中国循证医学杂志

中国循证医学杂志

保守治疗与切开复位内固定术治疗多发肋骨骨折疗效的系统评价

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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[OR=0.29,95%CI(0.19,0.43),P<0.000 01]、肺部感染发生率[OR=0.26,95%CI(0.19,0.37),P<0.000 01]和胸壁畸形发生率[OR=0.03,95%CI(0.01,0.14),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以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的限制,上述结论尚待更多高质量研究予以验证。

Objective To systematically review the efficacy of conservative treatment and open reduction and 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 2017 to collect studies about conservative treatment and open reduction and internal fixation for multiple rib fractures. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of included studies. RevMan 5.3 software was used for meta-analysis. Results A total of 16 studies were included, involving 1 374 patients, 723 patients in the surgical group and 651 patients 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<0.000 01), total length of stay (MD=–7.60, 95 %CI–10.67 to–4.53,P<0.000 01), incidence of pulmonary arylene (OR=0.29, 95%CI 0.19 to 0.43,P<0.000 01), incidence of lung infections (OR=0.26, 95%CI 0.19 to 0.37,P<0.000 01), incidence of chest wall malformation (OR=0.03, 95%CI 0.01 to 0.14,P<0. 0.000 01) in the surgical group were superior to the conservative group. Conclusion Compared with conservative treatment, open reduction and internal fixation can significantly improve the recovery time of patients with multiple rib fractures, reduce the hospitalization time, the incidence of perioperative complications, significantly improve the prognosis of patients, and is more conducive to the rehabilitation of patients.

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

Key words: Multiple rib fracture; Open reduction and internal fixation; Incidence of chest wall malformation; Systematic review; Meta-analysis; Randomized controlled trials; Cohort study; Surgery

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