Effectiveness of conservative treatment and open reduction with internal fixation for the treatment of multiple rib fractures: a systematic review_Chinese Journal of Evidence-Based Medicine

Authors：

SONG Ruiqiang ¹ ,  DENG Yanchao ¹ , WANG Zhipeng ² , ZONG Liang ³ , ZHANG Haiping ⁴

1. Department of Thoracic Surgery, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830001, P.R.China;
2. Department of Thoracic Surgery, the Affiliated Hospital of Weifang Medical University, Weifang, 262600, P.R.China;
3. Department of Thoracic Surgery, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830001, P.R.China;
4. Department of Thoracic Surgery, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830001, P.R.China;

Corresponding?author：

DENG Yanchao, Email: dych001@163.com

Keywords：

Multiple rib fracture; Open reduction and internal fixation; Incidence of chest wall malformation; Systematic review; Meta-analysis; Randomized controlled trials; Cohort study; Surgery

DOI：

10.7507/1672-2531.201803036

Video：

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Objectives To systematically review the efficacy of conservative treatment and open reduction with internal fixation for multiple rib fractures. Methods We searched WanFang Data, CNKI, VIP, PubMed, EMbase, The Cochrane Library and Web of Science from inception to December 2017 to collect studies on conservative treatment and open reduction with internal fixation for multiple rib fractures. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. RevMan 5.3 software was used for meta-analysis. Results A total of 16 studies were included, involving 1 374 patients, 723 patients in the surgical group and 651 patients in the conservative group. The meta-analysis showed that the length of stay in the ICU (MD=–3.41, 95%CI –4.92 to –2.43, P<0.000 01), total length of stay (MD=–7.60, 95 %CI–10.67 to–4.53,P<0.000 01), incidence of pulmonary arylene (RR=0.40, 95%CI 0.29 to 0.54,P<0.000 01), incidence of lung infections (RR=0.43, 95%CI 0.30 to 0.61,P<0.000 01), and incidence of chest wall malformation (RR=0.05, 95%CI 0.03 to 0.11,P<0. 0.000 01) in the surgical group were superior to the conservative group. Conclusions Compared with conservative treatment, open reduction with internal fixation can significantly improve the recovery time of patients with multiple rib fractures, reduce hospitalization time, the incidence of perioperative complications, and significantly enhance the prognosis of patients, which is more conducive to the rehabilitation of patients.

Citation： SONG Ruiqiang, DENG Yanchao, WANG Zhipeng, ZONG Liang, ZHANG Haiping. Effectiveness of conservative treatment and open reduction with internal fixation for the treatment of multiple rib fractures: a systematic review. Chinese Journal of Evidence-Based Medicine, 2018, 18(12): 1329-1336. doi: 10.7507/1672-2531.201803036 Copy

1.	徐志飛, 孫居仙. 肋骨骨折的診療進展. 中華創傷雜志, 2010, 26(6): 481-484.
2.	Doben AR, Eriksson EA, Denlinger CE, et al. Surgical rib fixation for flail chest deformity improves liberation from mechanical ventilation. J Crit Care, 2014, 29(1): 139-143.
3.	Winters BA. Older adults with traumatic rib fractures: an evidence-based approach to their care. J Trauma Nurs, 2009, 16(2): 93-97.
4.	Jacoby SF, Ackerson TH, Richmond TS. Outcome from serious injury in older adults. J Nurs Scholarsh, 2006, 38(2): 133.
5.	王鴻, 隨志輝, 高濤濤, 等. 胸腔鏡下記憶合金環抱器內固定治療多發肋骨骨折. 安徽醫學, 2015, 36(7): 851-853.
6.	Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9): 603-605.
7.	劉永靖, 于奇, 朱捷, 等. 純鈦肋骨接骨板治療連枷胸和多發性肋骨骨折. 中華創傷雜志, 2013, 29(7): 650-652.
8.	陸善偉, 鐘竑, 徐懷陽. 電視胸腔鏡聯合形狀記憶環抱接骨板治療多發性肋骨骨折. 中國胸心血管外科臨床雜志, 2012, 19(2): 210-212.
9.	楊仁榮, 曹金林, 劉桂寶, 等. 多發肋骨骨折的外科手術治療. 中華急診醫學雜志, 2013, 22(8): 914-917.
10.	張旭鳴, 邱美光, 林世水, 等. 非連枷胸多發肋骨骨折治療選擇及療效評價. 中華急診醫學雜志, 2013, 22(7): 795-797.
11.	茅一民, 周振宇, 葉芃, 等. 內固定術聯合胸腔鏡治療肋骨骨折. 中華創傷雜志, 2015, 31(11): 991-994.
12.	陳瑜, 趙青, 石云, 等. 手術與非手術治療創傷性連枷胸合并胸骨骨折的療效比較. 中華創傷雜志, 2015, 31(3): 224-227.
13.	牛世海. 胸腔鏡輔助下小切口鎳鈦記憶合金肋骨接骨板固定術治療多發肋骨骨折的療效研究. 河北醫藥, 2016, (3): 368-370.
14.	吳志軍, 張國飛. 胸腔鏡聯合記憶環抱式接骨板治療胸部創傷肋骨骨折的臨床療效研究分析. 浙江創傷外科, 2016, 21(2): 316-318.
15.	滕繼平, 楊志胤, 倪達, 等. 重癥連枷胸手術與非手術治療的臨床對比研究. 創傷外科雜志, 2014, 16(2): 104-108.
16.	Xu JQ, Qiu PL, Yu RG, et al. Better short-term efficacy of treating severe flail chest with internal fixation surgery compared with conservative treatments. Eur J Med Res, 2015, 20(1): 55.
17.	Althausen PL, Shannon S, Watts C, et al. Early surgical stabilization of flail chest with locked plate fixation. J Orthop Trauma, 2011, 25(11): 641-647.
18.	滕繼平, 程云閣, 倪達, 等. 手術內固定與非手術外固定治療創傷性連枷胸的效果比較. 上海交通大學學報(醫學版), 2009, 29(12): 1495-1498.
19.	Marasco SF, Davies AR, Cooper J, et al. Prospective randomized controlled trial of operative rib fixation in traumatic flail chest. J Am Coll Surg, 2013, 216(5): 924.
20.	Muhm M, H?rter J, Weiss C, et al. Severe trauma of the chest wall: surgical rib stabilisation versus non-operative treatment. Eur J Trauma Emerg Surg, 2013, 39(3): 257-265.
21.	Granetzny A, Abd EM, Emam E, et al. Surgical versus conservative treatment of flail chest. Evaluation of the pulmonary status. Interact Cardiovasc Thorac Surg,, 2005, 4(6): 583-587.
22.	Tanaka H, Yukioka T, Yamaguti Y, et al. Surgical stabilization of internal pneumatic stabilization? a prospective randomized study of management of severe flail chest patients. J Trauma Acute Care Surg, 2002, 52(4): 727.
23.	丁明, 張志宇, 潘忠軍, 等. 胸腔鏡輔助肋骨內固定術治療連枷胸. 中國胸心血管外科臨床雜志, 2016, 23(8): 844-846.
24.	Vana PG, Neubauer DC, Luchette FA. Contemporary management of flail chest. Am Surg, 2014, 80(6): 527-35.
25.	Marasco S, Lee G, Summerhayes R, et al. Quality of life after major trauma with multiple rib fractures. Injury, 2015, 46(1): 61-65.
26.	徐靖, 許國安, 方向明, 等. 微創肋骨內固定術治療多發肋骨骨折. 中國微創外科雜志, 2012, (1): 64-66.
27.	劉召. 多發性肋骨骨折手術治療與保守治療對比分析. 烏魯木齊: 新疆醫科大學, 2013.
28.	何哲, 喬貴賓, 徐恩五. 手術治療重度肋骨骨折的療效及經濟學分析. 中華創傷雜志, 2014, 30(12): 1201-1204.
29.	趙大勇. 固定手術與保守治療肋骨骨折的對比研究. 中國衛生標準管理, 2015, 6(5): 120-121.

1. 徐志飛, 孫居仙. 肋骨骨折的診療進展. 中華創傷雜志, 2010, 26(6): 481-484.
2. Doben AR, Eriksson EA, Denlinger CE, et al. Surgical rib fixation for flail chest deformity improves liberation from mechanical ventilation. J Crit Care, 2014, 29(1): 139-143.
3. Winters BA. Older adults with traumatic rib fractures: an evidence-based approach to their care. J Trauma Nurs, 2009, 16(2): 93-97.
4. Jacoby SF, Ackerson TH, Richmond TS. Outcome from serious injury in older adults. J Nurs Scholarsh, 2006, 38(2): 133.
5. 王鴻, 隨志輝, 高濤濤, 等. 胸腔鏡下記憶合金環抱器內固定治療多發肋骨骨折. 安徽醫學, 2015, 36(7): 851-853.
6. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9): 603-605.
7. 劉永靖, 于奇, 朱捷, 等. 純鈦肋骨接骨板治療連枷胸和多發性肋骨骨折. 中華創傷雜志, 2013, 29(7): 650-652.
8. 陸善偉, 鐘竑, 徐懷陽. 電視胸腔鏡聯合形狀記憶環抱接骨板治療多發性肋骨骨折. 中國胸心血管外科臨床雜志, 2012, 19(2): 210-212.
9. 楊仁榮, 曹金林, 劉桂寶, 等. 多發肋骨骨折的外科手術治療. 中華急診醫學雜志, 2013, 22(8): 914-917.
10. 張旭鳴, 邱美光, 林世水, 等. 非連枷胸多發肋骨骨折治療選擇及療效評價. 中華急診醫學雜志, 2013, 22(7): 795-797.
11. 茅一民, 周振宇, 葉芃, 等. 內固定術聯合胸腔鏡治療肋骨骨折. 中華創傷雜志, 2015, 31(11): 991-994.
12. 陳瑜, 趙青, 石云, 等. 手術與非手術治療創傷性連枷胸合并胸骨骨折的療效比較. 中華創傷雜志, 2015, 31(3): 224-227.
13. 牛世海. 胸腔鏡輔助下小切口鎳鈦記憶合金肋骨接骨板固定術治療多發肋骨骨折的療效研究. 河北醫藥, 2016, (3): 368-370.
14. 吳志軍, 張國飛. 胸腔鏡聯合記憶環抱式接骨板治療胸部創傷肋骨骨折的臨床療效研究分析. 浙江創傷外科, 2016, 21(2): 316-318.
15. 滕繼平, 楊志胤, 倪達, 等. 重癥連枷胸手術與非手術治療的臨床對比研究. 創傷外科雜志, 2014, 16(2): 104-108.
16. Xu JQ, Qiu PL, Yu RG, et al. Better short-term efficacy of treating severe flail chest with internal fixation surgery compared with conservative treatments. Eur J Med Res, 2015, 20(1): 55.
17. Althausen PL, Shannon S, Watts C, et al. Early surgical stabilization of flail chest with locked plate fixation. J Orthop Trauma, 2011, 25(11): 641-647.
18. 滕繼平, 程云閣, 倪達, 等. 手術內固定與非手術外固定治療創傷性連枷胸的效果比較. 上海交通大學學報(醫學版), 2009, 29(12): 1495-1498.
19. Marasco SF, Davies AR, Cooper J, et al. Prospective randomized controlled trial of operative rib fixation in traumatic flail chest. J Am Coll Surg, 2013, 216(5): 924.
20. Muhm M, H?rter J, Weiss C, et al. Severe trauma of the chest wall: surgical rib stabilisation versus non-operative treatment. Eur J Trauma Emerg Surg, 2013, 39(3): 257-265.
21. Granetzny A, Abd EM, Emam E, et al. Surgical versus conservative treatment of flail chest. Evaluation of the pulmonary status. Interact Cardiovasc Thorac Surg,, 2005, 4(6): 583-587.
22. Tanaka H, Yukioka T, Yamaguti Y, et al. Surgical stabilization of internal pneumatic stabilization? a prospective randomized study of management of severe flail chest patients. J Trauma Acute Care Surg, 2002, 52(4): 727.
23. 丁明, 張志宇, 潘忠軍, 等. 胸腔鏡輔助肋骨內固定術治療連枷胸. 中國胸心血管外科臨床雜志, 2016, 23(8): 844-846.
24. Vana PG, Neubauer DC, Luchette FA. Contemporary management of flail chest. Am Surg, 2014, 80(6): 527-35.
25. Marasco S, Lee G, Summerhayes R, et al. Quality of life after major trauma with multiple rib fractures. Injury, 2015, 46(1): 61-65.
26. 徐靖, 許國安, 方向明, 等. 微創肋骨內固定術治療多發肋骨骨折. 中國微創外科雜志, 2012, (1): 64-66.
27. 劉召. 多發性肋骨骨折手術治療與保守治療對比分析. 烏魯木齊: 新疆醫科大學, 2013.
28. 何哲, 喬貴賓, 徐恩五. 手術治療重度肋骨骨折的療效及經濟學分析. 中華創傷雜志, 2014, 30(12): 1201-1204.
29. 趙大勇. 固定手術與保守治療肋骨骨折的對比研究. 中國衛生標準管理, 2015, 6(5): 120-121.

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Effectiveness of conservative treatment and open reduction with internal fixation for the treatment of multiple rib fractures: a systematic review

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