Therapeutic effect of anatomical plates versus embracing fixators for thoracoscopic-assisted rib internal fixation in flail chest

Zhang Xin; Li Ying; Li Yanhu; Xu Gang

doi:10.3969/j.issn.1009-4237.2025.06.009

Abstract：Objective To investigate the effect of different rib internal fixations in thoracoscopic manage-ment of flail chest.Methods A total of 86 patients with flail chest who underwent thoracoscopic-assisted rib inter-nal fixations in the Third Hospital of Hebei Medical University from Jan.2022 to Jan.2023 were prospectively en-rolled,including 47 males and 39 females.The average age was 51.3 years(range,19-78 years).There were 71 ca-ses of unilateral chest wall fractures and 15 cases of bilateral;80 patients with combined injuries and 6 with single thoracic injuries.Patients were randomly divided into a plate group or an embrace group by random number table,with 43 participants in each group.In the plate group,the fractured ribs were fixed by using anatomical bone plates,while in the embrace group,claw-shaped embracing fixators were used for rib fixation.All surgeries were conducted with the assistance of thoracoscopy.The perioperative and long-term follow-up results of the two groups were statisti-cally analyzed and compared.Results All patients completed the operation uneventfully,and 78 patients were fol-lowed up for at least 1 year.There was no significant differences in terms of operation time,postoperative off-line time,or postoperative complications between the two groups(all P>0.05).The plate group revealed much less in-traoperative blood loss(mL,104.0±28.4 vs.132.3±29.8)but higher cost(10 thousand yuan,7.0±1.8 vs.5.1±1.1)(both P<0.05).The long-term follow-up showed no significant difference in fracture healing,dyspnea,internal fixa-tion-related complications,or chronic chest wall pain between the two groups.However,in the elderly patients(>65 years old),the distribution of dyspnea grading was better in the plate group(P>0.05),with a much lower incidence of chronic chest pain(18.2%vs.61.5%,P<0.05).Multivariate regression analysis showed that age,chronic chest wall pain,and postoperative complications were related to long-term postoperative respiratory function limitation.Conclusion In the thoracoscopic-assisted treatment of flail chest,fixation of the fractured ribs by anatomical plates can reduce intraoperative blood loss and improve the long-term postoperative quality of life,especially in elderly pa-tients,compared with fixation by claw-shaped embracing fixators.