Clinical experience of minimally invasive surgery for patients with multiple fractures of ribs

Objective To explore minimally invasive surgery treatments for patients with multiple fractures of ribs. Methods A retrospective analysis of the clinical data of 260 patients with multiple fractures of ribs who were admitted to the Department of Cardiothoracic Surgery, the Third Hospital of Shijiazhuang, from March 2015 to September 2018 was performed.The intraoperative and postoperative indicators were observed. Results Among all cases, no death occurred.The mean operative time was 103 min (40-180 min)and the mean operative blood loss was 83 ml(20-150 ml). 12 cases were transferred to ICU due to respiratory insufficiency, and after about 1-5 days’ care, endotracheal intubations could be pulled out and ventilators could be removed, the patients thus were transferred back to regular room.Chest pain was relieved remarkably in most patients, and some could stop using analgesics in a short period. Postoperative reexamination showed that all internal fixators were in good shape and thoracic contours were well formed, basically symmetrical with contralateral thoracic contours. Incisional fat liquefaction occurred in 11 cases, and all were cured by short-term dressing change. After 3 months’ follow-up, no obvious chest discomfort occurred and rib fractures were cured.Monthly follow-up after discharge, 3 months in a row, no obvious chest discomfort, fracture healing good. Conclusions On the basis of anatomic characteristics of thoracic cavity, minimally invasive surgery for rib fractures should be designed and performed differently according to the different injured part of body , the condition of fractured ribs, with different incision and anatomical dissociation to protect the surrounding nerves and blood vessels. Also, 3D printing techniques and endoscopic techniques can also be used together with minimally invasive techniques in the internal fixation procedure to perfectly restore thoracic morphology. Key words: Multiple fractures of ribs; Minimally invasive technique; Open reduction and internal fixation