Clinical efficacy analysis of 20 cases of multiple rib fractures treated with the application of memory alloy annulus.
[Abstract
Purpose: To explore the method and efficacy of applying memory alloy ring hugger in the treatment of multiple rib fractures. METHODS: The clinical data of 20 patients admitted to our hospital who were diagnosed with multiple multiple rib fractures by clinical and imaging examinations were retrospectively analyzed.
RESULTS: Postoperative chest pain was significantly reduced, chest wall was stable, thoracic integrity was good, respiratory status was significantly improved, incisions were all healed at stage I, no significant thoracic collapse deformity was observed on review 2-3 months after surgery, X-ray chest film showed solid internal fixation and bony healing of rib fracture ends.
Conclusion: The application of memory alloy annular appliance for the treatment of multiple rib fractures has the advantages of less trauma, shorter operation time, reliable fixation, safety and less complications, and is a better method for treating multiple rib fractures.
[Keywords] Internal fixation of multiple rib fractures with memory alloy annular apparatus
Rib fractures are very common in thoracic trauma, whether blunt or sharp injuries [1], and multiple multiple rib fractures are a more serious thoracic trauma. Multiple rib fractures will soften the local chest wall without intact rib support, resulting in paradoxical respiratory movements, i.e., softening of the chest wall during inspiration and protrusion during expiration, also known as shackle chest [2]. The paradoxical breathing due to shackle chest often seriously affects the respiratory and circulatory system, causing shock and respiratory dysfunction, etc. In the past, conservative treatment was mostly used, which has many complications and long recovery time [3]. 20 cases of multiple rib fractures were surgically treated with a memory alloy annuloplasty device from July 2009 to June 2011, all of which achieved satisfactory results. The results are reported as follows.
1. Clinical data
1.1 General data 16 male cases and 4 female cases in this group, aged 34-72 years. Causes of injury: 10 cases of car accident injury, 5 cases of fall injury, 4 cases of fall injury, 1 case of assault injury. The number of rib fractures was 3-12 in each case, with 8 cases of simple rib fractures, 5 cases of combined scapula fractures, 5 cases of limb fractures, 1 case of spinal fracture, and 1 case of pelvic fracture. There were 12 cases of combined hemothorax and/or pneumothorax, subcutaneous emphysema, 10 cases of pulmonary contusion, and 5 cases of shackled chest. All were closed fractures. All of them underwent internal fixation by ribotomy with a circumferential apparatus under general anesthesia from 8 hours to 10 days after the injury.
1.2 The whole group underwent chest x-ray, CT and rib three-dimensional imaging examination before surgery, and used the nickel-titanium shape-memory alloy ring hugger produced by Lanzhou West Pulse Memory Alloy Co. The length of the incision depends on the number of rib fractures and the fracture site, minimizing soft tissue damage to the chest wall and taking into account the treatment of multiple fracture sites. The fracture end is exposed and the surrounding blood clot is removed. If there is a pleural rupture, the thoracic cavity can be explored, and depending on the lung injury, the accumulated blood in the thoracic cavity can be removed, the lung or bronchial fracture can be repaired, and the bleeding point can be stopped. The soft tissues at the fracture end are removed and the periosteum (about 75px) is peeled off at both ends of the fracture to avoid excessive peeling of the periosteum, and attention is paid to protecting the intercostal nerves and blood vessels to prevent pleural rupture, and anatomical repositioning is given to restore the bone fragments to their original position. According to the curvature and width of the rib at the fracture, choose a suitable nickel-titanium alloy ring hugger, place it in sterilized ice water at 0~4℃ for 3~5min, and slowly prop up the tooth arms separately with a spreader so that the opening of each pair of tooth arms is slightly larger than the transverse diameter of the rib, then quickly remove the ring hugger and place it on the rib from above the fracture, and use a warm saline shower at 40~45℃ or hot saline gauze to warm up the ring hugger to hold it together. Move both ends of the fracture to confirm that the wall of the ring hugger teeth has fixed the two broken ends of the rib without loosening. The same method is used to fix the rest of the rib fractures in turn to achieve the purpose of treating the continuous shackle chest. Multiple multiple rib fractures are often combined with pleural rupture, and the chest cavity is explored and flushed before closing the chest, and closed chest drainage is placed intraoperatively. Postoperatively, oxygen was routinely administered, antibiotics were used to prevent infection, and lung management and complication prevention were enhanced. Observe the drainage of closed chest drainage tube, combine with chest X-ray and chest CT to remove the drainage tube, and encourage patients to get out of bed early.
1.3 Results of 20 patients after surgery: chest pain was significantly reduced, chest wall was stable, the integrity of the thorax was good, the respiratory condition was significantly improved, and the incision was healed at stage I. The patients were reviewed 2-3 months after surgery, and there was no obvious discomfort, no obvious thoracic collapse deformity, and the X-ray chest film showed that the internal fixation was firm, the joint plate was not loose or dislodged, and the bony healing of the rib fracture end.
2. Discussion
2.1 Multiple rib fracture is a more serious chest trauma, often combined with hemopneumothorax, pulmonary contusion, traumatic shock, chest wall floating, etc., resulting in respiratory and circulatory dysfunction and even death in severe cases. Traditional treatment methods mainly include wide adhesive tape fixation, cotton pad pressure bandage, chest strap fixation, chest wall scarf clamp traction fixation, etc., which require patients to rest strictly in bed and affect patients’ coughing and sputum excretion, and easily cause pneumonia, pulmonary atelectasis, decubitus ulcer, thrombosis, etc., with obvious defects and shortcomings, while the memory alloy ring-holding type ring-holder has shown more advantages in recent years and gradually received attention as follows.
1, simple surgical operation, not easy to displace, does not affect the bone marrow, and does not need to be removed after surgery [3].
2, the surgical operation is quick and time-saving, with low surgical intensity, without bone drilling, reducing intraoperative bleeding; it avoids both the risk of bone discontinuity due to extensive stripping of the periosteum by plate fixation and the risk of damage to the pleura and lung tissue by wire fixation [4].
3. The internal fixation of memory alloy with incision and repositioning can stabilize the fracture as soon as possible, rapidly improve the respiratory function, and reduce the patient’s chest pain and respiratory pain. It effectively prevents the occurrence of pulmonary complications such as pulmonary atelectasis and pulmonary infection.
4.Effectively restoring the integrity of the thorax, avoiding further injury caused by the fracture, and at the same time improving the appearance of the thorax, playing a cosmetic and plastic role.
2.2 Although memory alloy annuloplasty is a better method for treating multiple rib fractures, it is still necessary to master the indications for surgery.
(1) thoracic trauma with intrathoracic organ injury requiring open-heart surgery and internal rib fixation.
(2) continuous shackle chest with obvious paradoxical breathing, possibility of ARDS or obvious thoracic deformity after healing of chest wall collapse.
(3) The fracture severed end is obviously displaced and has multiple segments.
(4) The chest pain was obvious and the patient actively requested surgery. Among the 20 cases in this group, there were 10 cases of combined pulmonary contusion, 5 cases of continuous shackle chest, 3 cases of obvious fracture displacement, and 2 cases of severe chest pain actively requesting surgery.
In conclusion, the application of memory alloy annular apparatus for the treatment of multiple rib fractures has the advantages of less trauma, shorter operation time, reliable fixation, safety, and less complications, which is a better method for treating multiple rib fractures.