Flail chest wall external traction fixation

Traction outside the chest wall is an effective way to eliminate abnormal breathing movements. After traction is fixed, the respiratory and circulatory functions of the wounded can be quickly improved, and the chest will not be left with obvious deformation after healing. Animal experiments also observed that after traction treatment, the lung compliance of the animals increased, tidal volume increased, PaO2 increased, and PaCO2 decreased, confirming the effect of traction therapy. There are three methods for the traction and fixation of the thoracic chest and thoracic wall: 1 external fixation of the chest wall: the external fixation rib traction frame is made of several aluminum alloy slats with a thickness of 0.2cm, a width of 1.5cm and a length of 30cm. A combination of sharp stainless steel curved needles. When using, the slats are first screwed into a "well" type frame for use on both sides of the chest, or fixed into a "work" shape for use with a single side chest. The transverse frame is curved in the shape of the thorax, and a sponge pad is attached to both ends of the frame. The curvature of the stainless steel hook is just enough to bypass the ribs, and can directly puncture the skin, bypass the ribs through the inner surface of the ribs, and sag the depressed ribs. The upper end of the hook passes through the groove of the vertical frame slat, with the ingot The nut is fixed on the frame and generally needs to be fixed for 3 to 4 weeks. The frame is ribbed with the normal chest wall as the fulcrum, the structure is simple, the use is convenient, the effect is reliable, and the wounded can carry the movement, which is beneficial to the injured person to carry and evacuate. 2 towel clamp gravity traction: towel clamp gravity traction is conducive to the towel tongs to clamp the rib fracture section of the floating chest wall, with a certain gravity, suspended and fixed on the traction bed frame to correct the abnormal breathing movement of the chest wall. The advantage of this method is that the effect is indeed reliable, the fracture reduction and lung expansion are better, the disadvantage is that the wounded must stay in bed and can not get out of bed. 3 plexiglass plate chest wall external fixation: a plexiglass plate larger than the range of the floating chest wall area, drill a number of small holes in it, soaked in 70 ° C hot water to form the corresponding curvature of the thorax, the ribs used to sink The wire traction is fixed on the plexiglass plate. The advantage of this method is that the wounded can get out of bed and the chest wall deformity is not obvious after healing. Treatment of diseases: acute respiratory distress syndrome Indication Abnormal respiratory movements of the floating chest wall are obvious, and those with severe pulmonary contusion can be treated with external chest traction. If combined with severe pulmonary contusion or complicated acute respiratory distress syndrome, it is advisable to use rib internal fixation and artificial respirator to control breathing to correct respiratory failure. Surgical procedure 1. External chest wall fixed traction frame method 1 In the middle of the floating chest wall, select 1 to 2 ribs that can hold the force as the traction point. After partial infiltration anesthesia with 21% procaine, use a sterile rib to pull the hook, directly penetrate the skin along the upper edge of the rib, and circumvent the ribs against the back of the rib, gently hook the ribs and fix it on the aluminum alloy traction frame. . 3 Adjust the ingot nut to tighten and restore the thorax to normal to correct abnormal breathing. The fulcrum of the 4 frame should be placed on the normal thorax on both sides. Depending on the size of the floating chest wall, it can be pulled at one or more points. The double-sided floating chest wall adopts the "well" type traction frame, and the one-side floating chest wall adopts the "work" type traction frame. 5 After 2 to 3 weeks of general traction, the traction frame can be removed. 2. towel clamp gravity traction method 1 Infiltrate the anesthesia on the upper and lower edges of the selected rib fracture segment, puncture a small mouth with a sharp knife, and clamp the rib with a towel clamp. 2 Attached to the tail of the towel pliers with a traction rope and attached to the traction frame. 3 Traction by pulley with 2~3kg weight, the traction time is 2~3 weeks. 3. Plexiglass external fixation method 1 Select 2 to 3 rib fracture segments in the middle of the floating chest wall as the traction point. 2 After local infiltration anesthesia, use a towel clamp to lift the softened chest wall, cut a small opening in the upper edge of the rib of the traction point, use an aneurysm needle or a large-sized skin suture needle, and pass through the soft tissue of the chest wall and bypass the inner side of the rib. With the parietal pleura through the free chest cavity from the lower edge of the rib, introduce the wire. 3 Fix the wire on the prefabricated plexiglass plate and tighten it to correct the abnormal breathing movement.