我国高龄转子间骨折经髋关节置换与内固定治疗的Meta分析

发布时间：2018-06-16 16:31

本文选题：髋关节置换 + 转子间骨折　；参考：《山西医科大学》2017年硕士论文

【摘要】：目的:由于我国60岁以上人口的不断增加,高龄人群发生的ITF在临床工作中越来越常见,并且展现出逐年递增态势。转子间骨折有其自身的特点,如股骨转子间多为松质骨,暴力作用于该部位是常常造成粉碎性的不稳定型股骨转子间骨折骨折;该部位滋养血管较为丰富,骨折发生后多能较好的愈合;由于发生股骨转子间骨折时常累及股骨后内侧壁和股骨距,所以容易引起髋内翻畸形。高龄转子间骨折由于其并发症的存在,其死亡率一直很高,一年的死亡率高达30%,还有40%的病人丧失独立活动的能力,所以为减少病人死亡并且提升其生活品质,采用手术的方式已经得到大家的广泛认同。目前临床较为主流的方法是PFNA、DHS以及人工关节置换等。由于各种治疗方法各具其自身的优缺点,所以选取哪种方式治疗股骨转子间骨折一直存在比较大的争议。所以本文以Meta分析方式分别对比DHS与THA以及PFNA与THA治疗该类骨折疗效的差别。方法:机检PubMed、中国知网、万方、VIP等资料库,同时人工查阅相关专科杂志等发表的文章。搜集国内关于老年ITF经PFNA与髋关节置换治疗的随机对照试验的文献以及老年ITF经DHS与髋关节置换治疗的随机对照试验的文献。根据制定好的相关标准排除不符合标准的资料,纳入符合标准的资料,并对最终采纳的资料使用Jadad评分量表进行评分。评价指标包括手术时长、出血量、下地负重时间、住院天数、并发症、关节功能评分。由第一作者采用Cochrane协作网提供的Revman5.3软件进行分析。计数资料采用优势比(odds ration,OR)及其95%的可信区间(confidenceinterval,CI)表示。计量资料采用加权均数差(weightedmean difference,WMD)。同质性判定使用OR Cochrane Q检验(卡方),P0.1表示无异质性,P0.1表示存在异质性。异质性的定量分析使用I2,当I250%表明有异质性。对于同质性较好的宜采用Fixed effect model分析,对于有异质性的研究,应采用Random effect model分析。结果:PFNA组与THA组的对比。手术时间:P0.05没有意义,尚不能认为俩者在手术时长上存在差别;术中出血量:P0.05,有意义,认为THA术中出血量大于PFNA;住院时间:P0.05,有意义,认为THA住院天数小于PFNA组;术后下地负重时间:P0.05,认为THA下地负重时间小于PFNA;并发症:P0.05,认为THA并发症少于PFNA;术后Harris评分(6个月):P0.05,认为THA 6个月时关节功能评分优于PFNA组;术后Harris评分(术后12个月):P0.05,认为THA12个月时关节功能评分优于PFNA。DHS组与THA组各项观察指标的比较。手术时间:P0.05,认为THA在手术时长上好于DHS的。术中出血量:P0.05,尚不能认为DHS组与THA组在出血量上存在差别。住院时间:P0.05,THA在住院时间好于DHS。术后下地负重时间:P0.05,THA下地负重时间好于DHS。并发症:P0.05,表明THA并发症少于DHA。术后3个月Harris评分:P0.05,表明THA术后关节功能评分优于动力髋螺钉。结论:PFNA组与髋关节置换组的各项观察指标的比较,从手术时间上来说,本次分析结果显示髋关节置换组与PFNA组在手术时间上的差异无统计学意义。从出血量来说,PFNA在出血量上优于THA。从住院天数、负重时间、并发症发生率、关节功能评分这几方面来说,THA是优于PFNA。DHS和THA各项观察指标对比,除出血量这一项观察指标DHS和THA的差别无意义以外,在其他观察项目如住院天数、负重时间、关节功能评分等THA组是优于DHS组的。
[Abstract]:Objective: due to the increasing population of 60 years and older in China, the ITF in the elderly is becoming more and more common in the clinical work and shows an increasing trend year by year. The intertrochanteric fracture has its own characteristics, such as the most of the intertrochanteric femoral intertrochanteric, and the violent intertrochanteric fracture is often made into a comminuted and unstable femoral intertrochanteric fracture. Fracture, which has abundant nourishing blood vessels and better healing after the fracture, often causes the deformity of the coxa varus because of the femoral intertrochanteric fracture often involving the medial wall of the femur and the thighbone distance, and the death rate of the intertrochanteric fracture of the elderly is high, the death rate is up to 30%, and 40% in one year. Patients lose their ability to be independent, so to reduce patients' death and improve their quality of life, the method of operation has been widely recognized. The main main clinical methods are PFNA, DHS, and artificial joint replacement. The treatment of intertrochanteric fractures of the femur has been quite controversial. Therefore, this paper compares the difference between DHS and THA and PFNA and THA for the treatment of this type of fracture by Meta analysis. Methods: PubMed, Chinese knowledge network, Wanfang, VIP and other articles published in the relevant journals. Literature on randomized controlled trials of FNA and hip replacement therapy and a randomized controlled trial of the elderly ITF via DHS and hip replacement therapy. According to the relevant standards, the data were excluded from the standard, and the final adopted data were scored by the Jadad scale. It includes the length of operation, the amount of bleeding, the time of down the ground, the days of hospitalization, the complications, and the score of joint function. The first author uses the Revman5.3 software provided by the Cochrane cooperation network. The count data is represented by the odds ration (OR) and its 95% confidence interval (confidenceinterval, CI). The weight mean difference (Wei) is used in the measurement data. Ghtedmean difference, WMD). The homogeneity determination uses OR Cochrane Q test (chi square), P0.1 indicates no heterogeneity, P0.1 indicates heterogeneity. The quantitative analysis of heterogeneity uses I2 and I250% indicates heterogeneity. Analysis. Results: comparison between group PFNA and group THA. Operation time: P0.05 has no significance. There is no difference between the two in the operation. The amount of bleeding in the operation is P0.05, it is meaningful, it is considered that the amount of bleeding in THA is greater than PFNA; the time of hospitalization: P0.05, it is meaningful, that the number of THA is less than that of the PFNA group; the time after operation is: P0.05, THA under P0.05. The time of ground weight negative was less than PFNA; complication: P0.05, the complication of THA was less than PFNA; Harris score (6 months) after operation was P0.05, and the joint function score of THA was better than that of PFNA group at 6 months, and the postoperative Harris score (12 months after operation): P0.05. Room: P0.05, think that THA is better than DHS during operation. The amount of intraoperative hemorrhage: P0.05, it is not still thought that there is a difference between the DHS group and the THA group in the amount of bleeding. The time of hospitalization is P0.05, and the time of hospitalization is better than that of the THA after the operation of DHS.: P0.05, THA down time is better than that of DHS. complications: it shows that the complications are less than 3 months after the operation. RIS score: P0.05, indicating that the joint function score after THA is better than that of the dynamic hip screw. Conclusion: the comparison between the observation indexes of the group PFNA and the hip replacement group, from the time of operation, this analysis shows that there is no statistical difference between the hip replacement group and the PFNA group in the operation time. From the amount of bleeding, the amount of PFNA is on the amount of bleeding. THA is superior to THA. from the number of hospitalization days, weight bearing time, complication rate and joint function score, which is superior to the observation indexes of PFNA.DHS and THA. Except for the difference of the difference of the observation index of hemorrhage, DHS and THA, the THA group in other observation items such as the days of hospitalization, the time of weight bearing, and the joint function score are superior to those of the other observation items. Group DHS.
【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

【参考文献】