不稳定型骨质疏松性股骨粗隆间骨折PFNA与HA疗效对比的Meta分析

发布时间：2018-03-11 05:36

本文选题：骨质疏松　切入点：粗隆间骨折　出处：《新疆医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:不稳定型骨质疏松性股骨粗隆间骨折患者通常需要外科手术治疗,本文旨在利用Meta分析的方法综合评价防旋型股骨近端髓内钉(proximal femoral nail antirotation,PFNA)与关节置换(himiarthroplasty,HA)治疗不稳定型骨质疏松性股骨粗隆间骨折的疗效评价。方法:通过计算机检索万方数据库、维普数据库、中国知网、Pubmed、Embase等数据库的相关文献资料,检索文献时间截止2017年01月,语言不限。检索关键词为:股骨粗隆间骨折或股骨转子间骨折(Intertrochanteri c fracture),骨质疏松(osteoporosis),防旋型股骨近端髓内钉(PFNA),关节置换(himiarthroplasty)。利用Rev Man5.35对纳入的文献数据进行Meta分析。结果:共纳入9项随机对照试验,共969例不稳定型骨质疏松性股骨粗隆间骨折患者,其中P FNA组493例,HA组476例。Meta分析结果显示:与HA组相比,PFNA组手术时间更短[SMD=-1.03,95%CI(-1.91,-0.15),P=0.02],术中失血量更少[SMD=-3.81,95%CI(-6.79,-1.83),P0.05],术后病死率更低[RR=0.57,95%CI(0.40,0.82),P=0.003],其差异均有统计学意义;住院时间、术后并发症、术后髋关节功能评分和优良率差异均无统计学意义(P0.05)。结论:PFNA在治疗不稳定型骨质疏松性股骨粗隆间骨折的手术时间、术中失血量和病死率等方面均优于HA;两种手术方式在住院时间、术后并发症、术后患髋Harris功能评分和髋关节功能优良率等方面无显著差异;PFNA具有手术时间短、手术创伤小、术中失血量少和术后患者病死率低等优点,其对于不稳定型骨质疏松性股骨粗隆间骨折患者的治疗是一种合理的选择。
[Abstract]:Objective: unstable osteoporotic intertrochanteric fractures usually require surgical treatment. The purpose of this paper is to evaluate the efficacy of proximal femoral nail antirotation Meta analysis in the treatment of unstable osteoporotic femoral intertrochanteric fractures. WIP database, Chinese knowledge network Pubmedum Embase and other databases related to the literature retrieval time as of January 2017, The key words are intertrochanteri c fracture, osteoporosis, intramedullary intramedullary nail (PFNAN), joint replacement (Rev Man5.35) and Meta analysis. Fruit: included in 9 randomized controlled trials, A total of 969 patients with unstable osteoporotic intertrochanteric fracture of femur, The results of meta-analysis in 493 cases of PFNA group showed that compared with HA group, the operation time of PFNA group was shorter [SMD-1.03 + 95CIN -1.91U -0.15P0. 02], the amount of blood lost during operation was lower [SMD-3.8195CI-6.795 CI-1.83CU], and the postoperative mortality was lower [RR0.5795CIT 0.400.82P0.003], the difference was significant. There was no significant difference in hip function score and excellent and good rate after operation (P 0.05). Conclusion the operative time of the treatment of unstable osteoporotic intertrochanteric fracture of femur with 1% PFNA is not significant (P 0.05). There were no significant differences in hospital stay, postoperative complications, postoperative hip Harris score and excellent and good rate of hip joint function between the two operative methods. It is a reasonable choice for the treatment of unstable osteoporotic intertrochanteric fracture of femur because of the advantages of less blood loss during operation and lower fatality rate after operation.
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3;R580

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