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Objective <p>To systematically evaluate the perioperative safety and short- and long-term efficacy of minimally Invasive fixation using a reversed shape-memory alloy plate versus conventional open fixation for the treatment of flail chest in elderly patients.</p> Methods <p>This prospective cohort study enrolled 130 elderly patients (≥ 60 years) with flail chest between January 2022 and January 2026. After 1:1 propensity score matching, 100 patients were included (minimally invasive group, <i>n</i> = 50; open group, <i>n</i> = 50). Perioperative parameters (operative time, blood loss, C-reactive protein(CRP) at 24&#xa0;h/48&#xa0;h/72&#xa0;h, complications), short-term outcomes (resting/cough-evoked Numerical Rating Scale(NRS) pain scores, non-steroidal analgesic drug duration, rescue analgesic frequency, Patient-Controlled Analgesia Pump(PCA) consumption, time to ambulation, hospital stay), and long-term outcomes (implant dislodgement, 6-month pulmonary function, Douleur Neuropathique 4 Questions Naire(DN4), Medical Outcomes Study 36- Item Short Form Health Survey(SF-36)) were compared.</p> Results <p>The minimally invasive group had significantly fewer incision-related complications (<i>P</i> = 0.046), lower resting NRS scores on postoperative days 1 and 3 (<i>P</i> &lt; 0.01; <i>P</i> = 0.041), lower cough-evoked NRS score on day 1 (<i>P</i> = 0.011), shorter non-steroidal analgesic duration (<i>P</i> &lt; 0.01), and lower PCA consumption (<i>P</i> = 0.027). At 6 months, the minimally invasive group showed significantly lower DN4 scores (<i>P</i> = 0.03). No significant differences were observed in other outcomes.</p> Conclusion <p>minimally invasive fixation with a reversed shape-memory alloy plate is a safe, effective minimally invasive technique for elderly flail chest patients, offering advantages in incision-related complications, early pain control, analgesic requirements, and reduced risk of chronic neuropathic pain.</p>

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Minimally invasive versus open fixation for flail chest in elderly patients: a prospective cohort study on perioperative safety and long-term outcomes

  • 期刊论文

  • 发表日期：

    2026年6月1日

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  • Yang Tian,
  • Zhaowei Zheng,
  • Zhihao Ji,
  • Wei Lu,
  • Nannan Song,
  • Jun Wang

摘要

Objective

To systematically evaluate the perioperative safety and short- and long-term efficacy of minimally Invasive fixation using a reversed shape-memory alloy plate versus conventional open fixation for the treatment of flail chest in elderly patients.

Methods

This prospective cohort study enrolled 130 elderly patients (≥ 60 years) with flail chest between January 2022 and January 2026. After 1:1 propensity score matching, 100 patients were included (minimally invasive group, n = 50; open group, n = 50). Perioperative parameters (operative time, blood loss, C-reactive protein(CRP) at 24 h/48 h/72 h, complications), short-term outcomes (resting/cough-evoked Numerical Rating Scale(NRS) pain scores, non-steroidal analgesic drug duration, rescue analgesic frequency, Patient-Controlled Analgesia Pump(PCA) consumption, time to ambulation, hospital stay), and long-term outcomes (implant dislodgement, 6-month pulmonary function, Douleur Neuropathique 4 Questions Naire(DN4), Medical Outcomes Study 36- Item Short Form Health Survey(SF-36)) were compared.

Results

The minimally invasive group had significantly fewer incision-related complications (P = 0.046), lower resting NRS scores on postoperative days 1 and 3 (P < 0.01; P = 0.041), lower cough-evoked NRS score on day 1 (P = 0.011), shorter non-steroidal analgesic duration (P < 0.01), and lower PCA consumption (P = 0.027). At 6 months, the minimally invasive group showed significantly lower DN4 scores (P = 0.03). No significant differences were observed in other outcomes.

Conclusion

minimally invasive fixation with a reversed shape-memory alloy plate is a safe, effective minimally invasive technique for elderly flail chest patients, offering advantages in incision-related complications, early pain control, analgesic requirements, and reduced risk of chronic neuropathic pain.