Internal rib fixation combined with external chest fixation and mechanical ventilation for traumatic flail chest with pulmonary contusion

Abstract

Objective To analyze the clinical efficacy of internal rib fixation combined with external chest fixation and mechanical ventilation for traumatic flail chest with pulmonary contusion. Methods Sixty cases of traumatic flail chest with pulmonary contusion treated from January 2011 to December 2014 were assigned to experimental group (30 cases) and control group (30 cases) according to the random number table. Patients in control group received thoracic external fixation combined with mechanical ventilation. In experimental group the patients received the same care but in addition they had rib fixation. The two groups were compared with regard to general condition, arterial blood gas as well as vital signs before treatment and 24 hours after treatment, lung function 3 months after discharge, complication rate and mortality. Results ICU stay [(6.8±1.0)d], hospital stay [(15.0±1.8)d] and duration of mechanical ventilation [(4.8±1.0)d] in experimental group were significantly lower than these in control group[(13.6±2.5)d, (21.4±2.6)d, (10.3±1.3)d, respectively] (P<0.01). After treatment for 24 hours in either group, the pH value, PaO2, oxygenation index and systolic pressure (SBP) were significantly increased, and partial pressure of carbon dioxide (PaCO2), heart rate (HR) and respiratory rate (RR) were significantly lowered as compared to these before treatment (P<0.05). After treatment for 24 hours, experimental group demonstrated significantly enhanced levels in pH value, PaO2, oxygenation index and SBP but lowered levels in PaCO2, HR and RR as compared to control group (P<0.05). Three months after discharge, forced vital capacity (FVC), forced expiratory volume in one second (FEV1), peak expiratory flow (PEF), 75% forced expiratory flow (FEF75%) and total lung capacity (TLC) in experimental group were (81.7±2.6)%, (75.4±4.1)%, (83.2±4.6)%, (69.1±2.3)%, and (88.7±3.4)% respectively, significantly higher than (69.0±3.6)%, (71.3±3.9)%, (78.9±4.3)%, (62.3±3.3)%, and (79.0±4.6)% respectively in control group (P<0.01). In experimental group, there were four cases of pulmonary infection(13%), three pulmonary atelectasis(10%) and one intercostal neuralgia(3%). In control group, there were six cases of pulmonary infection(20%), five pulmonary atelectasis(17%), four intercostal neuralgia(13%) and four thoracocyllosis(13%)(P<0.05). There was no significant difference in mortality between the two groups. Conclusion Treatment effect of internal rib fixation for flail chest with pulmonary contusion is improved in combination with mechanical ventilation and external chest fixation. Key words: Rib fractures; Ventilators, mechanical; Flail chest