Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands.
Injury. 2020 Nov;51(11):2368-2378. doi: 10.1016/j.injury.2020.07.009. Epub 2020 Jul 3.
Surgical rib stabilization in flail chest is proven to be beneficial over nonoperative treatment in terms of rate of pneumonia, Intensive Care (IC) length of stay (ICLOS) and mechanical ventilation days. The aim of this systematic review and meta-analysis was to evaluate the effect of operative versus nonoperative treatment on the occurrence of pneumonia and other relevant clinical outcomes in patients with multiple simple rib fractures.
A search was performed in Embase, Medline Ovid, Cochrane Central, Web of Science, and Google Scholar. The primary outcome was the occurrence of pneumonia. Secondary outcomes were duration of mechanical ventillation, ICLOS, hospital length of stay (HLOS), mortality, and wound infections. Publication bias was assessed using funnel plots for the outcome measures and random-effect models were used when heterogeneity of data on outcome measures was significant (I≥40%).
The search resulted in 592 unique records, of which 14 studies on 13 cohorts were included. The 14 studies comprised five prospective and nine retrospective cohort studies with a cumulative total of 4565 patients. Meta-analysis showed a significant decrease of the occurrence of pneumonia (n=2659 patients; risk ratio, RR=0.66; 95% confidential interval [CI] 0.49 to 0.90; p=0.008), mortality (n=4456 patients; RR=0.32; 95% CI 0.19 to 0.54; p<0.001), and HLOS (n=648 patients; mean difference, MD=-5.78 days; 95% CI -10.40 to -1.15; p=0.01) in favor of operative treatment. No effect of operative treatment was found for the duration of mechanical ventilation (n=113 patients; MD=-6.01 days; 95% CI =-19.61 to 7.59; p=0.39), or ICLOS (n=524 patients; MD=-2.93 days; 95% CI -8.65 to 2.80; p=0.32). The postoperative wound infection rate ranged from 0 to 9.4%.
Surgical treatment of multiple simple rib fractures may result in a significant reduction of pneumonia, mortality, and hospital length of stay. A reducing effect of treatment on the duration of mechanical ventilation and IC length of stay, was not demonstrated. However, due to nonstandard or absent definitions of outcome measures as well as heterogenous patient groups and the observational design of studies, results must be interpreted with caution and high-quality studies are needed.
与非手术治疗相比，手术肋骨固定在连枷胸方面被证明在肺炎发生率、重症监护（IC）住院时间（ICLOS）和机械通气天数方面更具优势。本系统评价和荟萃分析的目的是评估手术与非手术治疗对多发性单纯肋骨骨折患者肺炎和其他相关临床结局的影响。
在 Embase、Medline Ovid、Cochrane 中心、Web of Science 和 Google Scholar 中进行了检索。主要结局是肺炎的发生。次要结局是机械通气时间、ICLOS、住院时间（HLOS）、死亡率和伤口感染。使用漏斗图评估结局指标的发表偏倚，如果数据在结局指标上存在显著异质性（I≥40%），则使用随机效应模型。
搜索结果产生了 592 条独特的记录，其中 14 项研究纳入了 13 个队列。这 14 项研究包括 5 项前瞻性和 9 项回顾性队列研究，共有 4565 名患者。荟萃分析显示，手术治疗显著降低了肺炎（n=2659 例；风险比，RR=0.66；95%置信区间 [CI] 0.49 至 0.90；p=0.008）、死亡率（n=4456 例；RR=0.32；95% CI 0.19 至 0.54；p<0.001）和 HLOS（n=648 例；平均差异，MD=-5.78 天；95% CI-10.40 至-1.15；p=0.01）。手术治疗对机械通气时间（n=113 例；MD=-6.01 天；95% CI-19.61 至 7.59；p=0.39）或 ICLOS（n=524 例；MD=-2.93 天；95% CI-8.65 至 2.80；p=0.32）无影响。术后伤口感染率为 0 至 9.4%。
手术治疗多发性单纯肋骨骨折可显著降低肺炎、死亡率和住院时间。但治疗对机械通气时间和 IC 住院时间的影响没有显示出降低的效果。然而，由于结局测量的非标准化或缺失定义以及异质的患者群体和研究的观察设计，结果必须谨慎解释，需要高质量的研究。
