髓内针与钢板固定治疗成人肱骨干骨折的Meta分析

发布时间：2018-04-01 02:03

本文选题：肱骨干骨折　切入点：髓内针　出处：《吉林大学》2017年硕士论文

【摘要】：目的:利用Meta分析研究比较髓内针固定(Intramedullary nailing,IMN)与钢板固定(Plate fixation,PLT)治疗成人肱骨干骨折的临床疗效,为临床治疗方案的选择提供参考。方法:依照Cochrane协作网举荐的方法进行Meta分析,计算机检索Pub Med、Cochran Central、Embase等数据库以及手动检索谷歌学术网站,检索时间为1990年1月~2016年10月。搜集髓内针与钢板固定治疗成人肱骨干骨折的临床随机对照试验(randomized controlled trial,RCT),并利用Cochrane协作网提供的偏倚风险评估工具对纳入研究的文献进行方法学质量评估,数据提取完成后采用Rev Man 5.3版本软件对数据进行合并分析,通过x2(chi-squared test)和I2统计评估异质性,在STATA 12.0软件中,利用Begg漏斗图和Egger偏倚测试方法检测纳入文献的发表偏倚情况,采用GRADE pro 3.6版本证据质量评价软件对结局指标证据质量进行评价。结果:经过筛选,最终20篇临床随机对照试验被纳入,共722名患者,其中髓内针组347例,钢板组375例。Meta分析结果表明二者在减少医源性骨折(RR=4.35,95%CI:1.38—13.73;P=0.01)、肩部撞击(RR=7.44,95%CI:3.32—16.65;P0.00001)、二次手术(RR=2.12,95%CI:1.36—3.30;P=0.0009)、肩部活动受限(RR=10.74,95%CI:2.04—56.41;P=0.005)、肩部僵硬(RR=3.19,95%CI:1.11—9.17;P=0.03)、肩关节黏连(RR=3.33,95%CI:1.12—9.89;P=0.03)的发生率和缩短平均术中X线透视时间(SMD=1.47,95%CI:0.34—2.59;P=0.01)以及在提高平均Constant评分(SMD=-0.68,95%CI:-1.12—-3.30;P=0.002)、平均Mayo评分(SMD=-1.01,95%CI:-1.62—-0.40;P=0.001)方面的比较中,结果显示差异均有统计学意义,表现出钢板组优于髓内针组。但在降低平均愈合时间(SMD=-0.53,95%CI:-0.77—-0.30;P=0.0001)、平均术中失血量(SMD=-1.75,95%CI:-3.36—-0.14;P=0.03)方面的比较中,提示髓内针组存在优势。余下二者在减少骨折延迟愈合(RR=1.82,95%CI:0.64—5.17;P=0.26)或骨折不愈合(RR=1.31,95%CI:0.77—2.23;P=0.32)、医源性桡神经损伤(RR=0.73,95%CI:0.42—1.26;P=0.25)、内固定失效(RR=1.21,95%CI:0.48—3.05;P=0.69)的发生率方面和在减少平均手术时间(SMD=-0.46,95%CI:-1.07—0.77;P=0.46)、平均住院时间(SMD=-1.15,95%CI:-2.41—0.10;P=0.07)、平均手术间隔时间(SMD=-3.85,95%CI:-8.34—0.64;P=0.09)方面以及在提高平均ASES得分(SMD=-0.36,95%CI:-0.76—0.05;P=0.08)、平均UCLA得分(SMD=-0.04,95%CI:-0.66—0.58;P=0.08)、平均C-M得分(SMD=-0.51,95%CI:-0.14—0.12;P=0.11)方面的比较中,结果显示其无统计学差异。Begg漏斗图和Egger偏倚检测结果显示,所受拭组P值均大于0.5,未发现明显发表偏倚。GRADE证据质量评价结果提示:6个中级证据、15个低级证据、1个极低级证据。结论:髓内针固定与钢板固定治疗成人肱骨干骨折各有优势,但髓内针固定易引发更多的临床并发症,所以优选钢板固定治疗成人肱骨干骨折。然而,由于结局指标证据质量评价并不高,故而今后仍需纳入更多高质量的前瞻性随机对照试验来进一步验证此结论或得出新的结论。
[Abstract]:Objective: to compare the clinical effects of intramedullary needle fixation (IMN) and plate fixation plate fixation (PLT) in the treatment of adult humeral shaft fractures by Meta analysis.Methods: the Meta analysis was carried out according to the recommendation method of Cochrane collaboration Network. The database of Pub Medcochran Central Embase and the academic website of Google were searched by computer from January 1990 to October 2016.To collect randomized controlled clinical trials of intramedullary needle and plate fixation for adult humeral shaft fractures, and evaluate the methodological quality of the literature included in the study by using the bias risk assessment tool provided by the Cochrane collaboration network.After data extraction was completed, the data were merged and analyzed by Rev Man 5.3 version software. Heterogeneity was evaluated by x2(chi-squared testand I2 statistics. In STATA 12.0 software, Begg funnel diagram and Egger bias test method were used to detect the publication bias of the included documents.GRADE pro 3.6 version of evidence quality evaluation software was used to evaluate the evidence quality of outcome indicators.Results: after screening, 20 clinical randomized controlled trials were included in 722 patients, including 347 cases in intramedullary needle group, 347 cases in intramedullary needle group, and 3 cases in intramedullary needle group.The average intraoperative X-ray fluoroscopy time was 1.47% and 95% CI: 0.34-2.59% P0.01) and compared with the average Constant score of SMD-0.6895 CI: -1.12-3.30% P0.002, and the average Mayo score of SMD-1.01C 95: CI-1.62-0.40P0. 001).The results showed that the difference was statistically significant, showing that the plate group was superior to the intramedullary needle group.But in reducing the average healing time of SMD-0.53C95 CI-0.77-0.30P0.0001, and the average intraoperative blood loss of SMD-1.7595% CI-3.36- 0.14P0.03, it was suggested that the intramedullary needle group had advantages.The results showed that there was no statistical difference between them. Begg funnel graph and Egger bias test showed that the P value of the swab group was higher than 0.5, and the quality evaluation results of the published bias. Grade evidence showed that: 6 intermediate evidence, 15 low-level evidence and 1 very low level evidence.Conclusion: intramedullary nail fixation and plate fixation have respective advantages in the treatment of adult humeral shaft fracture, but intramedullary needle fixation may lead to more clinical complications.However, because the quality evaluation of outcome indicators is not high, it is necessary to include more high-quality prospective randomized controlled trials in the future to further verify this conclusion or draw a new conclusion.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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