Flail chest wall internal fixation

Controlled mechanical ventilation is used to treat the floating chest wall called breathing internal fixation method. This method was advocated by Avery in 1956 and has been widely used in foreign countries. However, compared with surgical fixed cases, the mechanical ventilation treatment found tracheotomy. The opening rate, lung infection rate, incidence of barotrauma and ICU stay time were 2 to 5 times higher than those of the surgical fixation, and the injury rate was also increased by 3.5 to 5 times. Therefore, in recent years, most scholars have advocated the use of surgical fixation, the effect is indeed, the injured can be early activities, and can shorten the length of hospital stay. There are many surgical methods for fixed internal fixation of the chest wall. Commonly used are Judet fixation rib fixation, Kirschner wire medullary fixation and AO plate rib fixation. The Judet fixation rib fixation is simple and effective, especially for the fixation of the oblique rib fracture. It is an ideal fixation method. The Judet holder is made of various stainless steel plates and has been changed to titanium alloy sheet material in recent years. The transverse diameter is available in two sizes, one is 37mm with 4 claws and the other is 53mm with 6 claws. Its longitudinal diameter is 12 to 34 mm, and each interval is 2 mm. Therefore, each model has 12 models. The curvature of the claw is slightly curved according to the shape of the rib to form a "U" shape, the one-side claw has a curvature of 55° and the other side claw is 88°, and is fixed with a special force during surgery. Treatment of diseases: chest wall soft tissue injury Indication 1. Floating chest wall has severe chest and back pain or difficulty breathing and difficult to stay in bed. 2. There is organ damage in the chest or a progressive extrapleural hematoma. When the thoracotomy is required, the ribs can be fixed at the same time. 3. The rib fracture has obvious dislocation, and it is predicted that the thorax may be deformed. 4. It is best to perform within 3 days after the injury. Surgical procedure 1.Judet fixation rib fixation 1 Select the posterior lateral incision or anterior lateral incision. 2 When there is damage to the internal organs of the chest, the lungs, diaphragms, and mediastinal organs can be examined by intercostal thoracic surgery to stop bleeding, and if necessary, partial lung resection. After flushing the chest cavity, the chest drainage tube is placed above the second intercostal space of the midline of the clavicle and above the diaphragm of the midline of the iliac crest. 3 Understand the fracture of the rib, and peel the anterior and posterior periosteum of the fracture line for 3 to 4 cm, and then reset the fractured end of the fracture. 4 According to the situation of rib fracture, choose the appropriate type of Judet holder, bend it according to the shape of the rib, place 2 claws or 3 claws on the acute angle side (55°) of the fixing bracket on the lower edge of the rib, and then use special pliers. Secure the holder to the rib fracture. Generally, adult men use a fixed frame with a longitudinal diameter of 16 to 18 mm, and an adult woman uses a fixed frame with a longitudinal diameter of 14 to 16 mm. If the distance between the two fractures is relatively close, a frame with a diameter of 53 mm can be used, and if necessary, two frames can be used in parallel. 2. Kirschner wire rib internal fixation 1 reveal the location of the floating chest wall fracture. 2 Select the internal fixation ribs. 3 drill a small hole at the anterior and posterior rib fracture ends of the fracture, insert a Kirschner wire with a diameter of 1.5 to 2.0 mm, penetrate the small hole from one end, and then pass through the medullary cavity of the floating fracture segment, and then from the other The small hole at the broken end is pierced. The two ends of the Kirschner wire are exposed about 1 cm long outside the small hole, and are slightly bent so that they can be firmly fixed on the rib. 3. Plate fixation 1 Use orthopedic stainless steel plate whose length exceeds the rib fracture segment and bend according to the curvature of the rib. 2 The stainless steel wire is bundled around the ribs through the holes of the steel plate, and the ribs are tied at 1 point on the broken ends of the front and rear fractures, and the other two points are on the central floating ribs, so that the ribs are tightly fixed with the steel plate.

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