1
|
Hu M, Sun M, Bao C, Luo J, Zhuo L, Guo M. 3D-printed external fixation guide combined with video-assisted thoracoscopic surgery for the treatment of flail chest: a technical report and case series. Front Surg 2023; 10:1272628. [PMID: 37829598 PMCID: PMC10564999 DOI: 10.3389/fsurg.2023.1272628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 09/14/2023] [Indexed: 10/14/2023] Open
Abstract
Background Flail chest is a common and serious traumatic condition in thoracic surgery. The treatment of flail chest often includes open reduction and internal fixation, which is relatively traumatic, complicated, and expensive. As three-dimensional (3D) printing technology is widely used in the clinical field, the application of 3D-printed products to chest trauma will become a new treatment option. To date, the use of 3D-printed external fixation guides for flail chests has not been reported. Thus, we aimed to assess the short-term efficacy of a new technology that treated flail chests with an individualized 3D-printed external fixation guide combined with video-assisted thoracoscopic surgery (VATS). Patients and methods A retrospective analysis was performed on patients with flail chest treated with this new technique at our center from January 2020 to December 2022. The following parameters were included: operative time, thoracic tube extraction time, intensive care unit time, thoracic volume recovery rate, visual analog scale score 1 month postoperatively, and postoperative complication rate. All patients were followed up for at least 3 months. Results Five patients (mean age: 45.7 years) were enrolled; they successfully underwent surgery without chest wall deformity and quickly returned to daily life. The average number of rib fractures was 8.4; all patients had lung contusion, hemopneumothorax, and anomalous respiration. The abnormal breathing of all patients was completely corrected on postoperative day 1, and the chest wall was stable. One case experienced mild loosening of the 3D-printed guide postoperatively; however, the overall stability was not affected. The other four cases did not experience such loosening because we replaced the ordinary silk wire with a steel wire. All cases were discharged from the hospital 2 weeks postoperatively and returned to normal life 1 month after the removal of the 3D-printed guide on average. Only one case developed a superficial wound infection postoperatively, and no perioperative death occurred. Conclusions The 3D-printed external fixation guide combined with video-assisted thoracoscopic surgery is a novel technique in the treatment of flail chest and is safe, effective, feasible, and minimally invasive, with satisfactory clinical efficacy.
Collapse
Affiliation(s)
| | | | | | | | | | - Ming Guo
- Department of Cardiothoracic Surgery, Xiamen University Affiliated Chenggong Hospital (Army 73rd Group Military Hospital), Xiamen, China
| |
Collapse
|
2
|
Zhou X, Zhang D, Xie Z, Yang Y, Feng L, Hou C, Chen M, Liang Z, Zhang G, Lu H. Application of preoperative 3D printing in the internal fixation of posterior rib fractures with embracing device: a cohort study. BMC Surg 2023; 23:237. [PMID: 37580688 PMCID: PMC10426142 DOI: 10.1186/s12893-023-02128-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 07/28/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND To explore the impact of preoperative 3D printing on the fixation of posterior rib fractures utilizing a memory alloy embracing device of rib under thoracoscopy. METHODS The enrolled patients were divided into the 3D printing (11 patients) and the non-3D printing (18 patients) groups, based on whether a 3D model of ribs was prepared prior to surgery. Analysis was conducted comparing the average fixation time per fracture, postoperative fixation loss, and poor reduction of fractured end between the two groups. RESULTS The average fixation time of each fracture was 27.2 ± 7.7 min in the 3D printing group and 29.3 ± 8.2 min in the non-3D printing group, with no statistically significant difference observed between the two groups (P > 0.05). The incidence of poor fracture fixation in the 3D printing group was statistically lower than that in the non-3D printing group (12.9% vs. 44.7%, P < 0.05). Further stratified analysis revealed that the off-plate rate in the 3D printing group and the non-3D group was (3.2% vs. 12.8%, P > 0.05), and the dislocation rate of the fractured end was (9.7% vs. 31.9%, P < 0.05). CONCLUSIONS The application of 3D printing technology to prepare the rib model before surgery is proves beneficial in reducing the occurrence of poor fixation of fractures and achieving precise and individualized treatment.
Collapse
Affiliation(s)
- Xuetao Zhou
- Department of Cardiothoracic Surgery, Shijiazhuang Third Hospital, No.15 Tiyu South Street, Chang an District, Shijiazhuang, 050000, Hebei Province, China
| | - Dongsheng Zhang
- Department of Cardiothoracic Surgery, Shijiazhuang Third Hospital, No.15 Tiyu South Street, Chang an District, Shijiazhuang, 050000, Hebei Province, China.
| | - Zexin Xie
- Department of Cardiothoracic Surgery, Shijiazhuang Third Hospital, No.15 Tiyu South Street, Chang an District, Shijiazhuang, 050000, Hebei Province, China
| | - Yang Yang
- Department of Cardiothoracic Surgery, Shijiazhuang Third Hospital, No.15 Tiyu South Street, Chang an District, Shijiazhuang, 050000, Hebei Province, China
| | - Lei Feng
- Department of Cardiothoracic Surgery, Shijiazhuang Third Hospital, No.15 Tiyu South Street, Chang an District, Shijiazhuang, 050000, Hebei Province, China
| | - Chunjuan Hou
- Department of Cardiothoracic Surgery, Shijiazhuang Third Hospital, No.15 Tiyu South Street, Chang an District, Shijiazhuang, 050000, Hebei Province, China
| | - Menghui Chen
- Department of Cardiothoracic Surgery, Shijiazhuang Third Hospital, No.15 Tiyu South Street, Chang an District, Shijiazhuang, 050000, Hebei Province, China
| | - Zheng Liang
- Department of Cardiothoracic Surgery, Shijiazhuang Third Hospital, No.15 Tiyu South Street, Chang an District, Shijiazhuang, 050000, Hebei Province, China
| | - Guoliang Zhang
- Department of Cardiothoracic Surgery, Shijiazhuang Third Hospital, No.15 Tiyu South Street, Chang an District, Shijiazhuang, 050000, Hebei Province, China
| | - Huiqing Lu
- Department of Cardiothoracic Surgery, Shijiazhuang Third Hospital, No.15 Tiyu South Street, Chang an District, Shijiazhuang, 050000, Hebei Province, China
| |
Collapse
|
3
|
Preoperative Imaging of Costal Cartilage to Aid Reconstructive Head and Neck Surgery. Ann Plast Surg 2022; 89:e69-e80. [DOI: 10.1097/sap.0000000000003325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
4
|
Kong LW, Huang GB, Yi YF, Du DY. The Chinese consensus for surgical treatment of traumatic rib fractures 2021 (C-STTRF 2021). Chin J Traumatol 2021; 24:311-319. [PMID: 34503907 PMCID: PMC8606596 DOI: 10.1016/j.cjtee.2021.07.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/18/2021] [Accepted: 07/26/2021] [Indexed: 02/04/2023] Open
Abstract
Rib fracture is the most common injury in chest trauma. Most of patients with rib fractures were treated conservatively, but up to 50% of patients, especially those with combined injury such as flail chest, presented chronic pain or chest wall deformities, and more than 30% had long-term disabilities, unable to retain a full-time job. In the past two decades, surgery for rib fractures has achieving good outcomes. However, in clinic, there are still some problems including inconsistency in surgical indications and quality control in medical services. Before the year of 2018, there were 3 guidelines on the management of regional traumatic rib fractures were published at home and abroad, focusing on the guidance of the overall treatment decisions and plans; another clinical guideline about the surgical treatment of rib fractures lacks recent related progress in surgical treatment of rib fractures. The Chinese Society of Traumatology, Chinese Medical Association, and the Chinese College of Trauma Surgeons, Chinese Medical Doctor Association organized experts from cardiothoracic surgery, trauma surgery, acute care surgery, orthopedics and other disciplines to participate together, following the principle of evidence-based medicine and in line with the scientific nature and practicality, formulated the Chinese consensus for surgical treatment of traumatic rib fractures (STTRF 2021). This expert consensus put forward some clear, applicable, and graded recommendations from seven aspects: preoperative imaging evaluation, surgical indications, timing of surgery, surgical methods, rib fracture sites for surgical fixation, internal fixation method and material selection, treatment of combined injuries in rib fractures, in order to provide guidance and reference for surgical treatment of traumatic rib fractures.
Collapse
Affiliation(s)
- Ling-Wen Kong
- Department of Cardiothoracic Surgery, Chongqing Emergency Medical Center, Chongqing University Central Hospital, Chongqing, 400014, China
| | - Guang-Bin Huang
- Department of Trauma Surgery, Chongqing Emergency Medical Center, Chongqing University Central Hospital, Chongqing, 400014, China
| | - Yun-Feng Yi
- Department of Cardiothoracic Surgery, Xiamen University Affiliated Southeast Hospital, Zhangzhou, 363000, Fujian Province, China,Corresponding author. Xiamen University Affiliated Southeast Hospital, Zhangzhou, 363000, Fujian Province, China.
| | - Ding-Yuan Du
- Department of Cardiothoracic Surgery, Chongqing Emergency Medical Center, Chongqing University Central Hospital, Chongqing, 400014, China,Department of Trauma Surgery, Chongqing Emergency Medical Center, Chongqing University Central Hospital, Chongqing, 400014, China,Corresponding author. Chongqing Emergency Medical Center, Chongqing University Central Hospital, Chongqing, 400014, China.
| | - Consensus expert groupBaiXiang-JundChengLi-MingeCuiShu-SenfDuDing-YuangDuGong-LianghDengJiniDaiJi-GangjDangXing-BohFuXiao-BingkFuYonglGeBingmGaoJin-MougHouLi-JunnHuPei-YangoHouZhi-YongpJiangBao-GuoqJiangJian-XinrJiaYan-FeisJingJue-HuatKongLing-WengLiChun-MinguLvDe-ChengvLiuGuo-DongwLiangGui-YouxLianHong-KaiyLiKai-NanzLiLeiaaLiuLiang-MingrLinYi-DanabLiZhan-FeidLiuZhong-MinacShaoBiaoadShenYanaeTaoNingafTangPei-FukTanQun-YourHuangGuang-BingHuPinggWangChengagWuChunahWangDa-LiaiWangGangajWangHai-DongakWuJing-LanalWuQing-ChenamWangRu-WenrWangTian-BingsWuXuajWangZheng-GuorXuFenganXiaoRen-JuaoXiaoYing-BinapYuAn-YongaiYuBinajYangJunaqYangXiao-FengaeYiYun-FengarZhuDong-BoasZengJunatZhouJi-HongrZhangLian-YangauZhaoXing-JigZhongYong-FuavTongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyTongji Hospital, Tongji University School of MedicineChina-Japan Union Hospital of Jilin UniversityChongqing Emergency Medical Center, Chongqing University Central HospitalShanxi Province People's HospitalAffiliated Hospital of Guizhou Medical UniversityXinqiao Hospital, Army Military Medical UniversityGeneral Hospital of People's Liberation ArmyThe Second Hospital,University of South ChinaThe Fourth People's Hospital of GuiyangChangzheng Hospital, Second Military Medical UniversityTiantai People's Hospital of Zhejiang ProvinceThe Third Hospital of Hebei Medical UniversityPeking University People's Hospital, National Center for Trauma MedicineArmy Medical Center of People's Liberation ArmyThe Second Affiliated Hospital of Inner Mongolia Medical UniversityThe Second Hospital of Anhui Medical UniversityJilin Central HospitalFirst Affiliated Hospital of Dalian Medical UniversityEditorial Department of Chinese Journal of TraumaGuizhou Medical UniversityZhengzhou Central Hospital Affiliated to Zhengzhou UniversityAffiliated Hospital of Chengdu UniversityEditorial Department of Chinese Journal of Traumatology(English Edition)West China Hospital of Sichuan UniversityShanghai Oriental Hospital of Tongji UniversityThe First People's Hospital of KunmingThe First Affiliated Hospital, School of Medicine, Zhejiang UniversitySuining Central Hospital, Sichuan ProvinceThe First Affiliated Hospital of Hainan Medical UniversityChildren's Hospital of Chongqing Medical UniversityAffiliated Hospital of Zunyi Medical UniversitySouthern Hospital of Southern Medical UniversitySouthwest Hospital of Army Medical UniversityUnion Shenzhen Hospital, Huazhong University of Science and TechnologyThe First Affiliated Hospital of Chongqing Medical UniversityThe First Affiliated Hospital of Soochow UniversityPeople's Hospital of Xingyi City, Guizhou ProvinceXinqiao Hospital of Army Medical UniversityChongqing Emergency Medical Center, Central Hospital of Chongqing UniversityXiamen University Affiliated Southeast HospitalThe Affiliated Hospital of Nantong UniversitySichuan Provincial People's HospitalDaping Hospital, Army Military Medical UniversityChongqing University Three Gorges Hospital)
| |
Collapse
|
5
|
Zhang D, Zhou X, Yang Y, Xie Z, Chen M, Liang Z, Zhang G. Minimally invasive surgery rib fracture fixation based on location and anatomical landmarks. Eur J Trauma Emerg Surg 2021; 48:3613-3622. [PMID: 33983463 DOI: 10.1007/s00068-021-01676-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 04/17/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Rib fracture is closely related to thoracic injury with high morbidity and mortality. This study aimed to investigate the clinical effect of Zhang ZhiFei (ZZF) zoning method on the selection of incision and approach in minimally invasive surgery for rib fracture. METHODS A total of 110 patients with rib fractures from July 2017 to July 2019 were enrolled in the study. Preoperative computed tomography and three-dimensional reconstruction of ribs was performed. Then, the rib fractures to be surgically fixed were divided into costal cartilage zone, chest zone, lateral costal zone, high posterior costal zone, low posterior costal subscapular zone, and low posterior costal paraspinal zone, which was called ZZF zoning method. Rib fractures in each zone had unique minimally invasive incision approach, and the open reduction and internal fixation of rib fracture was performed under minimally invasive surgery of corresponding small incision. RESULTS The average incision length and number of incisions of the 110 patients were 6.2 cm and 1.3, respectively. The average number of internal fixation was 5.3 and the average operation time was 82 min. The postoperative fracture end was well aligned. After 3 months of follow-up, no internal fixation was displaced or detached. CONCLUSION Based on the anatomical characteristics of different zones of the chest wall, ZZF zoning method provides a new idea and reference for the selection of incision and approach in minimally invasive internal fixation for rib fracture.
Collapse
Affiliation(s)
- Dongsheng Zhang
- Department of Cardiothoracic Surgery, Shijiazhuang Third Hospital, No. 15 Tiyu South Street, Shijiazhuang, 050011, Hebei, China.
| | - Xuetao Zhou
- Department of Cardiothoracic Surgery, Shijiazhuang Third Hospital, No. 15 Tiyu South Street, Shijiazhuang, 050011, Hebei, China
| | - Yang Yang
- Department of Cardiothoracic Surgery, Shijiazhuang Third Hospital, No. 15 Tiyu South Street, Shijiazhuang, 050011, Hebei, China
| | - Zexin Xie
- Department of Cardiothoracic Surgery, Shijiazhuang Third Hospital, No. 15 Tiyu South Street, Shijiazhuang, 050011, Hebei, China
| | - Menghui Chen
- Department of Cardiothoracic Surgery, Shijiazhuang Third Hospital, No. 15 Tiyu South Street, Shijiazhuang, 050011, Hebei, China
| | - Zheng Liang
- Department of Cardiothoracic Surgery, Shijiazhuang Third Hospital, No. 15 Tiyu South Street, Shijiazhuang, 050011, Hebei, China
| | - Guoliang Zhang
- Department of Cardiothoracic Surgery, Shijiazhuang Third Hospital, No. 15 Tiyu South Street, Shijiazhuang, 050011, Hebei, China
| |
Collapse
|
6
|
Zhou X, Zhang D, Xie Z, Yang Y, Chen M, Liang Z, Zhang G, Li S. Application of 3D printing and framework internal fixation technology for high complex rib fractures. J Cardiothorac Surg 2021; 16:5. [PMID: 33583412 PMCID: PMC7883420 DOI: 10.1186/s13019-020-01377-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 12/04/2020] [Indexed: 12/25/2022] Open
Abstract
Objective To explore the clinical effect of 3D printing combined with framework internal fixation technology on the minimally invasive internal fixation of high complex rib fractures. Methods Total 16 patients with high complex rib fractures were included in the study. Before the procedure, the 3D rib model was reconstructed based on the thin-layer chest CT scan. According to the 3D model, the rib locking plate was pre-shaped, and the preoperative planning were made including the direction of the locking plate, the location of each nail hole and the length of the screw. During the operation, the locking plate was inserted from the sternum to the outermost fracture lines of ribs with screws at both ends. In addition, the locking plate was used as the frame to sequentially reduce the middle fracture segment and fix with screws or steel wires. Chest x-rays or chest CT scans after surgery were used to assess the ribs recovery. All patients were routinely given non-steroidal anti-inflammatory drugs (NSAIDS) for analgesia, and the pain level was evaluated using numerical rating scale (NRS). Results The preoperative planning according to the 3D printed rib model was accurate. The reduction and fixation of each fracture segment were successfully completed through the framework internal fixation technology. No cases of surgical death, and postoperative chest pain was significantly alleviated. Five to 10 months follow up demonstrated neither loosening of screws, nor displacement of fixtures among patients. The lungs of each patients were clear and in good shape. Conclusion The application of 3D printing combined with framework internal fixation technology to the high complex rib fractures is beneficial for restoring the inherent shape of the thoracic cage, which can realize the accurate and individualized treatment as well as reduces the operation difficulty.
Collapse
Affiliation(s)
- Xuetao Zhou
- Department of Thoracic Surgery, the Second Hospital of Hebei Medical University, No. 215, Heping west road, Shijiazhuang, 050000, China.,Department of Cardiothoracic Surgery, Shijiazhuang No. 3 Hospital, Shijiazhuang, 050011, China
| | - Dongsheng Zhang
- Department of Cardiothoracic Surgery, Shijiazhuang No. 3 Hospital, Shijiazhuang, 050011, China
| | - Zexin Xie
- Department of Cardiothoracic Surgery, Shijiazhuang No. 3 Hospital, Shijiazhuang, 050011, China
| | - Yang Yang
- Department of Cardiothoracic Surgery, Shijiazhuang No. 3 Hospital, Shijiazhuang, 050011, China
| | - Menghui Chen
- Department of Cardiothoracic Surgery, Shijiazhuang No. 3 Hospital, Shijiazhuang, 050011, China
| | - Zheng Liang
- Department of Cardiothoracic Surgery, Shijiazhuang No. 3 Hospital, Shijiazhuang, 050011, China
| | - Guoliang Zhang
- Department of Cardiothoracic Surgery, Shijiazhuang No. 3 Hospital, Shijiazhuang, 050011, China
| | - Shujun Li
- Department of Thoracic Surgery, the Second Hospital of Hebei Medical University, No. 215, Heping west road, Shijiazhuang, 050000, China.
| |
Collapse
|
7
|
Long R, Tian J, Wu S, Li Y, Yang X, Fei J. Clinical efficacy of surgical versus conservative treatment for multiple rib fractures: A meta-analysis of randomized controlled trials. Int J Surg 2020; 83:79-88. [PMID: 32931977 DOI: 10.1016/j.ijsu.2020.09.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/18/2020] [Accepted: 09/04/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND There are still controversies between surgical treatment and conservative treatment for multiple rib fractures (MRFs). No consensus has been reached concerning the indications and timing of surgery. In this meta-analysis, we aimed to determine the optimal treatment for MRFs. METHODS Six databases (PubMed, Medline, Embase, Cochrane, Cnki, Wanfang Database) were retrieved for all eligible randomized controlled trials (RCTs) published before January 2020. MRFs were treated either with operative reduction and internal fixation or conservative treatment. The pertinent data were retrieved. The quality of RCTs was evaluated by the modified Jadad rating scale and meta-analysis was performed using RevMan 5.3 software. RESULTS Seven RCTs involving 538 MRFs patients (260 were treated surgically vs. 278 conservatively) were included in this meta-analysis. Compared with conservative treatment, surgical treatment resulted in shorter length of hospital stay (WMD -8.48; 95% CI -11.34 to -5.63; P < 0.001), length of ICU stay (WMD -5.72; 95% CI -7.31 to -4.13; P < 0.001) and duration of mechanical ventilation (WMD -4.93; 95% CI -8.79 to -1.07; P = 0.01), with a lower risk of complications including pneumonia (RR 0.40; 95% CI 0.30 to 0.53; P < 0.001) and chest wall deformity (RR 0.07; 95% CI 0.03 to 0.14; P < 0.001). The sensitivity analysis carried out by excluding one study with significant heterogeneity showed that the rate of tracheostomy was lower in the surgical group than in the conservative group (RR 0.44; 95% CI 0.28 to 0.71; P = 0.0008). CONCLUSIONS For patients with MRFs, surgical treatment resulted in faster recovery, a lower risk of complications and better prognosis than conservative treatment.
Collapse
Affiliation(s)
- Rui Long
- Department of Emergency, Daping Hospital, Army Medical University, Chongqing, China; Medical Center of Trauma and War Injury, Daping Hospital, Army Medical University, Chongqing, China
| | - Junying Tian
- Department of Foreign Language, Chongqing Medical University, Chongqing, China
| | - Shasha Wu
- Intensive Care Unit, Daping Hospital, Army Medical University, Chongqing, China
| | - Yang Li
- Medical Center of Trauma and War Injury, Daping Hospital, Army Medical University, Chongqing, China
| | - Xiuhua Yang
- Department of Emergency, Daping Hospital, Army Medical University, Chongqing, China; Medical Center of Trauma and War Injury, Daping Hospital, Army Medical University, Chongqing, China
| | - Jun Fei
- Department of Emergency, Daping Hospital, Army Medical University, Chongqing, China; Medical Center of Trauma and War Injury, Daping Hospital, Army Medical University, Chongqing, China.
| |
Collapse
|
8
|
Onodera K, Ohashi Y, Tsunoda N, Kawai T, Miyamoto I, Yamada H. Computer-assisted surgery to treat fracture of an atrophic mandible. JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY, MEDICINE, AND PATHOLOGY 2020. [DOI: 10.1016/j.ajoms.2020.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|