动力髋螺钉和股骨近端防旋髓内钉治疗老年股骨粗隆间骨折的Meta分析

发布时间：2018-01-19 15:24

本文关键词： 股骨粗隆间骨折动力髋螺钉股骨近端防旋髓内钉 Meta分析　出处：《湖北中医药大学》2013年硕士论文　论文类型：学位论文

【摘要】：股骨粗隆间骨折多发于老年人。目前中国老龄人口中，据相关数据表明髋部骨折约660万人，，其中约250-300万为粗隆间骨折，发生率仅次于股骨颈骨折，约占全身骨折的3-4%。患者的平均年龄为70岁，女性多于男性。随着目前国内社会人口老龄人口增多，老年人口关怀机制的发展滞后，及交通、建筑业等发展，其发病率在逐年升高。老年股骨粗隆间骨折保守治疗常易出现并发症等，而无法获得满意疗效。其易并发压疮、坠积性肺炎、深静脉血栓等，死亡率较高。因其断端为松质骨，血运丰富，极少出现骨折不愈合。同时老龄人群因其骨质疏松，容易并发内固定物失效等情况，易致发生髋内翻畸形。即便骨折愈合，其功能也常因髋内翻，肌肉萎缩等而不能获得良好恢复。所以，如无明显手术禁忌症，选择合适的手术方式进行手术治疗，术后早期功能锻炼，对恢复患髋功能，降低死亡率，预防并发症的发生有重要意义。目的本研究通过对近10年来已经发表的关于老年股骨粗隆间骨折，经防旋型股骨近端髓内钉与动力髋螺钉手术治疗的临床疗效方面差异的随访研究性文献资料进行Meta分析，以期了解文献质量，找出相关证据来综合对比评价老年股骨粗隆间骨折经PFNA或DHS内固定手术治疗的手术时间、术中出血量、术后优良率、及手术并发症、住院时间、住院花费等临床问题，为临床治疗决策和下一步的研究提供一定的依据。材料与方法检索Medline（国际性综合生物医学信息书目数据库）、EMBASE、CENTRAL(The Cochrane central register of controlledtrials)、等权威外文数据库，检索中文期刊网数据库(CNKI)、中文科技期刊全文数据库、维普（VIP）、万方中国学术会议论文(CACP)、万方中国学位论文数据库(CDDB)等中文数据库。收集国内外公开发表的临床随机对照研究，同时运用计算机检索Medline(ovid搜索引擎2000-2013．3)等数据库，通过ovid搜索引擎手工检索《clinical orthopaedicsrelated research》，《Injury》等杂志。多渠道、多途径广泛收集相关文献。严格筛选检索到的文献，筛选符合要求的信息，将筛选后的文献经过改良后Jadad评分表，对其进行评分，确定可纳入的文献及相关样本。下载Meta分析软件进行异质性检验、效应合并统计量等分析，绘制手术时间、出血量、术后优良率、术后并发症等的森林图、漏斗图，分析发表性偏倚。结论通过最终评价并纳入文献10篇，其中英文文献4篇，中文文献6篇。共纳入股骨粗隆间骨折患者885例，其中DHS组患者445例，PFNA组患者440例。经Meta软件分析后，结果显示：接受PFNA治疗的患者相对接受DHS治疗的患者比较：接受PFNA手术治疗，术后股骨干骨折风险增高、手术时间较短、手术出血较少，结论有显著性意义（P＜0.05)；接受PFNA手术治疗，其术后优良率，住院时间，术后伤口感染等方面无明显性差异（P＞0.05）。说明老年性股骨粗隆间骨折，接受PFNA手术治疗相对DHS手术治疗，其术后股骨干骨折风险较高、但手术出血量及手术时间更短。
[Abstract]:Intertrochanteric fracture in the elderly. The Chinese aging population, according to the relevant data show that about 6 million 600 thousand hip fractures, of which about 250-300 million for intertrochanteric fracture incidence after femoral neck fracture, the average age of all fractures accounted for about 3-4%. of the patients was 70 years, with female than male. Theageing population increase, elderly care system development lags behind, and the traffic development of the construction industry, the incidence rate increased year by year. The elderly femoral intertrochanteric fracture conservative treatment often prone to complications, and can not obtain satisfactory curative effect. It is easy to bedsore, hypostatic pneumonia, deep vein thrombosis, high mortality. Because of the broken end of cancellous bone, abundant blood supply, rarely appear nonunion. But becauseof osteoporosis, internalfixationfailurereasons, prone to hip varus. Even bone Fracture healing, its function is often due to hip varus, muscle atrophy cannot get a good recovery. So, if there is no surgical contraindications, select the appropriate surgical approach for surgical treatment, early postoperative functional exercise on the recovery of hip function, reduce the mortality rate, has important significance to prevent the occurrence of complications.
objective
Based on the past 10 years have been published on senile intertrochanteric fractures with proximal femoral antirotation clinical curative effect between treatment and operative of dynamic hip screw nail of follow-up study of literature Meta analysis, in order to understand the quality of literature, find out the relevant evidence to comprehensive evaluation senile femoral intertrochanteric fracture by operation time PFNA or DHS internal fixation surgery, intraoperative bleeding, postoperative rate, and complications, hospitalization time, hospitalization costs and other clinical problems, and provide a basis for clinical treatment decisions and future research.
Materials and methods
The retrieval of Medline (international integrated biomedical information bibliographic database), EMBASE, CENTRAL (The Cochrane Central Register of controlledtrials), and other authoritative foreign language database retrieval, Chinese journal net database (CNKI), Chinese PSTP, Wei Pu (VIP), Wanfang China Symposium (CACP), Wanfang China degree the database (CDDB) and Chinese database. Randomized clinical research literatures published in China and abroad, while the use of computer retrieval Medline (Ovid search engine 2000-2013.3) database, search engine manual retrieval by Ovid, and other magazines. Multi channel, multi way extensive collection of relevant literature. Strict screening retrieved the screening, to meet the requirements of the information will be filtered documents after improving Jadad score, the score can be determined in the Literature and related samples. Meta analysis software was downloaded, heterogeneity test and effect combination statistics were used to analyze and draw the forest chart and funnel plot of operation time, bleeding volume, postoperative excellent rate, postoperative complications and so on.
conclusion
The final evaluation and 10 articles were included, of which 4 articles English, Chinese 6 literatures were included. 885 patients with femoral intertrochanteric fracture, including 445 cases of DHS patients, 440 PFNA patients. By Meta software analysis, the results show that: compared PFNA treated patients treated with DHS relative the patients received PFNA surgery, postoperative femoral shaft fracture risk increased, shorter operation time, less bleeding, significant conclusions (P < 0.05); PFNA received surgical treatment, the postoperative excellent rate, hospitalization time, postoperative wound infection and other aspects of no significant difference (P > 0.05). The senile intertrochanteric fracture treated with PFNA compared with DHS surgery, the higher risk of postoperative femoral shaft fractures, but operation bleeding volume and operation time shorter.

【学位授予单位】：湖北中医药大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R687.3

【参考文献】