摘要
目的系统评价保守治疗与切开复位内固定术治疗多发肋骨骨折的疗效。方法计算机检索PubMed、EMbase、The Cochrane Library、Web of Science、WanFang Data、CNKI和VIP数据库,搜集关于切开复位内固定术与保守治疗比较治疗多发肋骨骨折的随机对照试验(RCT)和队列研究,检索时限均从建库至2017年12月。由2位评价员独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan5.3软件进行Meta分析。结果共纳入16个研究(4个RCT,12个队列研究),包括1 374例患者,其中切开复位内固定组723例,保守治疗组651例。Meta分析结果显示:切开复位内固定组的ICU住院天数[MD=–3.41,95%CI(–4.39,–2.43),P<0.000 01]、总住院天数[MD=–7.60,95%CI(–10.67,–4.53),P<0.000 01]、肺不张发生率[RR=0.40,95%CI(0.29,0.54),P<0.000 01]、肺部感染发生率[RR=0.43,95%CI(0.30,0.61),P<0.000 01]和胸壁畸形发生率[RR=0.05,95%CI(0.03,0.11),P<0.000 01]均少于对照组。结论与保守治疗相比,切开复位内固定术在治疗多发肋骨骨折方面可明显减少患者住院时间,降低围术期并发症的发生率,改善患者预后,更有利于多发性肋骨骨折患者康复。受纳入研究数量和质量限制,上述结论尚待更多高质量研究予以验证。
Objectives To systematically review the efficacy of conservative treatment and open reduction with internal fixation for multiple rib fractures.Methods We searched WanFang Data,CNKI,VIP,PubMed,EMbase,The Cochrane Library and Web of Science from inception to December 2017to collect studies on conservative treatment and open reduction with internal fixation for multiple rib fractures.Two reviewers independently screened literature,extracted data,and assessed the risk of bias of included studies.RevMan 5.3software was used for meta-analysis.Results A total of 16 studies were included,involving 1374patients,723patients in the surgical group and 651patients in the conservative group.The meta-analysis showed that the length of stay in the ICU (MD=-3.41,95% CI -4.92 to -2.43, P<0.00001),total length of stay (MD=-7.60,95% CI-10.67 to-4.53,P<0.00001),incidence of pulmonary arylene (RR=0.40,95% CI 0.29 to 0.54,P<0.00001),incidence of lung infections (RR=0.43,95% CI 0.30 to 0.61,P<0.00001),and incidence of chest wall malformation (RR=0.05,95% CI 0.03 to 0.11,P<0.0.00001)in the surgical group were superior to the conservative group.Condusions Compared with conservative treatment,open reduction with internal fixation cansignificantly improve the recovery time of patients with multiple rib fractures,reduce hospitalization time,the incidence of perioperative complications,and significantly enhance the prognosis of patients,which is more conducive to the rehabilitation of patients.
作者
宋锐强
邓彦超
王志鹏
宗亮
张海平
SONG Ruiqiang;DENG Yanchao;WANG Zhipeng;ZONG Liang;ZHANG Haiping(Department of Thoracic Surgery,the First Affiliated Hospital of Xinjiang Medical University,Urumqi,830001,P.R.China;Department of Thoracic Surgery,the Affiliated Hospital of Weifang Medical University,Weifang,262600,P.R.China)
出处
《中国循证医学杂志》
CSCD
北大核心
2018年第12期1329-1336,共8页
Chinese Journal of Evidence-based Medicine
关键词
多发性肋骨骨折
切开复位内固定术
胸壁畸形发生率
系统评价
Meta分析
随机对照试验
队列研究
外科手术
Multiple rib fracture
Open reduction and internal fixation
Incidence of chest wall malformation
Systematic review
Meta-analysis
Randomized controlled trials
Cohort study
Surgery
