锁定钢板内固定术对比半肩关节置换术治疗肱骨近端三、四部分骨折的META分析

发布时间：2018-01-18 10:03

本文关键词：锁定钢板内固定术对比半肩关节置换术治疗肱骨近端三、四部分骨折的META分析　出处：《华北理工大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的对锁定钢板(LP)与半肩关节置换(HA)治疗肱骨近端三、四部分骨折的临床效果进行系统评价。方法通过计算机检索Pubmed数据库(1989年1月至2014年12月)、Embase数据库(1989年1月至2014年12月)、相关期刊论文(CNKI,1995年1月至2014至12月)、维普全文数据库(VIP,1995年1月至2014年12月);通过手工检索中华骨科杂志(2000年1月至2014年12月)、中华外科杂志(2000年1月至2014年12月)、中华创伤杂志(2000年1月至2014年12月)关于锁定钢板内固定与半肩关节置换术治疗肱骨近端骨折的病例对照研究,制定严格的文献纳入标准和排除标准,对纳入研究的非随机对照研究文献根据MINORS评分量表进行评分,对纳入研究的随机对照文献根据改良Jadad量表进行评分,采用Cochrane协作网出品的Revman5.0软件对数据进行统计分析。对连续性变量的表达采用加权均数差(WMD)或标准均数差(SMD)及95%的置信区间(95%CI作为效应尺度指标,二分类变量资料采用RR(相对危险度)或OR(比值比)及95%的置信区间(95%CI)做为效应尺度指标,根据异质性的大小选择随机效应模型或者固定效应模型,根据漏斗图判断文献的偏倚情况。结果采用锁定钢板治疗的患者在术后肩关节Constant评分方面(P=0.0004)比较优于半肩置换术,半肩置换术的患者在手术时间(P0.001)、术后并发症(P=0.006)、二次手术的发生率(P0.001)和VAS疼痛评分(P=0.02)指标方面优于锁定钢板治疗的患者,两种手术方式在手术出血量(P=0.56)、肩关节ASES功能评分(P=0.36)、术后优良率(P=0.99)三个方面没有统计学差异。结论1两种手术方式都是治疗肱骨近端三、四部分骨折的有效手段。2骨质量差,为解决疼痛而不追求活动范围的者,优先选择半肩置换术。3骨质量好,肩关节功能要求高的患者,优先选择锁定钢板内固定术。
[Abstract]:Objective to treat the proximal humerus with locking plate LP) and half-shoulder replacement. Methods the Pubmed database was searched by computer (January 1989 to December 2014). Embase database (January 1989-December 2014, CNKI, January 1995 to January 1995). Weip Full-text Database (Vip), January 1995 to December 2014; The Chinese Journal of Orthopaedics (January 2000 to December 2014) and the Chinese Journal of surgery (January 2000 to January 2000) were searched manually. Chinese Journal of Trauma (January 2000 to December 2014): a case-control study on the treatment of proximal humeral fractures with locking plate fixation and half-shoulder arthroplasty. To establish strict literature inclusion criteria and exclusion criteria, the non-randomized controlled study literature included in the study according to the MINORS scoring scale. The randomized controlled literature included in the study was graded according to the modified Jadad scale. The data are analyzed by Revman5.0 software produced by Cochrane cooperation network. The expression of continuous variables is expressed by weighted mean difference (WMD) or standard mean difference (SMD). And the confidence interval of 95% / 95 CI was used as the index of effect scale. RR (relative risk) or OR (ratio ratio) and 95% confidence interval (95 CI) were used as the effect scale index. The random effect model or the fixed effect model are selected according to the size of the heterogeneity. Results the patients treated with locking plate were superior to half shoulder replacement in terms of Constant score of shoulder joint (P < 0. 0004). Hemishoulder replacement was performed at a time of P0.001, with postoperative complications (P0.006). The incidence of secondary operation (P 0.001) and VAS pain score (P < 0.02) were better than those of patients treated with locking plate. There was no statistical difference in the ASES score of shoulder joint and the excellent and good rate (P < 0.99). Conclusion 1the two kinds of operation methods are the treatment of the proximal humerus. The effective method of four-part fracture is that the bone quality is poor, in order to solve the pain and do not pursue the range of movement, the first choice of the patients who have good bone quality and shoulder joint function requirement is the half shoulder replacement surgery with good bone quality. Locking plate fixation is preferred.
【学位授予单位】：华北理工大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.4

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