骨水泥半髋关节置换治疗老年股骨颈骨折临床疗效的Meta分析

发布时间：2018-04-25 11:17

本文选题：骨水泥 + 股骨颈骨折　；参考：《重庆医科大学》2017年硕士论文

【摘要】：目的:应用Cochrane系统评价方法对半髋关节置换中骨水泥与非骨水泥假体选择疗效差异进行系统评价,为手术治疗股骨颈骨折提供假体选择基础。方法:应用电脑对各大中英文数据库,如MEDLINE,Pub Med,Ovid及万方,维普网,知网等,检索时间从建库至2015年5月。再运用手动检索相关杂志,和利用网上资源如谷歌学术等,扩大检索范围。按照拟定的纳入排除标准,选出有关骨水泥和非骨水泥半髋关节置换治疗老年股骨颈骨折的随机对照试验文献(Random Control Trials,RCTs)。由两名人员单独阅读全文,提取拟定的评价指标数据,进行汇总,最后,使用Rev Man5.3软件进行Meta分析。结果:最终共纳入18篇随机对照文献,共计2308例髋,左侧1178例,右侧1130例,骨水泥组1157例,非骨水泥组1151例,结果得出骨水泥组较非骨水泥组手术时间长[MD=8.30,95%CI(6.86,9.74),P0.001],术中出血量多[MD=38.72,95%CI(0.11,77.32),P=0.05],假体并发症少[RR=0.29,95%CI(0.18,0.45),P0.00001],术后1年大腿疼痛发生率少[OR=0.69,95%CI(0.55,0.87),P=0.002]。翻修率[O R=0.91,95%CI(0.59,1.41),P=0.68]、心脑血管并发症[OR=1.03,95%CI(0.63,1.70),P=0.91]、死亡率[OR=0.89,95%CI(0.73,1.07),P=0.21]、深静脉血栓形成率[OR=1.10,95%CI(0.43,2.86),P=0.84]方面两者无统计学差异。结论:骨水泥需要更长手术时间,术中出血量更多,但在假体并发症和大腿疼痛上,具有明显优势,且骨水泥假体并没有增加死亡率、翻修率及深静脉血栓形成。
[Abstract]:Objective: to evaluate the difference between cement and non-bone cement prosthesis selection in hemihip arthroplasty with Cochrane system evaluation method, and to provide the basis for prosthesis selection for the surgical treatment of femoral neck fracture. Methods: the Chinese and English databases, such as MEDLINE, Pub MedOvid and Wanfang, Wiper, Knownet, etc., were searched by computer. The retrieval time was from the construction of the database to May 2015. Then use manual search related magazines, and the use of online resources such as Google academic, to expand the scope of search. According to the proposed exclusion criteria, random Control trialsof RCTs were selected for the treatment of femoral neck fractures in elderly patients with bone cement and uncemented semi-hip arthroplasty. The whole text is read separately by two people, the data of evaluation index is extracted and summarized. Finally, the Meta analysis is carried out by Rev Man5.3 software. Results: a total of 18 random controlled literatures were included. There were 2308 hips, 1178 left, 1130 right, 1157 bone cement and 1151 non-bone cement. The results showed that the operation time of bone cement group was longer than that of non-bone cement group [MDR 8.30 ~ 95CII 6.869.74 + P0.001], the amount of intraoperative bleeding was more [MDR 38.72 ~ 95CI0.1177.32 + P0. 05], the complications of prosthesis were less [RR0.2995CI0.180.45 + P0.00001], and the incidence of thigh pain was less one year after operation [OR0.6995CIT 0.550.87P 0.002]. There was no statistical difference between the two groups in revision rate (OR1.0395), mortality rate (OR0.89), deep vein thrombosis rate (OR1.1095CII 0.43) and deep venous thrombosis rate (OR1.1095CII 0.43 / 2.86P0.84), the revision rate was 0.69% (P = 0.68), cardiovascular and cerebrovascular complications (OR1.0395 / 95) were 0.631.70 / 0.91, mortality rate was 0.731.07 / 0.21, and there was no significant difference between the two groups in the rate of deep venous thrombosis (OR1.1095CII 0.43 / 2.86P0.84). Conclusion: bone cement needs longer operation time and more blood loss during operation, but it has obvious advantages in prosthesis complications and thigh pain, and does not increase mortality, revision rate and deep venous thrombosis.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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