股骨近端空心锁定板与空心加压螺钉治疗中青年股骨颈骨折有效性与安全性的Meta分析

发布时间：2018-11-04 09:55

【摘要】：目的:通过Meta分析方法在较大样本量的前提下,比较股骨近端空心锁定板与空心加压螺钉治疗中青年股骨颈骨折的临床疗效和安全性。方法:通过计算机检索Cochrane图书馆、Medline、Embase、中文期刊全文数据库、万方数据库等资源中比较股骨近端空心锁定板与空心加压螺钉治疗股骨颈骨折的各类型研究,依据纳入与排除标准选取文献,并追查已纳入文献的参考文献,提取相关数据,所得数据通过Rev Man5.3统计软件完成Meta分析,比较股骨近端空心锁定板组与空心加压螺钉组的髋关节Harris功能评分优良率、手术时间、骨折愈合率、骨折愈合时间、股骨头坏死率、术中出血量、术后远期髋关节Harris功能评分、并发症发生率等。结果:共纳入11个临床对照研究,共728例患者涉及本实验研究。Meta分析发现:股骨近端空心锁定板组的手术时间[MD=6.41,95%CI为(-0.21,13.03),P=0.06]、术中出血量[MD=21.32,95%CI为(-1.34,43.98),P=0.07]、术后引流量[MD=-7.74,95%CI(-18.22,2.75),P=0.15]、骨折愈合时间[P=0.41,M D=-1.56,95%CI为(-5.24,2.13)]均与空心加压螺钉组无明显差别。而对于术后髋关节功能恢复的优良率[OR=2.80,95%CI为(1.68,4.65)P0.0001],股骨近端空心锁定板组则明显高于空心加压螺钉组。总并发症方面[OR=0.29,95%CI为(0.11,0,37),P0.00001],股骨近端空心锁定板组则明显低于空心加压螺钉组。结论:股骨近端空心锁定板组治疗股骨颈骨折较空心加压螺钉组具有更好的远期临床效果,但手术持续时间、术中出血量、术后引流量、骨折愈合时间等无明显差别,因此在临床工作中对于治疗方法的选择应该谨慎。由于纳入研究数量少且质量不高,论证强度较弱,尚需开展和设计大样本随机对照研究做进一步验证。
[Abstract]:Objective: to compare the clinical efficacy and safety of femoral proximal locking plate and hollow compression screw in the treatment of femoral neck fracture in young and middle-aged patients with large sample size by Meta analysis. Methods: Cochrane library, Medline,Embase, Chinese periodical full-text database and Wanfang database were searched by computer to compare the different types of femoral neck fractures treated by femoral proximal locking plate and hollow compression screw. According to the criteria of inclusion and exclusion, the literature is selected, and the relevant data are extracted by tracing the references that have been included in the literature. The obtained data are analyzed by Meta through Rev Man5.3 statistical software. The excellent and good rate of hip joint Harris score, operation time, fracture healing rate, fracture healing time, femoral head necrosis rate, intraoperative bleeding volume and long-term hip joint Harris functional score were compared between the proximal femoral locking plate group and the hollow compression screw group. Incidence of complications, etc. Results: a total of 11 clinical controlled trials were conducted, and 728 patients were involved in this study. Meta analysis showed that the operative time of the proximal femoral hollow locking plate group [MD=6.41,95%CI = (-0.21 卤13.03), P < 0.06]. Intraoperative bleeding volume [MD=21.32,95%CI = (-1.34 卤43.98), P < 0.07], postoperative drainage volume [MD=-7.74,95%CI (-18.22 卤2.75), P0. 15], fracture healing time [P0. 41, P < 0. 41], There was no significant difference in CI (-5.24 卤2.13) between the two groups. The excellent and good rate of hip joint function recovery after operation [OR=2.80,95%CI was (1.68 卤4.65) P 0.0001], the proximal femoral hollow locking plate group was significantly higher than that of hollow compression screw group. The total complications [OR=0.29,95%CI (0.110.37), P0.00001] were significantly lower in the proximal femoral locking plate group than in the hollow compression screw group. Conclusion: the treatment of femoral neck fracture with femoral proximal hollow locking plate has better long-term clinical effect than that of hollow compression screw group, but there is no significant difference in operation duration, intraoperative blood loss, postoperative drainage, fracture healing time and so on. Therefore, the choice of treatment methods should be careful in clinical work. Because of the low quantity, low quality and weak demonstration intensity, it is necessary to carry out and design a large sample randomized controlled study for further verification.
【学位授予单位】：蚌埠医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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