Surgical management of rib fractures after blunt trauma: a systematic review anti meta-analysis of randomised controlled trials
ANNALS OF THE ROYAL COLLEGE OF SURGEONS OF ENGLAND(2022)
摘要
Introduction Multiple traumatic rib fractures are associated with significant morbidity and mortality. The last decade has seen a significant increase in rates of surgical fixation for both flail and non-flail rib fractures; the evidence for this has come from largely retrospective studies. The aim of this meta-analysis was to compare the efficacy of this approach with that of non-operative management. Methods A systematic search of the literature was performed to identify randomised controlled trials (RCTs) comparing surgical stabilisation to non-operative management. Both flail and non-flail injuries were included. Results Five RCTs reported the results of 286 patients. Only one study assessed non-flail fractures. The studies were heterogenic in nature and of mixed quality. Surgical stabilisation was associated with a reduction in pneumonia (RR 0.46, 95% confidence intervals (CI) 0.29 to 0.73, I-2=42%, p=0.001). The duration of mechanical ventilation (mean difference (MD) -6.3, 95% CI -12.16 to -0.43, I-2=95%, p=0.05) and critical care length of stay was also shorter after surgery (mean difference -6.46 days, 95% CI 9.73 to -3.19, p<0.001); however, the overall length of stay in hospital was not (MD -7.18, 95% CI -15.63 to -1.28, I-2=94%, p=0.1). No study demonstrated a significant reduction in mortality (RR 0.54, 95% CI 0.18 to 1.8, I-2=0%, p=0.28). Conclusions Surgical stabilisation of rib fractures is associated with some improved clinical outcomes. Further large RCTs are still needed to confirm if there is also a survival benefit.
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关键词
Rib, Fractures, Surgical, Non-flailing, flail
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