Comparative Assessment of Ultra-Minimally Invasive Approach versus Thoracoscopic Internal Fixation for Multiple Rib Fractures and Associated Thoracic Trauma

This study aims to comparatively evaluate the ultra-minimally invasive rib fixation versus thoracoscopic internal fixation for pulmonary function recovery and prognosis in patients with multiple rib fractures and associated thoracic trauma.

This retrospective analysis included 120 patients with multiple rib fractures complicated by thoracic trauma admitted to Huai'an 82 Hospital between January 2020 and November 2024. Based on different surgical approaches, the patients were divided into a control group (n = 68), who received thoracoscopic internal fixation of rib fractures, and an observation group (n = 52) who underwent ultra-minimally invasive rib fracture fixation. Several surgical indices were comparatively assessed, including clinical efficacy, surgical parameters, complication rates, visual analogue scale (VAS) scores (pre- vs post-operation), pulmonary function tests, serum inflammatory marker levels, and quality of life assessments.

The overall treatment efficacy between the observation and control groups [98.08% (51/52) vs 89.71% (61/68)] was not statistically significant (p = 0.146). The observation group had significantly shorter operation time, extubation time, time to ambulation, and hospitalization time than the control group, along with significantly reduced intraoperative bleeding (p < 0.001). The groups showed significant reductions in VAS scores at 12-h, 24-h, 48-h, and 72-h postoperatively compared to the preoperative baseline, with the observation group showing significantly lower scores than the control group at all time points (p < 0.05). Furthermore, significant increases in peak expiratory flow (PEF), forced vital capacity (FVC), and forced expiratory volume in 1 second (FEV1) were observed at 14 days after the procedure compared with their preoperative values, with the observation group indicating significantly higher values (p < 0.05). Similarly, C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), and interleukin-6 (IL-6) levels were substantially elevated in both groups at 48h postoperatively compared with their preoperative values; however, the observation group demonstrated significantly lower levels than the control group (p < 0.05). Three months after the procedure, both groups showed significant improvement in all eight areas of the 36-Item Short-Form Health Survey (SF-36) domains compared with preoperative values, with the observation group demonstrating significantly higher scores than the control group (p < 0.05). Additionally, the overall postoperative complications rate did not differ substantially between the two groups [13.46% (7/52) vs 16.18% (11/68); p = 0.680].

Compared with thoracoscopic internal fixation for multiple rib fractures complicated by thoracic trauma, ultra-minimally invasive rib fracture fixation offers clear advantages, including shorter operative time, reduced intraoperative bleeding, and faster postoperative recovery, while significantly improving pulmonary function and inflammatory marker levels.