人工关节置换术与内固定术治疗老年不稳定型股骨转子间骨折的系统评价

发布时间：2018-03-24 04:08

本文选题：人工关节置换术　切入点：内固定术　出处：《暨南大学》2015年硕士论文

【摘要】：研究目的对人工关节置换术与内固定术两种手术方法治疗老年不稳定型股骨转子间骨折的疗效及安全性进行系统评价,为临床选择治疗方式提供依据。材料和方法计算机检索Medline、Pubmed、EMBASE、CENTRAL、OVID、Cochrane、万方、维普、中国知网(CNKI)、中国生物医学文献数据库、Clinical Trials、NRR Archive、CCT、Meta-register of Controlled Trials、ISI proceedings、Medical Research Council C linical Trials Directory、SIGLE、中国学术会议论文数据库(CACP)自建库以来的所有论文,手工检索近10年来的骨科相关杂志以及国内外有关骨科的会议论文,并向同行咨询了解已完成或在研试验,获取所有人工关节置换术与内固定术治疗老年不稳定型股骨转子间骨折的随机或半随机对照试验,语种仅限英文与中文。由两名研究员分别独立使用Cochrane风险偏倚评估工具(5.1.0)评价文献,提取文献结局数据并录入Revman5.3.5软件行meta分析。结果共纳入11篇随机对照实验,共891例患者,其中内固定485例,关节置换406例。在某些结局指标中,内固定组需分成髓内固定和髓外固定分别讨论。Meta分析结果显示:髓内固定手术时间较短、术中出血量较少,在内植入物相关并发症发生率和再手术率上与人工关节置换术无差别;髓外固定术中出血量较少,内植入物相关并发症发生率和再手术率较高,在手术时间上与人工关节置换术无差别;内固定术输血量较少,下地负重时间较晚、住院时间较长;在术后内科并发症发生率和死亡率上与人工关节置换术无差别;人工关节置换术早期疗效比内固定术好,但随着时间的推移两组之间的差异将越来越不明显,最终趋于一致。结论目前尚无充分证据表明人工关节置换与内固定在治疗老年不稳定型转子间骨折中哪一项更有优势。应根据患者的具体情况选择个体化的治疗方法,并需要更多大样本、多中心合作的随机对照研究进一步证实。
[Abstract]:Objective to study the artificial joint replacement and internal fixation of two operative methods in treatment of senile unstable intertrochanteric fractures of the clinical efficacy and safety of systematic evaluation, provide the basis for clinical treatment. Materials and methods of computer retrieval Medline, Pubmed, EMBASE, CENTRAL, OVID, Cochrane, Wanfang, VIP, Chinese HowNet (CNKI), Chinese biomedical literature database, Clinical Trials, NRR Archive, CCT Meta-register, of Controlled Trials, ISI proceedings, Medical Research Council C linical Trials Directory, SIGLE, China academic conference papers database (CACP) from all papers since the establishment of the database, the manual retrieval in recent 10 years, the Journal of Department of orthopedics department of orthopedics domestic and international conference proceedings, and to the peer consultation to understand the completed or in the research test, obtain all arthroplasty and internal fixation for the treatment of elderly unstable Type of intertrochanteric fracture randomized or quasi randomized controlled trials, only English and Chinese languages. By two researchers independently using the Cochrane tool for assessing the risk of bias (5.1.0) evaluation of literature, literature analysis and extraction of outcome data input Revman5.3.5 software meta. The results of 11 randomized controlled trials were included, a total of 891 cases of patients. The internal fixation in 485 cases, joint replacement in 406 cases. In some outcomes, internal fixation group divided into intramedullary and extramedullary fixation respectively to discuss the results of.Meta analysis showed that intramedullary fixation with shorter operation time, less bleeding, including implant related complications and reoperation rate and artificial no difference in arthroplasty; extramedullary fixation less bleeding, implant related complications and high rate of re operation rate, at the time of surgery and artificial joint replacement and internal fixation. No difference; Less blood, weight-bearing time later under, long time of hospitalization; the postoperative medical complications and mortality rate and artificial joint replacement arthroplasty had no difference; the early efficacy of internal fixation operation, but the differences between the two groups with the passage of time will be more and more obvious, the final conclusion is consistent. There is no evidence of hip arthroplasty and internal fixation in the treatment of elderly patients with unstable intertrochanteric fractures in which one has more advantages. Individualized treatment should be chosen according to the specific circumstances of patients, and need more large sample, randomized controlled multi center collaborative research further confirmed.

【学位授予单位】：暨南大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.4

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