非手术疗法和手术治疗肋骨骨折疗效的Meta分析

Meta-analysis of the therapeutic efficacy of non-surgical treatment and surgical treatment on rib fractures

目的探讨非手术疗法和手术治疗肋骨骨折的疗效。方法计算机检索PubMed、Ovid、Embase、Web of Science、Cochrane图书馆、中国知网(中文期刊全文数据库)、万方数据库、维普数据库,收集建库至2019年11月有关手术和非手术疗法治疗肋骨骨折的随机对照研究(RCT),对相关文献按标准进行筛选、质量评价及获取相关数据。采用Review Manager 5.3软件进行Meta分析。结果共纳入11篇文献,患者909例,其中手术组448例,保守组461例。Meta分析显示,和保守组比较,手术组在肺部感染发生率[RR=0.41,95%CI(0.31,0.55),P<0.00001]、总住院时间[SMD=-1.86,95%CI(-2.52,-1.20),P<0.00001]、呼吸机支持时间[SMD=-1.97,95%CI(-2.97,-0.97),P=0.0001]比较,差异有统计学意义(P<0.05);两组在死亡率[RR=0.84,95%CI(0.34,2.08)]比较,差异无统计学意义(P>0.05)。结论手术治疗肋骨骨折在减少住院时间、降低肺部并发症方面具有一定优势,可改善患者预后。

Objective To investigate the therapeutic efficacy of non-surgical treatment and surgical treatment on rib fractures.Methods PubMed,Ovid,Embase,Web of Science,Cochrane Library,China Knowledge Network(full-text database of Chinese periodicals),Wanfang database and VIP database were searched by computer,and randomized controlled trials(RCT)were collected on surgical and non-surgical treatment on rib fractures from November 2019.According to the standards,the relevant literatures were screened,quality evaluated,and relevant data were obtained.Review Manager 5.3 software was used for Meta-analysis.Results A total of 11 literatures were included,with 909 patients,including 448 cases in the surgical group and 461 cases in the conservative group.It was showed by Meta-analysis that,compared with the conservative group,there were statistically significant differences in the incidence of pulmonary infection(RR=0.41,95%CI[0.31,0.55],P<0.00001),total hospitalization time(SMD=-1.86,95%CI[-2.52,-1.20],P<0.00001)and respirator support time(SMD=-1.97,95%CI[-2.97,-0.97],P=0.0001)in the surgical group(P<0.05).There was no statistically significant difference in mortality(RR=0.84,95%CI[0.34,2.08])between the two groups(P>0.05).Conclusion Surgical treatment of rib fractures has certain advantages in reducing hospitalization time and pulmonary complications,which can improve the prognosis of patients.