髓内钉与锁定钢板治疗肱骨近端两部分骨折疗效的Meta分析

发布时间：2018-03-19 08:28

本文选题：骨折固定术　切入点：髓内　出处：《山西医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：背景:肱骨近端骨折极为常见,老年人高发。而人口的老龄化正一步步逼近,这也导致肱骨近端骨折的患病率进一步提升,相关研究表明,未来30年,其患病率将增加3倍。两部分骨折在肱骨近端骨折中最为常见,对于那些存在明显移位、不稳定的两部分骨折,若无绝对手术禁忌证,通常需要手术治疗,从而尽早恢复肩关节功能。手术的方式多样,主要取决于患者的年龄、骨骼质量以及对肩关节功能的要求。如髓内钉内固定、锁定板内固定,两者均能获得较理想的效果,各有优劣,但目前对于采用何种手术方式仍存争议。目的:考虑到不同骨折类型之间的差异及相应的骨折特点,本研究通过限定一种骨折类型,即肱骨近端两部分骨折,采用循证医学这一可信度较高的方法,用以对比髓内钉与锁定板的效果,并比较其优缺点,从而得出更有针对性的结果,以进一步指导临床实践。方法:检索Pub Med、Springer Link、EMBASE、The Cochrane Library、Medline、Science Direct、中国知识资源总库、万方数据库、维普数据库,检索时间从1996年至2016年。英文检索词为:proximal humeral nail、Intramedullary Nail、locking plates、LPHP、Two-Part proximal humerus fractures、Two-Part Proximal Humeral Surgical Neck Fractures。中文检索词为:髓内钉、交锁髓内钉、肱骨近端、锁定板、锁定接骨板、外科颈骨折、两部分骨折。查找相关文献,内容均为髓内钉和锁定板治疗的效果对比,设定入选标准选择文献,并对入选的文献进行质量的高低评价,统计学上采用Rev Man 5.0软件,由国际Cochrane协作组供应。结果:总共有7篇文献入选,病人的总例数是295例,其中髓内钉病例136例,锁定板病例159例。Meta分析的结果表明,评价指标中,髓内钉组在手术时间(WMD=-27.71,95%CI( 36.07,-19.35),P0.05)、术中出血量(WMD=-114.18,95%CI( 169.91,-58.45),P0.0001)、术后骨折愈合时间(WMD= 2.91,95%CI( 5.80,-0.01),P=0.05)上明显优于锁定板组,而两组在Constant评分(WMD=-2.84,95%CI( 5.90,0.22),P=0.07)、术后并发症率(OR=0.89,95%CI(0.43,1.84),P=0.76)方面差异无统计学意义。结论:髓内钉在手术时间、术中出血量和骨折愈合时间上比锁定钢板有优势,然而Constant评分和术后并发症率仍存争议和讨论。因此,对于髓内钉与锁定板治疗肱骨近端两部分骨折的效果,仍需要更多大样本量、前瞻性研究来进一步证实。
[Abstract]:Background: proximal humeral fractures are extremely common, with a high incidence in the elderly. Population ageing is approaching, which leads to a further increase in the prevalence of proximal humeral fractures. The morbidity rate will increase threefold. Two parts of fractures are most common in proximal humerus fractures, and for those with obvious displacement and instability, surgery is usually required without an absolute contraindication. In order to restore shoulder function as soon as possible, the operation is varied, depending on the patient's age, bone quality and the requirements for shoulder function. If intramedullary nail fixation, locking plate fixation, both can achieve satisfactory results, There are some advantages and disadvantages, but there is still controversy about the operative method. Objective: considering the differences between different fracture types and the corresponding fracture characteristics, this study defined a fracture type, that is, the proximal humerus fracture, two parts of the humerus fracture. Evidence-based medicine, a reliable method, was used to compare the effect of intramedullary nail and locking plate, and to compare its advantages and disadvantages, so as to obtain more targeted results. Methods: to search Pub Medspinger Linkler EMBASEN the Cochrane Library Medline Medline Science Direct, China knowledge Resources General Database, Wanfang Database, Weip Database, The search time is from 1996 to 2016. The English key words are: proximal humeral nailary locking plates and LPHPTwo-part proximal humerus fracturespart Proximal Humeral Surgical Neck fractures. The Chinese key words are: intramedullary nail, interlocking intramedullary nail, proximal humerus, locking plate, locking plate, surgical neck fracture, surgical neck fracture, surgical neck fracture, intramedullary nail, interlocking intramedullary nail, proximal humeral nail, locking plate, locking plate, surgical neck fracture, Two parts fracture. Looking up the related literature, the contents are the comparison of the effect of intramedullary nail and locking plate, setting the selection standard and evaluating the quality of the selected document. The software of Rev Man 5.0 was used in statistics. Results: the total number of patients was 295, including 136 cases of intramedullary nail and 159 cases of locked plate. In the intramedullary nail group, WMD-27.71C95CII (36.07- 19.35) was significantly better than the locking plate group (WMD-114.1895CI) (169.91- 58.45), and the fracture healing time (WMD= 2.91) was significantly better than that in the locking plate group (5.80- 0.01P0.05), and the intramedullary nail group was significantly better than the locking plate group at the operative time of WMD-27.71C95CI (36.07U -19.35U), and the intramedullary intramedullary nailing group (WMD-114.1895CI) was significantly better than the locking plate group (P 0.0001). However, there was no significant difference between the two groups in the Constant score of WMD-2.84 / 95CI (5.90 / 0.22) and the rate of postoperative complications were 0.431.84 / 0.76. Conclusion: intramedullary nail has an advantage over locking plate in operative time, intraoperative blood loss and healing time of fracture, and there is no significant difference between the two groups in operative time, intramedullary blood loss and healing time of fracture. However, the Constant score and the rate of postoperative complications remain controversial and discussed. Therefore, the effect of intramedullary nail and locking plate in the treatment of proximal humeral fractures still needs to be further confirmed by prospective studies.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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