[Thoracoscopic minimally invasive surgery for the treatment of flail chest with multiple rib fractures].

Objective: To investigate the clinical efficacy of thoracoscopic minimally invasive surgery with nickel-titanium shape memory alloy wrap bone plate versus rib periosteal internal fixation in patients with multiple rib fractures (MRF) and flail chest.

Methods: A retrospective analysis was performed on 100 patients with MRF and flail chest treated with thoracoscopic minimally invasive surgery and internal fixation with rib fracture preservation between January 2019 and December 2022, including 54 males and 46 females, aged from 20 to 65 years old, with an average age of (38.0±18.0)years old. The duration of the disease ranged from 8 to 21 days. According to the different surgical methods, the patients were divided into control group and study group, with 50 patients in each group. The control group consisted of 23 males and 27 females, with an average age of (38.35±18.05) years old, who underwent rib preservation periosteal internal fixation. In the study group, there were 31 males and 19 females, with an average age of (38.15±17.99) years old, treated with thoracoscopic nickel-titanium shape memory alloy circumferential bone plate. The pulmonary function indices, electrocardiographic monitoring indices, pain severity, levels of inflammatory factors, complications, rehabilitation indices, and therapeutic efficacy were compared between the two groups before and after treatment.

Results: All patients were followed up for 6 months. After 3 days of treatment, the heart rate of both groups was (102.43±13.74) beats per minute vs (86.26±8.06) beats per minute, respiratory rate (28.45±3.40) breaths per minute (22.05±2.85) breaths per minute, blood oxygen saturation (89.68±3.66)% (98.46±4.84)%, rest pain (3.5±0.5) points (2.6±0.6) points, movement pain (3.6±0.5) points (2.5±0.5) points, and these differences were statistically significant(<0.05). The levels of Interleukin-6 (IL-6) (102.30±17.00) pg·ml (85.68±21.20) pg·ml and tumor necrosis factor-alpha (TNF-α)(33.44±4.85) pg·ml (18.14±4.28) pg·ml in both groups exhibited an increase post-treatment, while the C-reactive protein (CRP) (75.51±10.54) mg·L (60.75±9.84) mg·L demonstrated a decrease compared to pre-treatment levels. Furthermore, the study group displayed significantly lower levels than the control group (<0.05). After 10 days of treatment, the peak expiratory flow rate (3.31±0.52) L·s (5.69±0.74) L·s, forced expiratory volume (1.46±0.29) L (2.06±0.38) L, and forced vital capacity (2.68±0.95) L (4.26±1.05) L of both groups exhibited significant improvements compared to pre-treatment levels. Moreover, the study group demonstrated significantly higher values than the control group (<0.05). The incidence of postoperative complications in the study group was significantly lower compared to the control group (6 cases 14 cases, <0.05). Additionally, the duration of bone callus formation(9.50±1.40) days and fracture healing (72.20±8.32) days in the study group was significantly shorter compared to the control group(11.35±2.15) days, (93.70±9.90) days (<0.001).

Conclusion: Compared with traditional rib-preserving internal fixation, patients with MRF and flail chest treated with minimally invasive internal fixation with thoracoscopic nickel-titanium shape memory alloy surround bone plate have better therapeutic effect, because of less surgical trauma, less pain and inflammatory reaction, fewer postoperative pulmonary complications, faster and better recovery of lung function, and thus promote the recovery of patients.