股骨转子间骨折的流行病学调查研究和老年髋部骨折死亡危险因素的META分析
发布时间：2018-03-06 20:30
本文选题：股骨转子间骨折 切入点：骨质疏松 出处：《天津医科大学》2017年硕士论文 论文类型：学位论文
【摘要】：目的:本文的主要研究目的是通过回顾性分析,来搜集符合条件的临床患者病历资料,探讨股骨转子间骨折的发病情况及其流行病学分布特点,用Meta分析来比较国内外老年髋部骨折死亡危险因素,从而进一步为股骨转子间骨折的预防和治疗提供科学指导。方法:本研究先从临床病例观察来回顾性分析股骨转子间骨折的发病情况并结合国内外大量文献来分析其流行病学分布特点,并通过Meta分析来评估有关髋部骨折死亡的危险因素。第一部分:本研究所选用的病例来自天津医科大学总医院于2013年1月至2015年12月以来收治的股骨转子间骨折患者,按照纳入标准和排除标准,筛选出符合要求的股骨转子间骨折住院患者共179例,其中男性66例,女性113例;年龄介于52-96岁之间,平均年龄为(76.98±9.74)岁。记录并比较其年龄、性别、致伤原因、骨折类型、主要伴发病的分布以及治疗方式、住院天数等资料。其中计数资料以率或百分比(%)表示,样本间比较采用χ2检验;计量资料以mean±SD表示,样本间比较采用t检验。应用SPSS13.0统计学软件分析调查数据,进行统计学分析,描述性统计病例特点。第二部分:计算机检索Cochrane数据库、PubMed、中国知网、万方数据库、EMBASE、Medline等一些较大的网络数据库,筛选出那些和老年髋部骨折死亡危险因素相关的中英文参考文献,同时我们还人工筛选出那些符合纳入和排除标准的参考文献。同时根据随机对照实验Meta分析的质量报告规范(QUOROM)给出的建议标准,由2名独立的评价员分别对文献的题目和摘要进行初步检索,符合标准的则阅读全文,不符合标准的予以排除,对数据资料进行提取和质量评价,采用Revman5.0统计学软件进行Meta分析。用I2和卡方检验对所纳入的文献进行异质性检验,采用定性和定量的方法同时评估,当P㩳0.05为差异有统计学意义。若I250%,存在异质性,采用随机效应模型,当异质性不高且I2≤50%时,采用固定效应模型进行定量分析。此外,对于那些因为两种不同的治疗方式可能会对结果产生影响的变量,我们采用亚组分析。P㩳0.05为差异有统计学意义。结果:第一部分:被纳入179例股骨转子间骨折的基本情况为:男性66人,女性113人;平均年龄(76.98±9.74)岁;患者数量居前3位的年龄段分别为81~90岁(71例,39.66%)、71~80岁(50例,27.93%)和61~70岁(36例,20.11%);造成髋部骨折前3位的致伤因素分别为摔伤(86.03%)、坠落伤(8.38%)和车祸(4.47%);按照AO分型,31-A1型83例,占46.37%;31-A2型55例,占30.73%;31-A3型41例,占22.91%;Evans分型中,Ⅰ、Ⅱ、Ⅲ、Ⅳ、Ⅴ型骨折依次减少,分别为90例(50.28%)、48例(26.82%)、27例(15.08%)、10例(5.59%)和4例(2.23%)。全组手术治疗占93.30%(167/179),非手术治疗占6.70%(12/179)。在各种合并症中,合并一种疾病的占32.4%(58/179),合并两种疾病的占29.1%(52/179),合并三种疾病的占12.3%(22/179),合并四种疾病的占6.1%(11/179),合并五种疾病的占1.1%(2/179)。在所有转子间骨折患者中,有下肢静脉血栓的占12.8%(23/179)。第二部分:根据纳入和排除标准,我们共纳入20篇研究文献,包括59462例患者,总体结果的发表偏倚用漏斗图进行了测量,漏斗图提示基本对称,不存在大的偏倚。Meta分析结果显示:在各种危险因素中,年龄大于60岁、男性、ASA评分、骨折前糖尿病、骨折前心血管疾病、骨折前呼吸系统疾病、骨折前脑血管疾病、骨质疏松、高血压病、痴呆的研究结果有统计学差异,提示以上这些危险因素是老年髋部骨折后死亡的主要危险因素,而骨折类型、体质量指数(BMI)、骨折到手术时间的研究结果无统计学差异,说明这三种因素不是老年髋部骨折死亡的危险因素。结论:(1)股骨转子间骨折是以老年人占绝大多数、以跌倒为主要致伤原因的骨质疏松性骨折。(2)随着年龄的增长,股骨转子间骨折的发生概率有逐年增加的趋势,且女性患者多于男性。(3)在AO分型中,31-A1型最多;在Evans分型中,Ⅰ型最多。股骨转子间骨折以手术治疗为主。在各种合并症中,高血压的发病率最高,其次为糖尿病。下肢静脉血栓以81-90岁年龄段最多。(4)Meta分析的结果显示男性、年龄、ASA评分、骨折前糖尿病、骨折前心血管疾病、骨折前呼吸系统疾病、骨折前脑血管疾病、骨质疏松、高血压病和痴呆是老年髋部骨折后死亡的主要危险因素,因此老年人髋部骨折的治疗与预防是临床医师面临的主要问题。(5)老年髋部骨折患者死亡率高可能是老年人生理状况、骨折前患有慢性疾病等多种因素共同作用的结果,治疗前应充分了解患者身体机能和健康状况,充分评估手术风险,选择适宜手术类型,提高患者术后机能恢复效果,降低并发症发生的可能。
[Abstract]:Objective: the aim of this study is the retrospective analysis of clinical data to collect patient records to meet the conditions, to investigate the intertrochanteric fracture incidence and epidemiology, Meta analysis was used to compare the domestic and foreign elderly hip fracture risk factors of death, so as to provide scientific guidance for the prevention and treatment of femoral intertrochanteric fractures. Methods: This study first from the clinical observation to retrospective analysis of the incidence of femoral intertrochanteric fracture combined with a large number of domestic and foreign literature to analyze the epidemiological characteristics and through the cloth, Meta analysis to assess the risk factors for hip fracture in death. The first part: the study selected cases from General Hospital Affiliated to Tianjin Medical University in January 2013 since December 2015 were intertrochanteric fracture patients, according to the inclusion and exclusion criteria, selected The femoral fracture between inpatients were 179 cases, including 66 cases of male, female 113 cases; age ranged from 52-96 years old, the average age was (76.98 + 9.74) years old. Recorded and compared the age, gender, cause of injury, type of fracture, mainly with the disease distribution and treatment, hospitalization days the data. The count data at the rate or percentage (%), compared with 2 test samples; measurement data with mean + SD, samples were compared by t test. Analyze the survey data using SPSS13.0 statistical software, statistical analysis, descriptive statistical characteristics of the cases. The second part: Cochrane database, PubMed China, CNKI, Wanfang database, EMBASE, Medline and other large network database, and filter out those elderly hip fracture risk factors of death in English related references, we also screened the artificial With some references to the inclusion and exclusion criteria. According to the analysis of randomized controlled trials of Meta quality report (QUOROM) recommendations are given, the primary retrieval by 2 independent reviewers of the document title and abstract standard is to read the full text, does not meet the criteria to be excluded, extraction and to evaluate the quality of the data, Meta analysis was performed using Revman5.0 statistical software. We test on the test for heterogeneity in literature by I2 and card, the methods of quantitative and qualitative evaluation at the same time, when P? 0.05 for the difference was statistically significant. If I250%, the heterogeneity, the random effects model, when heterogeneity is not high and the I2 is less than or equal to 50%, using fixed effect model for quantitative analysis. In addition, because for those two different treatments may affect the results of the variables, we use sub components 鏋，
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