Surgical invasion and other relevant indicators in rib fracture patients with different injury sites:thoracoscopic or open internal fixations
Liu Yingqian
Xiao Xi
Liang Xiang
Li Ming
Abstract：Objective To investigate the effects of complete thoracoscopic internal fixation on surgical trau-ma and other related indicators of patients with rib fractures.Methods A retrospective analysis was conducted on 125 patients with rib fractures who required surgical treatment at our department from Jun.2022 to Jun.2024.There were 78 males and 47 females,aged31-70 years,with an average of 47.8 years.The fracture locations were divided into 7 types:anterior rib in 8 cases,lateral rib in 5,posterior rib in 19,anterior+lateral ribs in 5,anterior+posterior ribs in 60,lateral+posterior ribs in 12,and anterior+lateral+posterior ribs in 16 cases.The causes of in-juries were 54 cases of road accident injuries,33 falls from height,24 ground-level falls,and 14 crush injuries.A-mong them,98 were combined with traumatic hemopneumothorax,and 27 with flail chest.Primary diseases included 58 cases of hypertension,53 diabetes,and 14 coronary heart disease.The injury severity score(ISS)was 9-16,with an average of 13.8.According to the surgical method,patients were divided into endoscopic group(minimally invasive complete thoracoscopic rib fracture internal fixation,n=64)and open surgery group(traditional rib fracture internal fixation,n=61).Incision trauma index,surgical trauma index,operation time,intraoperative bleeding,post-operative drainage volume and drainage tube removal time of different rib fracture locations were observed.Results Comparison between the endoscopic and open surgery groups revealed significantly less trauma in the former when the rib fracture was located at posterior,anterior+posterior,lateral+posterior,and anterior+lateral+posterior(the incision trauma index:3.6±2.4 vs.7.6±4.5,4.2±2.8 vs.9.5±4.2,3.1±1.7 vs.8.3±2.6,and 5.3±1.8 vs.11.3±3.9,all P<0.001;the surgical trauma index:19.5±10.9 vs.32.3±16.4,21.6±14.7 vs.33.1±16.4,20.7±18.6 vs.34.9±20.6,22.6±17.6 vs.37.9±19.4,all P<0.001).Moreover,other surgery relevant indicators were much minimal in the endoscopic group than in the open surgery group for the abovementined four types of rib fracture locations,i.e.,posterior,anterior+posterior,lateral+posterior,and anterior+lateral+posterior(operation time,min,109.8±13.6 vs.152.6±15.3,129.4±11.5 vs.154.2±13.4,127.5±14.6 vs.155.3±16.6,and 140.6±16.3 vs.167.6±17.4,all P<0.001;perioperative bleeding,mL,70.5±21.3 vs.95.3±22.1,72.9±22.5 vs.92.4±25.2,80.2±21.9 vs.96.7±24.1,and 122.4±26.6 vs.167.8±24.4,all P<0.001;postoperative drainage volume,mL,787.8±23.6 vs.830.4±24.6,821.6±24.2 vs.887.8±27.9,820.7±28.7 vs.874.9±26.6,and 842.9±32.8 vs.933.5±33.4,all P<0.001;drainage tube removal time,d,2.9±1.9 vs.3.3±1.4,2.6±1.7 vs.3.4±1.4,2.7±1.6 vs.3.9±0.6,2.6±1.6 vs.3.9±1.4,all P<0.001).However,the incision or surgical trauma indexes,operation time,perioperative bleeding,postoperative drainage volume,and drainage tube removal time revealed no significant differences between the endoscopic and open surgery groups when the rib fracture locations were anterior,lateral,and anterior+lateral(all P>0.05).Conclusion Compared with traditional open rib fracture internal fixation,thoracoscopic internal fixations induce less trauma in patients with sim-ple posterior rib fractures or combined with posterior rib fractures.
Keywords：Rib fracturesComplete thoracoscopic surgeryIncision trauma indexSurgical trauma index
Publication Date：2025-10-15
Online Publishing Date：2025-11-07(First online date of this platform, not the publication date of the document)
Pages：6( 751-756 )