摘要目的 比较非手术和手术治疗连枷胸的疗效.方法 采用回顾性病例对照研究分析2013年3月-2016年4月收治的连枷胸患者60例,其中男42例,女18例;年龄36～ 62岁[(49.8±10.3)岁].根据治疗方式不同分为非手术组(28例)和手术组(32例).伤后3,6个月摄胸部CT片,同时采用生活质量评价量表(SF-36)对健康状况进行评估,比较两组肺膨胀不全、胸廓畸形、骨折延迟愈合、肺功能等指标的差异.结果 手术组与非手术组伤后3个月比较,胸部CT肺膨胀不全、胸廓畸形、骨折延迟愈合发生率明显下降,肺功能用力肺活量(FVC)、第1秒用力呼气容积(FEV1)、1秒率(FEV1/FVC)、最大自主通气量(MVV)增加,SF-36各观察指标得分均有提高,差异均有统计学意义(P＜0.05);伤后6个月,除胸廓畸形手术组6例(19％)与非手术组11例(39％)差异有统计学意义外(P＜0.05),胸部CT、肺功能、SF-36各观察指标两组差异均无统计学意义(P＞0.05);手术组组内伤后6个月与3个月比较,胸部CT、肺功能、SF-36各观察指标差异均无统计学意义(P＞0.05);非手术组组内伤后6个月与3个月比较,胸廓畸形伤后3个月就基本固定无变化,差异无统计学意义(P＞0.05),而肺膨胀不全、骨折延迟愈合、肺功能及SF-36各观察指标好转,差异均有统计学意义(P＜0.05).结论 手术治疗连枷胸能促进骨折愈合,减少胸廓畸形,较非手术治疗更早改善生活质量,虽然6个月后非手术与手术治疗生活质量评价差异不明显,但胸廓畸形仍有明显差异.

abstractsObjective To compare the clinical effect of non-operative and operative treatment for flail chest.Methods A retrospective case control study was made on 60 cases of flail chest treated from March 2013 to April 2016.There were 42 males and 18 females,at the age range of 36-62 years [(49.8 ± 10.3)years].According to the treatment methods,the patients were divided into non-operation group (28 cases) and operation group (32 cases).Chest CT,pulmonary function and 36-item short-form health survey(SF-36) were measured in all patients 3 months and 6 months after injury.Differences in atelectasis,chest wall deformity,delayed fracture healing,pulmonary function and life quality were analyzed between the two groups.Results Compared to non-operative group at postoperative 3 months,rates of atelectasis,chest wall deformity and delayed fracture healing in operation group were obviously lower,while indices of pulmonary function pulmonary function including forced vital capacity (FVC),forced expiratory volume in one second(FEV1),one second rate (FEV1/FVC) and maximal voluntary ventilation measured value (MVV) in operation group wcre higher,and SF-36 parameters including physical functioning (PF),role-physical (RP),bodily pain (BP),general health (GH),vitality (VT),social functioning (SF) and mental health (MH) in operation group were better (all P ＜ 0.05).As to the data measured 6 months after injury,there were no significant differences between the two groups,except that the rate of chest wall deformity in non-operative group (6 cases,39％) was higher than that in operation group (11 cases,19％) (P ＜ 0.05).As to c hest CT,indices of pulmonary function and SF-36 parameters (P ＜ 0.05),there were no significant differences within operation group at postoperative 3 months and 6 months (P ＞ 0.05).Non-operation group showed better results in rate of atelectasis,rate of delayed fracture healing,indices of pulmonary function and SF-36 parameters measured 6 months after injury than the detections at postoperative 3 months (P ＜ 0.05),without difference in rate of chest wall deformity (P ＞ 0.05).Conclusions Surgical treatment of flail chest can accelerate fracture healing,reduce rate of chest wall deformity and improve life quality of patients early compared to non-operative treatment.Although there is no obvious difference in life quality of patients between operative and non-operative treatment 6 months after injury,but the chest wall deformity remains significantly different.