Dongbin Wang

Chest trauma accounts for ~13.5% of all traumas, and direct death from chest trauma accounts for 20‑25% of all traumatic deaths. Chest trauma is the second cause of death from trauma. Frequent rib fractures, especially in patients with flail chest, often cause severe pain, chest wall softening, abnormal breathing and severe lung contusion and laceration, usually requiring thoracic surgery. In recent years, the open reduction and internal fixation treatment of rib fractures with flail chest has achieved satisfactory results, and some surgical indications have reached consensus. A number of scholars and medical centers have demonstrated the practicality and cost‑effectiveness of rib fixation in flail chest, including the small incidence of pulmonary complications, the short ICU mechanical ventilation time, and the reduction of digestive tract inhibition. Open reduction and internal fixation of rib fractures involves multiple ribs. Conventional rib fractures require a large incision to achieve satisfactory exposure. Chest wall muscles, blood vessels and nerves (long thoracic and thoracodorsal nerves) are injured, resulting in a high infection rate of the incision and postoperative dysfunctions, such as limited upper limb, shoulder and back function, and long time numbness on the affected side of the chest. Therefore, the damage of muscles and nerves caused by conventional surgical methods limits the development of such surgical technique. Although the video‑assisted thoracoscopic technique has become a necessary technical means for the treatment of thoracic trauma and has been applied to thoracic exploration and hemostasis, there is no report on the application of open reduction and internal fixation for rib fracture. The difficulty lies in the tightly combined bony thorax and the soft tissue of the chest wall. Therefore, experts have explored a variety of minimally invasive surgical methods for the flail chest. The current status and research progress of minimally invasive surgery for thoracic surgery are reviewed.

This study aimed to investigate the feasibility of applying thoracoscope combined with internal support system of chest wall (ISSW) in minimally invasive internal fixation for rib fracture on patients with multiple rib fractures. A total of 84 patients undergoing open reduction and internal fixation for rib fracture from January 2017 to December 2017 in the Department of Cardiothoracic Surgery, Tianjin Hospital were selected into the study, and retrospective analyses were carried out. The clinical data, pain score, operating time, intraoperative blood loss, indwelling time of thoracic tube, total drainage volume of thoracic tube for 3 days after operation, indwelling time of wound drainage tube, total drainage volume of wound drainage tube, length of stay, hospitalization costs, postoperative complications, C‑reactive protein (CRP) and pulmonary function of patients in the groups were compared. The patients were followed up for prognosis for 2‑4 months via re‑examination, and chest numbness at 1 month after operation was recorded. Compared with that (145.27±18.80 min) in the traditional group, the operating time in the minimally invasive group (112.20±21.40 min) was shorter (p<0.05). The total drainage volume of wound drainage tube was 145.75±61.03 ml in the minimally invasive group and 248.91±93.95 ml in the traditional group (p<0.05). In addition, the chest numbness at 1 month after operation (11.8%) in the minimally invasive group was better than that (34.00%) in the traditional group (p<0.05). Postoperative pain score, CRP and pulmonary function tests were also significantly different between the two groups (p<0.05). The results indicated that the application of thoracoscope combined with ISSW in minimally invasive internal fixation for rib fracture can effectively improve the prognosis of patients and reduce the length of stay and adverse reactions, and has high economic benefits, which is worthy of promotion and use in clinical practice.