that in the late operation group(8.92±2.86)*10~9/L vs(12.83±5.07)*10~9/L,P<0.001;the total amount of thoracic drainage and postoperative catheterization time in the early surgery group were lower than that in the late surgery group(955.65±483.39)ml vs(1214.40±370.26)ml,P=0.017,(6.42±2.81)d vs(9.49±2.25)d,P<0.001,and the postoperative hospital stay time in the early surgery group was significantly shorter than that the late surgery group(P<0.001).Conclusion:Early(3?days)rib internal fixation in flail chest patients can reduce the ventilator-assisted breathing time,the incidence of lung infections and atelectasis,reduce the total amount of thoracic drainage after surgery,shorter the postoperative thoracic tube indwelling time and postoperative hospital stay time,etc.for flail chest patients early rib internal fixation surgery is beneficial to the patient's early postoperative recovery. |
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