不同时机切开复位内固定治疗多发肋骨骨折疗效的Meta分析

Efficacy evaluation of open reduction and internal fixation in the treatment of multiple rib fractures at different timing:a Meta-analysis

目的评价早期与晚期切开复位内固定对多发肋骨骨折的影响。方法在PubMed、Embase、Cochrane Library、Web of Science、中国知网、万方数据库、维普期刊数据库及中国生物医学文献数据库,检索早期切开复位内固定与晚期切开复位内固定治疗多发肋骨骨折的相关文献。对按照纳入标准与排除标准筛选到的文献严格质量评价,采用Stata 15.0软件进行Meta分析。比较受伤72 h内切开复位内固定(早期组)与受伤72 h后切开复位内固定(晚期组)在肺部并发症发生率、胸部疼痛改善率、术后呼吸机辅助通气时间、术后胸部X线片改善时间、术后卧床时间、术后胸管留置时间、住院时间、手术时间及病死率方面的差异。结果共纳入11项研究、712例患者,其中早期组360例,晚期组352例。Meta分析结果显示,早期组与晚期组肺部并发症发生率(OR=0.25,95%CI 0.16~0.37,P<0.01)、胸部疼痛改善率(OR=6.15,95%CI 1.63~23.27,P<0.01)、术后呼吸机辅助通气时间(SMD=-0.97,95%CI-1.70~-0.24,P<0.01)、术后胸部X线片改善时间(SMD=-15.91,95%CI-18.42~-13.41,P<0.01)、术后卧床时间(SMD=-11.07,95%CI-12.31~-9.84,P<0.01)、术后胸管留置时间(SMD=-0.98,95%CI-1.77~-0.20,P<0.05)及住院时间(SMD=-0.96,95%CI-1.26~-0.66,P<0.01)比较,差异有统计学意义;而两组手术时间(SMD=-2.44,95%CI-4.89~0.02,P>0.05)和病死率(OR=0.24,95%CI 0.04~1.51,P>0.05)差异无统计学意义。结论早期切开复位内固定治疗多发肋骨骨折能够减少肺部并发症,减轻胸部疼痛,缩短术后呼吸机辅助通气时间、术后胸部X线片改善时间、术后卧床时间、术后胸管留置时间及住院时间,但不能缩短手术时间或减少病死率。

Objective To evaluate the effect of early and late open reduction and internal fixation on multiple rib fractures.Methods The related literatures of early and late open reduction and internal fixation of multiple rib fractures were searched in PubMed,Embase,Cochrane Library,Web of Science,China National Knowledge Infrastructure,WanFang database,VIP database and China Biology Medicine database.The retrieved literatures were screened according to the inclusion criteria and exclusion criteria.The quality of the literature was strictly evaluated and Meta analysis was carried out by using Stata 15.0 software.The open reduction and internal fixation within 72 hours after injury(early operation group)and more than 72 hours after injury(late operation group)were compared in the incidence of pulmonary complications,chest pain improvement rate,duration of postoperative ventilator-assisted ventilation,postoperative chest X-ray improvement time,postoperative bed rest time,duration of postoperative chest tube retention,length of hospitalization,operation time and mortality rate.Results A total of 11 studies with 712 patients were included.There were 360 patients in early operation group and 352 patients in late operation group.The two groups showed significant differences in the incidence of pulmonary complications(OR=0.25,95%CI 0.16-0.37,P<0.01),chest pain improvement rate(OR=6.15,95%CI 1.63-23.27,P<0.01),duration of postoperative ventilator-assisted ventilation(SMD=-0.97,95%CI-1.70--0.24,P<0.01),postoperative chest X-ray improvement time(SMD=-15.91,95%CI-18.42--13.41,P<0.01),postoperative bed rest time(SMD=-11.07,95%CI-12.31--9.84,P<0.01),duration of post-operative chest tube retention(SMD=-0.98,95%CI-1.77--0.20,P<0.05)and length of hospitalization(SMD=-0.96,95%CI-1.26--0.66,P<0.01).The operation time(SMD=-2.44,95%CI-4.89-0.02,P>0.05)and mortality rate(OR=0.24,95%CI 0.04-1.51,P>0.05)were not statistically different between the two groups.Conclusion Early open reduction and internal fixation in the treatment of multiple rib fractures can reduce pulmonary complications and chest pain and shorten postoperative ventilator-assisted ventilation time,postoperative chest X-ray improvement time,postoperative bed rest time,duration of postoperative chest tube retention and hospital stay,but cannot shorten operation time or reduce mortality.