Objective:To evaluate the effect of early and late open reduction and internal fixation on multiple rib fractures.Methods:The related literatures of early and late open reduction and internal fixation of multiple rib fractures were searched in PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, WanFang database, VIP database and China Biology Medicine database. The retrieved literatures were screened according to the inclusion criteria and exclusion criteria. The quality of the literature was strictly evaluated and Meta analysis was carried out by using Stata 15.0 software. The open reduction and internal fixation within 72 hours after injury (early operation group) and more than 72 hours after injury (late operation group) were compared in the incidence of pulmonary complications, chest pain improvement rate, duration of postoperative ventilator-assisted ventilation, postoperative chest X-ray improvement time, postoperative bed rest time, duration of postoperative chest tube retention, length of hospitalization, operation time and mortality rate.Results:A total of 11 studies with 712 patients were included. There were 360 patients in early operation group and 352 patients in late operation group. The two groups showed significant differences in the incidence of pulmonary complications ( OR=0.25, 95% CI 0.16-0.37, P<0.01), chest pain improvement rate ( OR=6.15, 95% CI 1.63-23.27, P<0.01), duration of postoperative ventilator-assisted ventilation ( SMD=-0.97, 95% CI -1.70--0.24, P<0.01), postoperative chest X-ray improvement time ( SMD=-15.91, 95% CI -18.42--13.41, P<0.01), postoperative bed rest time ( SMD=-11.07, 95% CI -12.31--9.84, P<0.01), duration of post-operative chest tube retention ( SMD=-0.98, 95% CI -1.77--0.20, P<0.05) and length of hospitalization ( SMD=-0.96, 95% CI -1.26--0.66, P<0.01). The operation time ( SMD=-2.44, 95% CI -4.89-0.02, P>0.05) and mortality rate ( OR=0.24, 95% CI 0.04-1.51, P>0.05) were not statistically different between the two groups. Conclusion:Early open reduction and internal fixation in the treatment of multiple rib fractures can reduce pulmonary complications and chest pain and shorten postoperative ventilator-assisted ventilation time, postoperative chest X-ray improvement time, postoperative bed rest time, duration of postoperative chest tube retention and hospital stay, but cannot shorten operation time or reduce mortality.

目的 对手术和传统方法治疗多发性肋骨骨折进行系统评价,对比其疗效.方法 计算机检索中国期刊全文数据库(CNKI)、万方数据库(Wanfang)、维普期刊数据库(VIP)、PubMed、OVID、EMbase、TheCochrane Library、Thieme及Springer Link数据库.收集有关手术和传统方法治疗多发性肋骨骨折的随机对照研究(RCT),检索时限为各数据库建库至2019年7月.对文献进行筛选、质量评价及数据提取.Meta分析采用RevMan 5.3软件.结果 共纳入文献12篇,患者1 039例.其中手术组512例,传统组527例.Meta分析显示:两组在肺部感染发生率[RR=0.41,99％CI (0.29,0.58),P＜0.000 01]、肺不张发生率[RR=0.24,99％CI(0.06,0.94),P=0.007]、呼吸机支持时间[SMD=-2.64,99％CI(-4.38,-0.91),P＜0.000 1]、住ICU时间[SMD=-1.33,99％a(-2.26,-0.40),P=0.0002]、总体住院时间[SMD=-2.25,99％CI (-3.30,-1.19),P＜0.000 01]、胸壁畸形发生率[RR=0.08,99％CI (0.04,0.17),P＜0.000 01]等方面差异有统计学意义.在住院死亡率[RR=0.75,99％CI(0.23,2.46),P=0.53]、气管切开率[RR=0.69,99％CI (0.39,1.21),P=0.09]、呼吸机支持率[RR=0.65,99％CI(0.41,1.05),P=0.02]、胸腔引流时间[SMD=-2.58,99％CI(-6.41,1.25),P=0.08]等方面差异无统计学意义.结论 手术治疗多发性肋骨骨折能够减少肺部并发症、缩短住院时间、降低胸壁畸形发生率,有利于患者快速康复和改善生活质量.

Objective The treatment of multiple rib fractures is worthy of consideration. A Meta-analysis on the surgical and conservative treatment of multiple rib fractures was carried out in this paper to explore the curative effect of these methods and provide some medical evidence. Methods Articles about randomized controlled trials (RCT) on the surgical and conservative treatment of multiple rib fractures were retrieved from the PubMed, Embase and Cochrane library databases, and were screened then to extract the data. The results were displayed by forest plots. Results This study included 5 articles and 337 cases which were divided into the surgical group (161 cases) and conservative group (176 cases). The Meta-analysis showed that differences between the two groups in respirator support time, intensive care unit (ICU) stay time, length of stay, and the incidence of pulmonary infection, chest wall deformity, chest tightness and breathlessness on exertion were statistically significant, and the differences between the two groups in the rate of tracheotomy and in-hospital mortality were not statistically significant. Conclusion The surgical treatment of multiple rib fractures can shorten the respirator support time, ICU stay time and length of stay, and reduce the incidence of pulmonary infection and chest disability, but this should be verified further by more randomized controlled trials. Key words: rib fractures; flail chest; surgical intervention; conservative treatment; Meta-analysis

目的 探讨氟比洛芬酯在胸外伤手术中对老年患者应激反应及相关蛋白的影响.方法 60例美国麻醉师协会(ASA)Ⅰ~Ⅱ级需行胸外伤手术的老年患者随机分为两组各30例,对照组进行常规麻醉,观察组麻醉诱导前给予氟比洛芬酯,记录两组血压、心率(HR)、血氧等应激情况,并对镇痛效果及内皮素(ET)-1的水平变化进行对比.结果 观察组患者平均动脉压(MAP)、HR、血氧饱和度(SpO2)水平均明显优于对照组(P<0.05).观察组甲肾上腺素(NE)及ET-1水平低于对照组,但差异不明显(P>0.05).观察组患者术后1、6、12 h视觉模拟疼痛评分均明显小于对照组(P<0.05).观察组发生嗜睡、恶心呕吐等不良反应发生率,明显少于对照组,且住院时间明显少于对照组(P<0.05).结论 氟比洛芬酯能够有效减轻麻醉诱导引发的注射痛,减轻苏醒期的应激反应,减少不良反应的发生,缩短住院时间.

Objective:To explore the clinical efficacy of pneumothorax treated with thoracic closed drainage through the 4th intercostal space in the axillary frontline.Methods:From May 2014 to May 2016,100 patients with pneumothorax or pneumothorax with small amount hemothorax were randomly divide into traditional group (56 cases) and improved group (44 cases).Traditional group were treated with thoracic closed drainage through the Second intercostal space in the midclavicular line, and improved group were treated through the 4th intercostal space in the axillary frontline.The operation time,extubation time, pain degree (at the 12th hour,the 24th hour, the 36th hour after operation),drainage effect, cases of drainage pipe blockaged or fall off,cases of incision reuse for VATS (video-assisted thoracoscope surgery), adaptability after operation,satisfaction for incision site in the two groups were compared.Results:There were no significantly difference in the two groups about the operation time,extubation time,pain degree (at the 24th hour, the 36th hour after operation) and drainage effect (P>0.05), however, the pain degree in improved group was lower than that of traditional group (P<0.05).There were no cases of drainage pipe blockaged or fall off in two groups.The incision in improved group were all reused successfully in VATS.The rate in improved group of adaptability after operation were higher than that of traditional group,and the similar results about satisfaction for incision site.Conclusion:In most cases, treating pneumothorax by thoracic closed drainage through the 4th intercostal space in the axillary frontline revealed reliable result, well adaptability and can meet the requirements of the beauty,deserve the clinical expansion.

[Objective] To explore the expression level and clinical significance of poly ADP-ribose polymerase (PARP) protein in esophageal cancer.[Methods] A total of 84 cases with esophageal cancer undergoing the operation in our hospital were selected from May 2014 to February 2015 and divided into the observation group.There were 20 health-checkup examinees with normal esophageal mucosa in the control group.The mRNA and protein expression levels of PARP in both groups were detected by quantitative real-time polymerase chain reaction (QRT-PCR) and immunohistochemistry.The relationship between PARP expression and clinical pathological factors was analyzed.[Results] The mRNA expression level of PARP was significantly higher than that in the control group (P＜0.05).The positive protein expression rate of PARP in esophageal cancer tissues was also significantly higher than that in normal esophageal mucosa (P＜0.05).In patients with esophageal cancer,the expression rate of PARP was correlated with the differentiation degree of esophageal cancer,TMN stage,invasion depth and lymph node metastasis (P＜0.05),while it was unrelated to age,gender and tumor sites (P ＞ 0.05).[Conclusion] The over-expression of PARP may be involved in the occurrence and development of esophageal cancer.The detection of PARP expression may play an auxiliary role in the treatment for esophageal cancer.

The skeletal thorax supports and protects the internal organs,as well as participates in respiration.Chest trauma or chest wall surgery tends to thoracic destabihzation and chest wall defects.In the corresponding treatment,materials for thoracic reconstruction are the core element,and have been continuously improved by professionals in the field of medical materials.With the development of medical materials,inert metals,artificial materials and tissue engineering materials have been widely applied for thoracic fixation and rehabilitation.And thoracic surgeons have been summarizing the indications in clinical practice.As a result,materials for thoracic reconstruction will be more diversified and individualized.This article reviewed the features of clinical common materials for thoracic reconstruction in recent years in order to guide clinicians in practice.

Objective To systemic evaluate thoracoscopic lobectomy and open chest operation for the treatment of pe -ripheral lung cancer treatment.Methods Computer searched on Embase, PubMed, OVID, Springer Link, Cochrane Library, CNKI, CBMdisc, VIP database, collected thoracoscopic and open chest surgical treatment for peripheral lung cancer , research types include:randomized controlled trials ( RCT ) and non random control test ( non-RCT ) .2 researchers independently evaluated the quality of the literature and extracted the relevant data , using RevMan5.3 software for Meta analysis .In order to improve the reliability , RCT research and Non-RCT study were evaluated respectively .Results A total of 15 articles were in-cluded, 383 patients of 6 studies were RCT, 1 085 patients of 9 studies were Non-RCT.(1)RCT study:the thoracoscope op-eration (CVATS) group and thoracic operation group in the number of lymph node dissection ( SMD =-0.26, 95%CI-0.63 to 0.11, P =0.16),operation time (SMD=0.20, 95%CI -0.10 to 0.49, P =0.19) had no significant differ-ences;in the amount of bleeding(SMD=-1.46, 95%CI -2.50 to -0.42, P =0.006),drainage (SMD=-1.26,95%CI-2.13 to -0.39, P =0.005),extubation time (SMD=-2.05,95%CI -3.35 to -0.75, P =0.002),CRP after first days (WMD=-20.32, 95%CI -24.50 to -17.06, P <0.01), CRP after the fifth day of operation (WMD=-19.78, 95%CI -22.54 to -17.06, P <0.01), postoperative ambulation (WMD =-1.84,95%CI -2.35 to -1.33, P <0.01),hospitalization time (SMD=-2.54, 95% CI -3.88 to -1.19, P =0.000 2), complications rate (RR=0.35, 95%CI 0.20 to 0.63, P =0.000 4) showed statistically significant.(2)Non-RCT groups:CVATS group and thoracic opera-tion group's number of lymph node dissection (SMD=0.04, 95%CI -0.27 to 0.34, P =0.81), postoperative complications (OR=0.69, 95%CI 0.41 to 1.15, P =0.15), 1 year survival rate (OR=1.61, 95%CI 0.26 to 9.83, P =0.61) showed no significant difference;operation time (SMD=0.71, 95%CI 0.22 to 1.20, P <0.01), loss of blood amount (SMD=-1.32, 95%CI -1.94 to -0.70, P <0.01), drainage (SMD=-2.20, 95%CI -3.66 to -0.74, P =0.003), tho-racic drainage tube placement time (SMD=-1.42, 95%CI -2.46 to -0.38, P <0.01), the level of CRP at first day af-ter operation (WMD=-1.78, 95%CI -2.24 to -1.33, P <0.01), the level of CRP at fifth days after operation (SMD=-1.89, 95%CI -3.01 to 0.78, P <0.01), hospitalization time (SMD=-1.38, 95%CI -1.96 to -0.79, P <0.01) showed statistical differences .Conclusion The clinical efficacy of the surgical treatment of peripheral lung carcinoma in the treatment of peripheral lung cancer is very similar to that of surgical treatment .

【Objective】 By comparing the benefit-risk ratioin patients with deep venous thrombosis(DVT),continued to be treated with low molecule weight heparin(LMWH) or vitamin K antagonists(VKA),to explore the more effective,safe and convenient therapeutic regimen.【Methods】 Patients fit the standard in this study from December 2008 to March 2011 were randomly divided into two groups.Patients in Group A were treated with Low-molecular-weight heparins calcium injection,and Warfarin in Group B.A follow-up visit was perpormed every two months for half a year,the content including whether there was bleed,heparin-induced thrombocytopenia(HIT),and the recrudescence event occurs,in this period hemoglutination function and platelet count were monitored regularly,and according to the date to make adjustment in medication plan.【Results】 Effective anticoagulation was obtained in the two groups,and the incidence rate of side effect in group A was lower than that in group B obviously(P0.05).There was no difference about the rate of recrudescence in DVT(P0.05),but along with the anticoagulant time expand,the hemorrhage rate increasedin the two groups.However,in the DVT recrudescence patient.The rate in ilio-femoral vein was the highest,next was femoral vein,and finally was popliteal vein.Patient treated with LMWH revealed a better compliance.【Conclusion】 Using LWMH for patients with DVT outside hospital continuely revealed reliable result and high medication security,low side effect,simple operation and monitor,so it is better in benefit-risk than using VKA.

【Objective】By comparing the curative effect and adverse events in treating calcanodynia by fumigation with Traditional Chinese Medicine and local blocking respectively,to explore the effective and convenient therapeutic treatment modality.【Methods】 130 cases of calcanodynia were randomily divided into two groups 65 in each.Cases of Group A were treated by fumigation with Traditional Chinese Medicine,and local blocking in Group B.Curative effect and adverse events were recorded and analyzed.【Results】There were no significant different in Group A and Group B on the effective rate of treatment(P 0.05).In group A,drug allergy was observed in 2 cases and mildly scalded in 3.In group B,incision infection was observed in 2 cases,hypodermic gore in 6 and subcutaneous nodules formation in 3.The statistical results show that the percentage of adverse events in group A was lower than that of group B(P 0.05).【Conclusion】The modality was effective,simple and dependable in treating calcanodynia with fumigation with Traditional Chinese Medicine.