微型钢板与克氏针内固定治疗掌指骨骨折的Meta分析

发布时间：2018-05-16 10:58

本文选题：微型钢板 + 克氏针　；参考：《西南医科大学》2017年硕士论文

【摘要】：背景:掌指骨骨折是骨科急诊的常见疾病,其中又以复杂性掌指骨骨折较为多见。虽然治疗掌指骨骨折时可供选择的内固定材料较多,如微型钢板、克氏针、微型外固定支架和钢丝等,但是目前临床上使用最多的还是微型钢板和克氏针。克氏针是最早被应用于临床的固定材料,克氏针内固定术具有经济适用,手术创伤小,操作简单易行等优点。然而,长期的临床实践后发现其存在固定效果不可靠,手术后遗症多等缺点,手术效果不能完全令医生和患者满意。微型钢板具有表面刚度大,固定效果切实可靠,允许患者术后早期进行功能锻炼等优点,手术治疗效果得到不少医生和患者的认可,近年来其临床应用日趋普遍。然而,选用微型钢板进行内固定也存在一些不容忽视的弊端,如手术费用昂贵、手术创伤大、需要二次手术取出等。虽然目前有众多学者从多方面对微型钢板和克氏针的临床疗效进行了对比性研究,但是这些研究的样本量普遍偏小,仍然缺乏全面和系统的分析评价。目前针对手术中应用哪种固定材料来治疗掌指骨骨折才能取得更好的治疗效果学者们尚未形成一致意见。目的:对比分析微型钢板与克氏针治疗掌指骨骨折的疗效,为临床医师在固定材料的选择上提供依据。方法:分别按照主题词检索和关键词检索的方法使用计算机检索万方数据库、中国知网数据库(China national knowledge infrastructure,CNKI)、中国生物医学文献数据库(Chinese biomedical database,CBM)、维普期刊资源整合服务平台(VIP)、Pubmed数据库、Embase数据库和Cochrane Library数据库。手工检索骨科相关杂志。分别采用Jadad评分系统和newcastle-ottawascale(nos)评分系统对纳入的前瞻性随机对照研究和回顾性队列研究的文献进行质量评价。使用拟定的纳入标准和排除标准对检索出来的文献进行筛选,最后只保留与本研究的内容密切相关的高质量文献。提取纳入的文献的研究设计类型、文献的一般情况、文献的基线指标、干预措施、各组患者的随访时间和结局指标等信息。采用revman5.3统计学软件对纳入文献中骨折愈合时间、关节活动功能优良率、手术时间、住院时间、伤口感染率和固定物不良事件发生率的相关数据进行分析。根据纳入研究结果间的异质性大小采用固定效应模型(mantel-haenszel法)或随机效应模型(inversevariance法)对各研究结果进行合并分析。通过剔除权重大的研究结果后再分析所得的统计量与剔除以前的统计量进行比较的方法对研究的结果进行敏感性分析。通过观察倒漏斗图中数据点的对称分布情况评估文献的发表性偏倚。结果:通过文献过滤,最终纳入文献14篇。其中有6篇文献采用的是前瞻性随机对照研究,其余8篇文献采用的是回顾性队列研究,其中采用jadad评分系统评出的总分≥4分或采用nos评分系统评出的总分≥5分的高质量的中文文献11篇,被sci(sciencecitationindex)收录的外文文献2篇,外文普刊文献1篇。数据分析结果显示,微型钢板组与克氏针组比较,两组患者的骨折愈合时间[wmd=-1.53,95%ci(-1.90,-1.17),p0.00001]、关节活动功能优良率[rr=1.18,95%ci(1.13,1.25),p0.00001]、伤口感染率[rr=0.39,95%ci(0.25,0.61),p0.00001]和固定物不良事件发生率[rr=0.35,95%ci(0.17,0.73),p=0.009]的差异有统计学意义,而两组患者的手术时间[wmd=21.46,95%ci(-13.08,56.00),p=0.22]和住院时间[WMD=-1.32,95%CI(-3.17,0.52),P=0.16]的差异不明显。敏感性分析结果显示手术时间和住院时间的结果的敏感性较差。由伤口感染率生成的倒漏斗图显示,数据点基本对称的分布,本研究存在发表性偏倚的可能性较小。结论:与克氏针相比,尽管手术时间和住院时间的差异不明显,但是采用微型钢板内固定治疗掌指骨骨折可以使患者获得更短的骨折愈合时间,更好的关节活动功能,更小的伤口感染率和内固定物不良事件发生率。从总体上讲,微型钢板内固定治疗掌指骨骨折的疗效比克氏针更好。
[Abstract]:Background: Metacarpophalangeal Fracture is a common disease in the emergency department of orthopedics. Complex metacarpophalangeal fractures are more common. Although there are more internal fixation materials for metacarpophalangeal fractures, such as mini plate, Kirschner pin, micro external fixator and steel wire, the most commonly used clinical materials are microplate and Kirschner. Kirschner needle is the earliest fixed material for clinical application. Kirschner pin internal fixation has the advantages of economic application, small operation trauma, easy operation and so on. However, after long-term clinical practice, it is found that the fixation effect is not reliable and the surgical sequelae are many, and the effect of the operation can not completely satisfy the doctors and patients. Microplate has a table. The effect of surgical treatment has been recognized by many doctors and patients. In recent years, its clinical application is becoming more and more common. However, the selection of mini plate for internal fixation has some disadvantages that can not be ignored, such as expensive operation and large surgical trauma. Two surgical removal is needed. Although many scholars have made a comparative study of the clinical efficacy of microplate and Kirschner's needle from many aspects, the sample size of these studies is generally small and still lacks comprehensive and systematic analysis. At present, which fixed material is used to treat metacarpal and phalangeal fractures in the operation can be taken to take the treatment of the metacarpal and phalanges. Better therapeutic effect scholars have not yet formed a consensus. Objective: To compare the efficacy of microplate and Kirschner's needle in the treatment of metacarpal and phalangeal fractures, and to provide a basis for clinicians in the selection of fixed materials. The database (China national knowledge infrastructure, CNKI), the Chinese biomedical literature database (Chinese biomedical database, CBM), the resource integration service platform (VIP) of the VP journal, Pubmed database, Embase database and database. The ttawascale (NOS) scoring system evaluated the quality of the included prospective randomized controlled study and the literature of retrospective cohort study. Using the proposed inclusion criteria and exclusion criteria, the retrieved literature was screened, and the high quality literature closely related to the content of this study was retained. Type, general literature, baseline indicators of literature, intervention, follow-up time and outcome indicators of each group. Revman5.3 statistical software was used to include the correlation between the time of fracture healing, the good rate of joint activity, the time of operation, the time of hospitalization, the rate of infection and the incidence of adverse events. Data are analyzed. According to the heterogeneity of the results, a fixed effect model (Mantel-Haenszel method) or a random effect model (inversevariance method) is used to combine the results of each research. The method of sensitivity analysis of the results of the study. By observing the symmetry distribution of the data points in the inverted funnel plot, the publication bias of the literature was evaluated. Results: 14 articles were included in the literature through the literature filtering. Among them, 6 literature adopted prospective randomized controlled studies, and the other 8 literature adopted retrospective cohort study. The total score of the total score of the total score of the Jadad score system was more than 4 or the total score of the total score of the NOS score system was more than 5, 11 of the Chinese literature, 2 of the foreign literature included by SCI (sciencecitationindex), and 1 in the foreign literature. The results of data analysis showed that the fracture healing time of the two groups of patients was [wmd=- compared with the Kirschner group. 1.53,95%ci (-1.90, -1.17), p0.00001], the excellent rate of joint activity [rr=1.18,95%ci (1.13,1.25), p0.00001], [rr=0.39,95%ci (0.25,0.61) of wound infection rate, p0.00001] and [rr=0.35,95%ci (0.17,0.73), the difference between the two groups was statistically significant. 00) the difference between p=0.22] and [WMD=-1.32,95%CI (-3.17,0.52) was not obvious. The sensitivity analysis showed that the sensitivity of the results of the operation time and the time of hospitalization was poor. The inverted funnel map generated by the wound infection rate showed that the distribution of the data points was basically symmetrical, and the possibility of the publication bias was less. Compared with Kirschner's needle, although the difference of operation time and time of hospitalization is not obvious, the mini plate internal fixation for metacarpophalangeal fracture can make the patient get shorter fracture healing time, better joint activity function, smaller wound infection rate and the incidence of bad internal fixtures. The treatment of metacarpal and phalangeal fracture is better than that of the Ke's needle.

【学位授予单位】：西南医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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