切开复位内固定术与非手术治疗多发肋骨骨折疗效的Meta分析

Meta-analysis of open reduction internal fixation and non-operative treatment of multiple rib fractures

目的比较切开复位内固定术与非手术治疗多发肋骨骨折的疗效。方法检索1990—2016年Pubmed、Embase、中国知网（CNKI）、中国生物医学文献库（CBM）、万方数据库、维普数据库（VIP），收集切开复位内固定术与非手术治疗多发肋骨骨折疗效对比研究的相关文献进行质量评价。比较切开复位内固定术与非手术治疗在住院时间、ICU住院时间、呼吸机支持天数、肺部炎症比例、肺不张比例及肺功能相关指标等方面的差异。结果共纳入11篇文献，涉及799例患者，其中内固定组431例，非手术组368例。与非手术组比较，内固定组在住院时间（95％CI-11．00～-3．34，P〈0．05）、ICU住院时间（95％CI-4．48～-1．29，P〈0．05）、呼吸支持天数（95％CI-7．52～-1．54，P〈0．05）、肺部炎症比例（95％CI0．19～0．42，P〈0．05）、肺不张比例（95％CI0．24～0．57，P〈0．05）、肺总量（95％CI1．57～1．97，P〈0．05）、用力肺活量（95％CI0．98～1．27，P〈0．05）、第1秒用力呼气容积（FEV1）（95％CI0．68～0．95，P〈0．05）方面差异有统计学意义。结论切开复位内固定治疗多发肋骨骨折可明显提高患者康复速度、降低住院期间肺部并发症的发生率，术后更利于患者肺功能恢复。

Objective To compare the efficacy between open reduction internal fixation and nonoperative treatment of multiple rib fractures. Methods Pubmed, Embase, Chinese National Knowledge Infrastructure database （CNKI）, Chinese Biological Medical Literature database （CBM）, Wanfang database and VIP database were searched for relevant studies comparing the effect of open reduction internal fixation and non-operative treatment of multiple rib fractures during 1990 and 2016. RevMan 5.3 software was used for the meta-analysis to compare differences of the two treatments concerning hospital stay, total ICU stay, duration of mechanical ventilation, proportion of pneumonia and atelectasis and pulmonary function. Results Eleven studies containing 799 patients met the inclusion criteria, including 431 patients in internal fixation group and 368 patients in non-operative group. Two groups had significant differences in hospital stay （95% CI -11.00-- 3.34, P 〈 -0.05）, total ICU stay （95% CI - 4.48- - 1.29, P 〈 0. 05 ）, duration of mechanical ventilation （ 95 % CI - 7.52- - 1.54, P 〈 0. 05 ） , proportion of pneumonia （95% CI 0. 19-0.42, P 〈 0.05 ）, proportion of atelectasis （95% CI 0. 24-0.57, P 〈0.05） and total lung capacity （95% CI 1.57-1.97, P 〈0.05）, forced vital capacity （FVC） （95% CI 0. 98-1.27, P 〈 0.05 ） and forced expiratory volume in one second （ FEV1 ） （95% CI 0. 68-0.95, P 〈 0.05 ）. Conclusion Open reduction internal fixation of multiple rib fractures can significantly improve rehabilitation rate,reduce incidence of pulmonary complications during hospitalization, and facilitate recovery of lung function.