关节置换与保留关节修复肱骨近端移位3，4部分骨折的Meta分析

发布时间：2018-08-01 17:49

【摘要】：目的：收集肱骨近端移位3,4部分骨折保留关节与关节置换治疗的随机对照试验,对两种治疗方法的疗效差异进行Meta分析。方法：检索Medline(1966年1月至2013年12月)、Pubmed(1980年1月至2013年12月)、Embase(1990年1月至2013年12月)、Science(1990年1月至2013年12月)、Springer(1990年1月至2013年12月)、CNKI(1994至2013年)、万方数据库(1982至2013年)等数据库中关于肱骨近端3,4部分骨折保留关节与关节置换治疗的随机对照试验,纳入符合标准的文献,提取相关数据输入Comprehensive Meta-Analysis Software (CMA)软件进行Meta分析。结果：共7篇文献符合纳入标准,共计320例患者(165例行保留关节治疗,155例行关节置换治疗),均为英文文献,经改良的Jadad评分判定均为高质量研究。Meta分析结果显示,总Constant平均值为55.9(95%CI：50.7-61.1,P0.001),保留关节治疗组的Constant评分值高于关节置换组(P0.01)。研究的异质性显著(I2=88%,Q统计量=107.6,Q=13,P0.001),在Meta分析时肩关节Constant评分值随着男女性别比增长、肱骨结节骨吸收率增加而下降。结论：提示保留关节肱骨近端移位3,4部分骨折患者治疗后期可较关节置换得到较高的Constant平分值。此外年龄、骨折类型、性别比和并发症发生率是影响Constant值的显著因子。鉴于研究的异质性和方差,需要有更多更好的随机对照试验进一步证明。
[Abstract]:Objective: to collect the randomized controlled trial on the treatment of 3 parts of humeral proximal displacement fracture with reserved joint and joint replacement, and to analyze the difference of the curative effect between the two methods by Meta. Methods: Medline (January 1966-December 2013), Medline (January 1980 to December 2013), Medline (January 1990 to December 2013), Wanfang database (1982 to 2013) and other databases were searched. A randomized controlled trial on the treatment of partial fracture of proximal humerus, preserving joint and joint replacement, The relevant data are extracted and input into Comprehensive Meta-Analysis Software (CMA) software for Meta analysis. Results: a total of 7 articles were in accordance with the inclusion criteria. A total of 320 patients (165 patients with retained joint therapy and 155 patients with joint replacement therapy) were all in English. The modified Jadad scores were all classified as high quality research. Meta-analysis showed that, The average value of total Constant was 55.9 (95 CI: 50.7-61.1 P0.001), and the Constant score in the reserving joint treatment group was higher than that in the joint replacement group (P0.01). The heterogeneity of the study was significant (I _ 2 / 888 / Q statistic 107.6 / Q ~ (13) P ~ 0.001). The Constant score of shoulder joint decreased with the increase of sex ratio between male and female, and the absorption rate of humeral tubercle increased with the increase of sex ratio of male and female. Conclusion: preservation of proximal humerus displacement in patients with partial fracture of the humerus may result in higher Constant score at the later stage of treatment than that in joint replacement. In addition, age, fracture type, sex ratio and incidence of complications were significant factors affecting Constant value. In view of the heterogeneity and variance of the study, more and better randomized controlled trials are needed.
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.4
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