SandersⅢ、Ⅳ型严重跟骨骨折治疗中植骨与否的系统评价

发布时间：2018-03-24 04:10

本文选题：跟骨骨折　切入点：植骨　出处：《昆明医科大学》2015年硕士论文

【摘要】：研究背景SandersⅢ型和Ⅳ型跟骨骨折均累及距下关节,导致距下关节跟骨关节面的骨质缺损。目前此类严重跟骨骨折的主要治疗方式是切开复位(ORIF)结合钢板螺钉内固定手术,但在手术过程中对骨质缺损的处理仍然存在植骨与不植骨的争议。本研究旨在通过系统评价和Meta分析,对SandersⅢ、Ⅳ型跟骨骨折治疗中植骨与不植骨进行比较,探讨这两种治疗方式在手术时间、术后并发症、功能疼痛评分、影像学测量值等方面的差异。目的通过系统评价和Meta分析,了解SandersⅢ、Ⅳ型跟骨骨折治疗中植骨与不植骨在手术时间、术后并发症、功能疼痛评分、影像学测量值等方面的差异。为其治疗方式的选择提供循证医学的证据,以供临床治疗进行参考。研究方法按照纳入与排除标准检索文献,对文献进行筛选及质量评估,提取数据并以系统评价和Meta分析的方法分析数据从而得到循证医学证据。检索方法：计算机结合手工检索美国国立医学图书馆国际综合生物医学信息书目数据库(Medline)、荷兰Elsevier Science医学信息书目数据库(EMBase)、实证医学对照试验中心注册库(CENTRAL)、Ⅰ临床决策循证数据库(Foreign Evidence-Based Medicine, FEBM)、西文生物医学期刊文献数据库(Foreign Medical Journal Service, FMJS)等权威外文数据库(至2015年3月),检索中文期刊网数据库(CNKI)、中国生物医学文献数据库(CBM)、维普期刊资源整合服务平台、万方中文学位论文数据库等权威中文数据库(至2015年3月),检索收集国内外公开发表的临床随机对照(RCT)研究文献。检索世界卫生组织国际临床试验注册平台(WHO ICTRP)、临床试验数据库(ClinicalTrials.gov Database)、中国临床试验注册中心(ChiCTR)查找目前进行中的相关研究。通过OvidTechnologies数据库、中国知识基础设施工程(CNKI)、万方中国学术会议论文(CACP)、万方中国学位论文数据库(CDDB)检索骨与创伤协会的年会档案、未正式发表的论文及学位论文等灰色文献。检索过程中不限制时间或语言,多途径多渠道广泛收集相关文献。选择标准：对比切开复位内固定术(ORIF)结合植骨与不植骨治疗跟骨关节内移位骨折(DIACFs)的随机或半随机临床对照研究。数据收集与分析：由两名评估员独立的进行检索、筛选检索结果、评估偏倚风险、确定可纳入的文献及样本。以Review Manager (RevMan)软件及R软件对手术时间、术后并发症、功能疼痛评分、影像学测量值等进行异质性检验、合并效应量等分析。并使用GREADprofile (GREADpro)软件对证据进行分级。结果最终纳入文献7篇,其中英文文献3篇、中文文献4篇。共纳入严重跟骨关节内移位骨折(SandersⅢ、Ⅳ型)患者431例(共431足),其中植骨组223足,非植骨组208足。经改良Jadad评分量表评估：低质量文献5篇、高质量文献2篇；经Cochrane协作网的偏倚风险评价工具评估：3篇高偏倚风险文献,4篇偏倚风险不清楚的文献。将纳入文献的数据通过Meta分析得到结果：植骨组与非植骨组在术后1年内及2年的功能疼痛评分优良率和评价为“差”率均无统计学差异(P0.05),术后并发症无统计学差异(P0.05),术后1年的Bohler's角、Gissane角、跟骨长度、高度及术后2年的Bohler's角、Gissane角无统计学差异(P0.05),植骨组手术时间较非植骨组手术时间延长(P0.05)。通过系统评价得到结果：植骨组与非植骨组在骨折愈合时间、健康相关生活质量方面无统计学差异(P0.05),但植骨组失血量多于非植骨组(P0.05)。结论在SandersⅢ、Ⅳ型跟骨骨折的手术治疗中,植骨组与非植骨组在术后功能疼痛评分、术后并发症、骨折愈合时间、健康相关生活质量及影像学测量值方面不具有有统计学差异(P0.05)。植骨组与非植骨组相比,植骨组的手术时间更长(MD=15.79min, 95%CI[13.62～17.96]min, P0.05)、术中失血量更多 ((MD=36.09ml, 95%CI[28.68～43.50]ml, P0.05)。据此,本研究认为在SandersⅢ、Ⅳ型跟骨骨折的手术治疗中,植骨并不具有优势,其预后与不植骨者并无统计学差异,植骨操作反而增加了不必要的手术时间和术中失血量。
[Abstract]:On the background of Sanders type III and type IV calcaneal fractures were subtalar joint, leading to subtalar articular surface of the calcaneus bone defect. The main treatment at present such serious calcaneal fracture is open reduction (ORIF) combined with internal fixation, but during the operation process of bone defect and bone graft is still controversial without bone graft. The purpose of this study is to through the system evaluation and Meta analysis, the Sanders III, compared with treatment of bone graft without bone graft type IV calcaneal fractures, to investigate the two treatments at the time of surgery, postoperative complications, functional pain score, difference imaging measurement value. Through objective analysis system evaluation and Meta, Sanders III, treatment of bone graft and bone graft at the time of surgery type IV calcaneal fractures, postoperative complications, functional pain score, difference imaging measurement value. For the treatment Provide evidence-based choice for clinical treatment for reference. Methods according to the inclusion and exclusion criteria document retrieval, screening and quality evaluation of literature, data extraction and analysis method in system evaluation and Meta analysis data to obtain evidence of evidence-based medicine. Retrieval methods: manual retrieval of international comprehensive biomedical information the bibliographic database of the National Library of medicine combined with computer (Medline), Holland Elsevier Science medical information bibliographic database (EMBase), empirical medical central register of controlled trials (CENTRAL), clinical evidence-based decision-making database (Foreign Evidence-Based Medicine, FEBM), Western biomedical journal literature database (Foreign Medical Journal Service, FMJS) and other authoritative foreign language the database (March 2015), retrieved Chinese journal net database (CNKI), Chinese biomedical literature database (CBM), The VIP information resource integration service platform, Chinese Wanfang dissertation database etc Chinese database (March 2015), randomized clinical searches were published at home and abroad (RCT) research literature retrieval. WHO international clinical trial registration platform (WHO ICTRP), the clinical trial database (ClinicalTrials.gov Database), Chinese clinical trial registration center (ChiCTR) find related research in progress at present. Through the OvidTechnologies database, Chinese knowledge infrastructure (CNKI), Wanfang Chinese Symposium (CACP), Wanfang China Dissertations Database (CDDB) retrieval of bone and Trauma Association annual meeting, archives, papers and Dissertations of grey literature have not formally published. The time or the language does not limit the retrieval process, multi-channel extensive collection of relevant literature. Selection criteria: open reduction and internal fixation comparison (ORIF) Combined with bone graft and bone graft in the treatment of intra-articular calcaneal fracture (DIACFs) control study of randomized or quasi randomized. Data collection and analysis: by two independent assessors of the retrieval, filtering the retrieval results, assessed the risk of bias, and to determine the sample can be incorporated into. Review (RevMan) and Manager software R software for the operation time, postoperative complications, functional pain score, heterogeneity test imaging measurements were analyzed, the combined effect of the amount. And use the GREADprofile software (GREADpro) to classify the evidence. The final literatures of 7 papers, including 3 papers English, 4 literatures were included. Chinese serious intra-articular calcaneal fracture (Sanders III, IV) in 431 patients (431 feet), of which 223 foot bone graft group, non bone graft group 208. The modified Jadad scores were evaluated: 5 literatures of low quality, high quality 2 articles; the Cochrane Co The net bias risk assessment tool for assessment of 3 high risk of bias of literature, 4 articles are not clear. The risk of bias will be included in the literature data obtained by Meta analysis results: bone graft group and non bone graft group after 1 years and 2 years of pain score excellent rate and evaluation function is poor "there was no statistical difference (P0.05), there was no significant difference in postoperative complications (P0.05, Bohler's) 1 years after operation angle, Gissane angle and calcaneal length, Bohler's height and 2 years after operation angle, Gissane angle had no significant difference (P0.05), bone graft group operation time is non graft bone lengthening group the operation time (P0.05). The results obtained through the system evaluation: bone graft group and non bone graft group in the healing time, no significant differences in health-related quality of life (P0.05), but the bone graft group blood loss than non bone graft group (P0.05). Conclusion in Sanders III, surgical treatment of type IV calcaneal fractures in, Bone graft group and non bone graft group score function in postoperative pain, postoperative complications, fracture healing time, health-related quality of life and imaging measurements do not have significant difference (P0.05). Bone graft group compared with non bone graft group, the operation time is longer the bone graft group (MD= 15.79min, 95%CI[13.62 to 17.96]min, P0.05), intraoperative blood loss more ((MD=36.09ml, 95%CI[28.68 ~ 43.50]ml, P0.05). Therefore, this study suggests that the Sanders III, surgical treatment of type IV calcaneal fractures, bone graft does not have the advantage, the prognosis and the bone graft operation there was no significant difference between the increased loss of blood. The operative time and unnecessary weight.

【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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