探讨多发性肋骨骨折微创治疗的手术方法。

回顾性分析2015年3月至2018年9月在石家庄市第三医院心胸外科行微创手术治疗260例多发肋骨骨折患者的临床资料。观察患者的术中和术后指标。

全组无死亡病例，手术时间40～180 min，平均手术时间103 min，手术出血量20～150 ml，平均手术出血量83 ml。术后12例患者因呼吸功能不全，送ICU过渡，1～5d顺利拔出气管插管、脱离呼吸机，转回普通病房。多数患者术后胸痛明显缓解，短期可停用镇痛药物，生活质量明显改善。术后复查显示内固定物塑形良好，胸廓成型良好，与对侧胸廓基本对称。切口脂肪液化、感染患者11例，均经短期换药治愈。出院后每月随访，连续3个月，无明显胸部不适，骨折断端愈合良好。

以胸廓的解剖特点为基础，根据不同部位及肋骨骨折情况选择、设计切口，解剖性游离、保护周围神经、血管，并结合3D打印技术、腔镜技术等，可以个体化、微创化的方式完成内固定手术，完美恢复胸廓形态，取得满意疗效。

To explore minimally invasive surgery treatments for patients with multiple fractures of ribs.

A retrospective analysis of the clinical data of 260 patients with multiple fractures of ribs who were admitted to the Department of Cardiothoracic Surgery, the Third Hospital of Shijiazhuang, from March 2015 to September 2018 was performed.The intraoperative and postoperative indicators were observed.

Among all cases, no death occurred.The mean operative time was 103 min (40-180 min)and the mean operative blood loss was 83 ml(20-150 ml). 12 cases were transferred to ICU due to respiratory insufficiency, and after about 1-5 days’ care, endotracheal intubations could be pulled out and ventilators could be removed, the patients thus were transferred back to regular room.Chest pain was relieved remarkably in most patients, and some could stop using analgesics in a short period. Postoperative reexamination showed that all internal fixators were in good shape and thoracic contours were well formed, basically symmetrical with contralateral thoracic contours. Incisional fat liquefaction occurred in 11 cases, and all were cured by short-term dressing change. After 3 months’ follow-up, no obvious chest discomfort occurred and rib fractures were cured.Monthly follow-up after discharge, 3 months in a row, no obvious chest discomfort, fracture healing good.

On the basis of anatomic characteristics of thoracic cavity, minimally invasive surgery for rib fractures should be designed and performed differently according to the different injured part of body , the condition of fractured ribs, with different incision and anatomical dissociation to protect the surrounding nerves and blood vessels. Also, 3D printing techniques and endoscopic techniques can also be used together with minimally invasive techniques in the internal fixation procedure to perfectly restore thoracic morphology.