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

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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.	徐志飞, 孙居仙. 肋骨骨折的诊疗进展. 中华创伤杂志, 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.	王鸿, 随志辉, 高涛涛, 等. 胸腔镜下记忆合金环抱器内固定治疗多发肋骨骨折. 安徽医学, 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.	刘永靖, 于奇, 朱捷, 等. 纯钛肋骨接骨板治疗连枷胸和多发性肋骨骨折. 中华创伤杂志, 2013, 29(7): 650-652.
8.	陆善伟, 钟竑, 徐怀阳. 电视胸腔镜联合形状记忆环抱接骨板治疗多发性肋骨骨折. 中国胸心血管外科临床杂志, 2012, 19(2): 210-212.
9.	杨仁荣, 曹金林, 刘桂宝, 等. 多发肋骨骨折的外科手术治疗. 中华急诊医学杂志, 2013, 22(8): 914-917.
10.	张旭鸣, 邱美光, 林世水, 等. 非连枷胸多发肋骨骨折治疗选择及疗效评价. 中华急诊医学杂志, 2013, 22(7): 795-797.
11.	茅一民, 周振宇, 叶芃, 等. 内固定术联合胸腔镜治疗肋骨骨折. 中华创伤杂志, 2015, 31(11): 991-994.
12.	陈瑜, 赵青, 石云, 等. 手术与非手术治疗创伤性连枷胸合并胸骨骨折的疗效比较. 中华创伤杂志, 2015, 31(3): 224-227.
13.	牛世海. 胸腔镜辅助下小切口镍钛记忆合金肋骨接骨板固定术治疗多发肋骨骨折的疗效研究. 河北医药, 2016, (3): 368-370.
14.	吴志军, 张国飞. 胸腔镜联合记忆环抱式接骨板治疗胸部创伤肋骨骨折的临床疗效研究分析. 浙江创伤外科, 2016, 21(2): 316-318.
15.	滕继平, 杨志胤, 倪达, 等. 重症连枷胸手术与非手术治疗的临床对比研究. 创伤外科杂志, 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.	滕继平, 程云阁, 倪达, 等. 手术内固定与非手术外固定治疗创伤性连枷胸的效果比较. 上海交通大学学报(医学版), 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, Härter 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, 张志宇, 潘忠军, 等. 胸腔镜辅助肋骨内固定术治疗连枷胸. 中国胸心血管外科临床杂志, 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, 许国安, 方向明, 等. 微创肋骨内固定术治疗多发肋骨骨折. 中国微创外科杂志, 2012, (1): 64-66.
27.	刘召. 多发性肋骨骨折手术治疗与保守治疗对比分析. 乌鲁木齐: 新疆医科大学, 2013.
28.	何哲, 乔贵宾, 徐恩五. 手术治疗重度肋骨骨折的疗效及经济学分析. 中华创伤杂志, 2014, 30(12): 1201-1204.
29.	赵大勇. 固定手术与保守治疗肋骨骨折的对比研究. 中国卫生标准管理, 2015, 6(5): 120-121.

1. 徐志飞, 孙居仙. 肋骨骨折的诊疗进展. 中华创伤杂志, 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. 王鸿, 随志辉, 高涛涛, 等. 胸腔镜下记忆合金环抱器内固定治疗多发肋骨骨折. 安徽医学, 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. 刘永靖, 于奇, 朱捷, 等. 纯钛肋骨接骨板治疗连枷胸和多发性肋骨骨折. 中华创伤杂志, 2013, 29(7): 650-652.
8. 陆善伟, 钟竑, 徐怀阳. 电视胸腔镜联合形状记忆环抱接骨板治疗多发性肋骨骨折. 中国胸心血管外科临床杂志, 2012, 19(2): 210-212.
9. 杨仁荣, 曹金林, 刘桂宝, 等. 多发肋骨骨折的外科手术治疗. 中华急诊医学杂志, 2013, 22(8): 914-917.
10. 张旭鸣, 邱美光, 林世水, 等. 非连枷胸多发肋骨骨折治疗选择及疗效评价. 中华急诊医学杂志, 2013, 22(7): 795-797.
11. 茅一民, 周振宇, 叶芃, 等. 内固定术联合胸腔镜治疗肋骨骨折. 中华创伤杂志, 2015, 31(11): 991-994.
12. 陈瑜, 赵青, 石云, 等. 手术与非手术治疗创伤性连枷胸合并胸骨骨折的疗效比较. 中华创伤杂志, 2015, 31(3): 224-227.
13. 牛世海. 胸腔镜辅助下小切口镍钛记忆合金肋骨接骨板固定术治疗多发肋骨骨折的疗效研究. 河北医药, 2016, (3): 368-370.
14. 吴志军, 张国飞. 胸腔镜联合记忆环抱式接骨板治疗胸部创伤肋骨骨折的临床疗效研究分析. 浙江创伤外科, 2016, 21(2): 316-318.
15. 滕继平, 杨志胤, 倪达, 等. 重症连枷胸手术与非手术治疗的临床对比研究. 创伤外科杂志, 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. 滕继平, 程云阁, 倪达, 等. 手术内固定与非手术外固定治疗创伤性连枷胸的效果比较. 上海交通大学学报(医学版), 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, Härter 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, 张志宇, 潘忠军, 等. 胸腔镜辅助肋骨内固定术治疗连枷胸. 中国胸心血管外科临床杂志, 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, 许国安, 方向明, 等. 微创肋骨内固定术治疗多发肋骨骨折. 中国微创外科杂志, 2012, (1): 64-66.
27. 刘召. 多发性肋骨骨折手术治疗与保守治疗对比分析. 乌鲁木齐: 新疆医科大学, 2013.
28. 何哲, 乔贵宾, 徐恩五. 手术治疗重度肋骨骨折的疗效及经济学分析. 中华创伤杂志, 2014, 30(12): 1201-1204.
29. 赵大勇. 固定手术与保守治疗肋骨骨折的对比研究. 中国卫生标准管理, 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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