本文選題：微型鋼板 + 克氏針　； 參考：《西南醫(yī)科大學(xué)》2017年碩士論文

【摘要】：背景:掌指骨骨折是骨科急診的常見疾病,其中又以復(fù)雜性掌指骨骨折較為多見。雖然治療掌指骨骨折時可供選擇的內(nèi)固定材料較多,如微型鋼板、克氏針、微型外固定支架和鋼絲等,但是目前臨床上使用最多的還是微型鋼板和克氏針。克氏針是最早被應(yīng)用于臨床的固定材料,克氏針內(nèi)固定術(shù)具有經(jīng)濟適用,手術(shù)創(chuàng)傷小,操作簡單易行等優(yōu)點。然而,長期的臨床實踐后發(fā)現(xiàn)其存在固定效果不可靠,手術(shù)后遺癥多等缺點,手術(shù)效果不能完全令醫(yī)生和患者滿意。微型鋼板具有表面剛度大,固定效果切實可靠,允許患者術(shù)后早期進行功能鍛煉等優(yōu)點,手術(shù)治療效果得到不少醫(yī)生和患者的認(rèn)可,近年來其臨床應(yīng)用日趨普遍。然而,選用微型鋼板進行內(nèi)固定也存在一些不容忽視的弊端,如手術(shù)費用昂貴、手術(shù)創(chuàng)傷大、需要二次手術(shù)取出等。雖然目前有眾多學(xué)者從多方面對微型鋼板和克氏針的臨床療效進行了對比性研究,但是這些研究的樣本量普遍偏小,仍然缺乏全面和系統(tǒng)的分析評價。目前針對手術(shù)中應(yīng)用哪種固定材料來治療掌指骨骨折才能取得更好的治療效果學(xué)者們尚未形成一致意見。目的:對比分析微型鋼板與克氏針治療掌指骨骨折的療效,為臨床醫(yī)師在固定材料的選擇上提供依據(jù)。方法:分別按照主題詞檢索和關(guān)鍵詞檢索的方法使用計算機檢索萬方數(shù)據(jù)庫、中國知網(wǎng)數(shù)據(jù)庫(China national knowledge infrastructure,CNKI)、中國生物醫(yī)學(xué)文獻數(shù)據(jù)庫(Chinese biomedical database,CBM)、維普期刊資源整合服務(wù)平臺(VIP)、Pubmed數(shù)據(jù)庫、Embase數(shù)據(jù)庫和Cochrane Library數(shù)據(jù)庫。手工檢索骨科相關(guān)雜志。分別采用Jadad評分系統(tǒng)和newcastle-ottawascale(nos)評分系統(tǒng)對納入的前瞻性隨機對照研究和回顧性隊列研究的文獻進行質(zhì)量評價。使用擬定的納入標(biāo)準(zhǔn)和排除標(biāo)準(zhǔn)對檢索出來的文獻進行篩選,最后只保留與本研究的內(nèi)容密切相關(guān)的高質(zhì)量文獻。提取納入的文獻的研究設(shè)計類型、文獻的一般情況、文獻的基線指標(biāo)、干預(yù)措施、各組患者的隨訪時間和結(jié)局指標(biāo)等信息。采用revman5.3統(tǒng)計學(xué)軟件對納入文獻中骨折愈合時間、關(guān)節(jié)活動功能優(yōu)良率、手術(shù)時間、住院時間、傷口感染率和固定物不良事件發(fā)生率的相關(guān)數(shù)據(jù)進行分析。根據(jù)納入研究結(jié)果間的異質(zhì)性大小采用固定效應(yīng)模型(mantel-haenszel法)或隨機效應(yīng)模型(inversevariance法)對各研究結(jié)果進行合并分析。通過剔除權(quán)重大的研究結(jié)果后再分析所得的統(tǒng)計量與剔除以前的統(tǒng)計量進行比較的方法對研究的結(jié)果進行敏感性分析。通過觀察倒漏斗圖中數(shù)據(jù)點的對稱分布情況評估文獻的發(fā)表性偏倚。結(jié)果:通過文獻過濾,最終納入文獻14篇。其中有6篇文獻采用的是前瞻性隨機對照研究,其余8篇文獻采用的是回顧性隊列研究,其中采用jadad評分系統(tǒng)評出的總分≥4分或采用nos評分系統(tǒng)評出的總分≥5分的高質(zhì)量的中文文獻11篇,被sci(sciencecitationindex)收錄的外文文獻2篇,外文普刊文獻1篇。數(shù)據(jù)分析結(jié)果顯示,微型鋼板組與克氏針組比較,兩組患者的骨折愈合時間[wmd=-1.53,95%ci(-1.90,-1.17),p0.00001]、關(guān)節(jié)活動功能優(yōu)良率[rr=1.18,95%ci(1.13,1.25),p0.00001]、傷口感染率[rr=0.39,95%ci(0.25,0.61),p0.00001]和固定物不良事件發(fā)生率[rr=0.35,95%ci(0.17,0.73),p=0.009]的差異有統(tǒng)計學(xué)意義,而兩組患者的手術(shù)時間[wmd=21.46,95%ci(-13.08,56.00),p=0.22]和住院時間[WMD=-1.32,95%CI(-3.17,0.52),P=0.16]的差異不明顯。敏感性分析結(jié)果顯示手術(shù)時間和住院時間的結(jié)果的敏感性較差。由傷口感染率生成的倒漏斗圖顯示,數(shù)據(jù)點基本對稱的分布,本研究存在發(fā)表性偏倚的可能性較小。結(jié)論:與克氏針相比,盡管手術(shù)時間和住院時間的差異不明顯,但是采用微型鋼板內(nèi)固定治療掌指骨骨折可以使患者獲得更短的骨折愈合時間,更好的關(guān)節(jié)活動功能,更小的傷口感染率和內(nèi)固定物不良事件發(fā)生率。從總體上講,微型鋼板內(nèi)固定治療掌指骨骨折的療效比克氏針更好。
[Abstract]:Background: Metacarpophalangeal Fracture is a common disease in the emergency department of orthopedics. Complex metacarpophalangeal fractures are more common. Although there are more internal fixation materials for metacarpophalangeal fractures, such as mini plate, Kirschner pin, micro external fixator and steel wire, the most commonly used clinical materials are microplate and Kirschner. Kirschner needle is the earliest fixed material for clinical application. Kirschner pin internal fixation has the advantages of economic application, small operation trauma, easy operation and so on. However, after long-term clinical practice, it is found that the fixation effect is not reliable and the surgical sequelae are many, and the effect of the operation can not completely satisfy the doctors and patients. Microplate has a table. The effect of surgical treatment has been recognized by many doctors and patients. In recent years, its clinical application is becoming more and more common. However, the selection of mini plate for internal fixation has some disadvantages that can not be ignored, such as expensive operation and large surgical trauma. Two surgical removal is needed. Although many scholars have made a comparative study of the clinical efficacy of microplate and Kirschner's needle from many aspects, the sample size of these studies is generally small and still lacks comprehensive and systematic analysis. At present, which fixed material is used to treat metacarpal and phalangeal fractures in the operation can be taken to take the treatment of the metacarpal and phalanges. Better therapeutic effect scholars have not yet formed a consensus. Objective: To compare the efficacy of microplate and Kirschner's needle in the treatment of metacarpal and phalangeal fractures, and to provide a basis for clinicians in the selection of fixed materials. The database (China national knowledge infrastructure, CNKI), the Chinese biomedical literature database (Chinese biomedical database, CBM), the resource integration service platform (VIP) of the VP journal, Pubmed database, Embase database and database. The ttawascale (NOS) scoring system evaluated the quality of the included prospective randomized controlled study and the literature of retrospective cohort study. Using the proposed inclusion criteria and exclusion criteria, the retrieved literature was screened, and the high quality literature closely related to the content of this study was retained. Type, general literature, baseline indicators of literature, intervention, follow-up time and outcome indicators of each group. Revman5.3 statistical software was used to include the correlation between the time of fracture healing, the good rate of joint activity, the time of operation, the time of hospitalization, the rate of infection and the incidence of adverse events. Data are analyzed. According to the heterogeneity of the results, a fixed effect model (Mantel-Haenszel method) or a random effect model (inversevariance method) is used to combine the results of each research. The method of sensitivity analysis of the results of the study. By observing the symmetry distribution of the data points in the inverted funnel plot, the publication bias of the literature was evaluated. Results: 14 articles were included in the literature through the literature filtering. Among them, 6 literature adopted prospective randomized controlled studies, and the other 8 literature adopted retrospective cohort study. The total score of the total score of the total score of the Jadad score system was more than 4 or the total score of the total score of the NOS score system was more than 5, 11 of the Chinese literature, 2 of the foreign literature included by SCI (sciencecitationindex), and 1 in the foreign literature. The results of data analysis showed that the fracture healing time of the two groups of patients was [wmd=- compared with the Kirschner group. 1.53,95%ci (-1.90, -1.17), p0.00001], the excellent rate of joint activity [rr=1.18,95%ci (1.13,1.25), p0.00001], [rr=0.39,95%ci (0.25,0.61) of wound infection rate, p0.00001] and [rr=0.35,95%ci (0.17,0.73), the difference between the two groups was statistically significant. 00) the difference between p=0.22] and [WMD=-1.32,95%CI (-3.17,0.52) was not obvious. The sensitivity analysis showed that the sensitivity of the results of the operation time and the time of hospitalization was poor. The inverted funnel map generated by the wound infection rate showed that the distribution of the data points was basically symmetrical, and the possibility of the publication bias was less. Compared with Kirschner's needle, although the difference of operation time and time of hospitalization is not obvious, the mini plate internal fixation for metacarpophalangeal fracture can make the patient get shorter fracture healing time, better joint activity function, smaller wound infection rate and the incidence of bad internal fixtures. The treatment of metacarpal and phalangeal fracture is better than that of the Ke's needle.

【學(xué)位授予單位】：西南醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R687.3

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