PFNA与DHS治疗老年不稳定型股骨粗隆间骨折的Meta分析

发布时间：2019-01-08 20:35

【摘要】：目的：随着全球老龄化加剧及人均寿命的延长,老年人骨折发生率逐年升高,针对老年不稳定型股骨粗隆间骨折患者,手术治疗已成为首选治疗方案,而手术内固定材料的选择仍存在争论。DHS可进行动力加压,力学强度可靠,固定牢固可为患者的功能康复创造条件,但其术后并发症发生率高；PFNA具有操作简单、创伤小、出血量少等特点,但研究发现髓内钉固定与髋关节螺钉治疗髋关节囊外骨折比较,前者术后移位的发生率高；因次本研究通过对PFNA与DHS两种内固定手术方式治疗的临床疗效进行系统评价,以期为临床决策提供循证依据。方法：制定纳入标准及排除标准,确定检测指标,通过计算机及手工两种检索方式检索出完全符合纳入标准和排除标准的文献研究,计算机检索中文数据库包括万方医学、中国知网、维普医药及中国生物医学,英文数据库包括Cochrane Library、Embase.Medline、PubMed,手工检索国内近五年收集的杂志,包括《中华外科杂志》、《中华骨科杂志》、《中华创伤杂志》、《中华创伤骨科杂志》、《中国骨与关节损伤杂志》、《中国矫形外科杂志》和《昆明医科大学学报》等。对纳入本研究的文献由两名评价者独立采用改良的Jadad评分系统及最新的质量评价方法进行方法学质量评价和数据收集,若意见不统一时,由两名评价者讨论或由第三方专家决定,最后对收集的数据运用RevMan5.3专用系统评价软件进行Meta分析。结果：依据制定的纳入标准及排除标准,共有10篇文献研究纳入本次研究,其中包括1篇英文文献和9篇为中文文献,总共纳入患者715例,其中PFNA组366例,DHS组349例,根据改良的Jadad质量评分,1篇为高质量研究,9篇为低质量研究,Meta分析结果示,两组在平均手术时间方面比较差异具有统计学意义(MD=-24.79,95% CI:-35.07～14.51,P0.00001)；在平均术中出血量方面比较差异具有统计学意义(MD=-201.28,95% CI:-229.13～-173.43,P0.00001)；在手术切口长度方面比较差异具有统计学意义(MD=-7.80,95% CI:-8.58～7.01, P0.00001):在术后优良率方面差异具有统计学意义(OR=4.90,95% CI: 2.89～8.32, P0.00001);在术后并发症发生率方面差异具有统计学意义(OR=0.46,95% CI:0.26～0.80,P=0.006);在住院天数方面差异具有统计学意义(MD=-4.14,95% CI:-7.74～-0.53,P=0.02)。结论：通过对PFNA与传统经典手术DHS在治疗老年不稳定型股骨粗隆间骨折的平均手术时间、平均术中出血量、手术切口长度、术后优良率、术后并发症发生率及住院天数方面指标进行检测比较,结果显示PFNA更具优势,但是地区差异、术者技术差异及骨质量程度差异等因素对检测指标有一定的影响,因此需要通过严格设计大样本随机对照试验、采用正确的随机方法、分配隐藏、盲法,并对纳入研究的对象长期随访,尽可能统一评价疗效来进一步研究。
[Abstract]:Objective: with the aggravation of global aging and the prolongation of life expectancy, the incidence of fracture in the elderly has increased year by year. Surgical treatment has become the first choice for the elderly patients with unstable intertrochanteric fracture of femur. However, the choice of internal fixation materials is still controversial. DHS can be used for dynamic compression, reliable mechanical strength, solid fixation can create conditions for the functional rehabilitation of patients, but the incidence of postoperative complications is high. PFNA has the characteristics of simple operation, less trauma and less bleeding. However, it is found that intramedullary nail fixation has a higher incidence of postoperative displacement than that of hip screw in the treatment of extracapsular hip fractures. In order to provide evidence-based basis for clinical decision-making, this study systematically evaluated the clinical efficacy of PFNA and DHS in the treatment of internal fixation. Methods: the inclusion criteria and exclusion criteria were formulated, the test indexes were determined, and the literature studies that fully met the inclusion criteria and exclusion criteria were retrieved by computer and manual retrieval methods. The Chinese computer retrieval database included universal medicine. Chinese Journal of surgery, Chinese Journal of Orthopaedics, Chinese Journal of Trauma, The Chinese Journal of Orthopedic Trauma, the Chinese Journal of Bone and Joint injury, the Chinese Journal of Orthopaedic surgery and the Journal of Kunming Medical University. The literature included in this study was independently evaluated and collected by two evaluators using the improved Jadad scoring system and the latest quality assessment methods. In the event of disagreement, It is discussed by two evaluators or decided by a third party expert. Finally, the collected data is analyzed by Meta using RevMan5.3 special system evaluation software. Results: according to the inclusion criteria and exclusion criteria, 10 literature studies were included in this study, including 1 English and 9 Chinese literature. A total of 715 patients were included in the study, including 366 patients in PFNA group and 349 in DHS group. According to the improved Jadad quality score, one study was of high quality and nine were of low quality. The results of Meta analysis showed that there was a statistically significant difference between the two groups in terms of average operative time (MD=-24.79,95% CI:-35.07~14.51,). P0.00001); There was significant difference in mean intraoperative bleeding volume (MD=-201.28,95% CI:-229.13~-173.43,P0.00001). The difference in the length of incision was statistically significant (MD=-7.80,95% CI:-8.58~7.01, P0.00001), and the difference in the excellent and good rate after operation was statistically significant (OR=4.90,95% CI: 2.89 8.32, P 0.00001). P0.00001); There was significant difference in the incidence of postoperative complications (OR=0.46,95% CI:0.26~0.80,P=0.006). The difference in hospitalization days was statistically significant (MD=-4.14,95% CI:-7.74~-0.53,P=0.02). Conclusion: the treatment of unstable intertrochanteric fracture of femur in elderly patients with PFNA and classical DHS was performed on the basis of mean operative time, average intraoperative bleeding, length of operative incision, excellent and good rate after operation. The incidence of postoperative complications and length of stay were compared. The results showed that PFNA had more advantages, but regional differences, technical differences and bone quality differences had some effects on the indexes. Therefore, it is necessary to study further by strictly designing large sample randomized controlled trials, using correct random methods, assigning hidden and blind methods, and following up the subjects involved in the study for a long time, and to evaluate the curative effect as uniformly as possible.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

【相似文献】