Federal University of Santa Catarina, R. João Pio Duarte, 144, Córrego Grande, Florianópolis, SC, 88037-000, Brazil.
University of the Extreme South of Santa Catarina, Criciúma, Santa Catarina, Brazil.
Eur J Trauma Emerg Surg. 2023 Dec;49(6):2531-2541. doi: 10.1007/s00068-023-02339-0. Epub 2023 Aug 1.
Conflicting evidence exists on the choice of surgical or non-surgical treatment of flail chest injuries. We aimed to perform a meta-analysis comparing outcomes in patients presenting flail chest undergoing surgical or non-surgical treatment.
Embase, PubMed, and Cochrane databases were searched for randomized controlled trials (RCTs) comparing surgery to no surgery in patients with acute unstable chest wall injuries. We computed weighted mean differences (WMDs) for continuous outcomes and risk ratios (RRs) for binary endpoints, with 95% confidence intervals (CIs). Random effects meta-analyses were performed. Heterogeneity was assessed using I statistics.
Six RCTs (544 patients) were included, and surgical treatment was used in 269 (49.4%). Compared to no surgery, surgery reduced mechanical ventilation days (WMD - 4.34, 95% CI - 6.98, - 1.69; p < 0.01; I = 87%; GRADE: very low; PI - 13.51, 4.84); length of intensive care unit stay (WMD - 4.62, 95% CI - 7.19, - 2.05; p < 0.01; I = 78%; GRADE: low; PI - 12.86, 3.61) and the incidence of pneumonia (RR 0.50, 95% CI 0.31, 0.81; p = 0.005; I = 54%; GRADE: moderate; PI 0.13, 1.91). No difference in mortality (RR 0.56, 95% CI 0.19, 1.65; p = 0.27; I = 23%; GRADE: moderate; PI 0.04, 7.25), length of hospital stay (WMD - 5.39, 95% CI - 11.38, - 0.60; p = 0.08; I = 89%; GRADE: very low; PI - 11.38, 0.60), or need for tracheostomy (RR 0.59, 95% CI 0.34, 1.03; p = 0.06; I = 54%; GRADE: moderate; PI 0.11, 3.24) was found.
Our results suggest that surgical treatment is advantageous compared to non-surgical treatment for patients with flail chest secondary to rib fractures.
对于连枷胸损伤的手术或非手术治疗选择，存在相互矛盾的证据。我们旨在进行一项荟萃分析，比较连枷胸患者接受手术与非手术治疗的结果。
检索 Embase、PubMed 和 Cochrane 数据库，以纳入比较急性不稳定胸壁损伤患者手术与非手术治疗的随机对照试验（RCT）。我们计算了连续结局的加权均数差（WMD）和二分类结局的风险比（RR），置信区间（CI）为 95%。采用随机效应荟萃分析。使用 I ² 统计评估异质性。
纳入了 6 项 RCT（544 例患者），其中 269 例（49.4%）接受了手术治疗。与非手术治疗相比，手术治疗可减少机械通气天数（WMD -4.34，95%CI -6.98，-1.69；p<0.01；I²=87%；GRADE：极低；PI-13.51，4.84）、重症监护病房住院时间（WMD -4.62，95%CI -7.19，-2.05；p<0.01；I²=78%；GRADE：低；PI-12.86，3.61）和肺炎发生率（RR 0.50，95%CI 0.31，0.81；p=0.005；I²=54%；GRADE：中；PI 0.13，1.91）。死亡率（RR 0.56，95%CI 0.19，1.65；p=0.27；I²=23%；GRADE：中；PI 0.04，7.25）、住院时间（WMD -5.39，95%CI -11.38，-0.60；p=0.08；I²=89%；GRADE：极低；PI-11.38，0.60）或气管切开术需求（RR 0.59，95%CI 0.34，1.03；p=0.06；I²=54%；GRADE：中；PI 0.11，3.24）均无显著差异。
我们的结果表明，与非手术治疗相比，手术治疗对于连枷胸患者是有利的，尤其是对于肋骨骨折导致的连枷胸患者。
