本文關(guān)鍵詞： 股骨粗隆間骨折 動力髖螺釘 股骨近端防旋髓內(nèi)釘 Meta分析　出處：《湖北中醫(yī)藥大學(xué)》2013年碩士論文　論文類型：學(xué)位論文

【摘要】：股骨粗隆間骨折多發(fā)于老年人。目前中國老齡人口中，據(jù)相關(guān)數(shù)據(jù)表明髖部骨折約660萬人，，其中約250-300萬為粗隆間骨折，發(fā)生率僅次于股骨頸骨折，約占全身骨折的3-4%�；颊叩钠骄挲g為70歲，女性多于男性。隨著目前國內(nèi)社會人口老齡人口增多，老年人口關(guān)懷機(jī)制的發(fā)展滯后，及交通、建筑業(yè)等發(fā)展，其發(fā)病率在逐年升高。老年股骨粗隆間骨折保守治療常易出現(xiàn)并發(fā)癥等，而無法獲得滿意療效。其易并發(fā)壓瘡、墜積性肺炎、深靜脈血栓等，死亡率較高。因其斷端為松質(zhì)骨，血運(yùn)豐富，極少出現(xiàn)骨折不愈合。同時老齡人群因其骨質(zhì)疏松，容易并發(fā)內(nèi)固定物失效等情況，易致發(fā)生髖內(nèi)翻畸形。即便骨折愈合，其功能也常因髖內(nèi)翻，肌肉萎縮等而不能獲得良好恢復(fù)。所以，如無明顯手術(shù)禁忌癥，選擇合適的手術(shù)方式進(jìn)行手術(shù)治療，術(shù)后早期功能鍛煉，對恢復(fù)患髖功能，降低死亡率，預(yù)防并發(fā)癥的發(fā)生有重要意義。 目的 本研究通過對近10年來已經(jīng)發(fā)表的關(guān)于老年股骨粗隆間骨折，經(jīng)防旋型股骨近端髓內(nèi)釘與動力髖螺釘手術(shù)治療的臨床療效方面差異的隨訪研究性文獻(xiàn)資料進(jìn)行Meta分析，以期了解文獻(xiàn)質(zhì)量，找出相關(guān)證據(jù)來綜合對比評價老年股骨粗隆間骨折經(jīng)PFNA或DHS內(nèi)固定手術(shù)治療的手術(shù)時間、術(shù)中出血量、術(shù)后優(yōu)良率、及手術(shù)并發(fā)癥、住院時間、住院花費(fèi)等臨床問題，為臨床治療決策和下一步的研究提供一定的依據(jù)。 材料與方法 檢索Medline（國際性綜合生物醫(yī)學(xué)信息書目數(shù)據(jù)庫）、EMBASE、CENTRAL(The Cochrane central register of controlledtrials)、等權(quán)威外文數(shù)據(jù)庫，檢索中文期刊網(wǎng)數(shù)據(jù)庫(CNKI)、中文科技期刊全文數(shù)據(jù)庫、維普（VIP）、萬方中國學(xué)術(shù)會議論文(CACP)、萬方中國學(xué)位論文數(shù)據(jù)庫(CDDB)等中文數(shù)據(jù)庫。收集國內(nèi)外公開發(fā)表的臨床隨機(jī)對照研究，同時運(yùn)用計(jì)算機(jī)檢索Medline(ovid搜索引擎2000-2013．3)等數(shù)據(jù)庫，通過ovid搜索引擎手工檢索《clinical orthopaedicsrelated research》，《Injury》等雜志。多渠道、多途徑廣泛收集相關(guān)文獻(xiàn)。嚴(yán)格篩選檢索到的文獻(xiàn)，篩選符合要求的信息，將篩選后的文獻(xiàn)經(jīng)過改良后Jadad評分表，對其進(jìn)行評分，確定可納入的文獻(xiàn)及相關(guān)樣本。下載Meta分析軟件進(jìn)行異質(zhì)性檢驗(yàn)、效應(yīng)合并統(tǒng)計(jì)量等分析，繪制手術(shù)時間、出血量、術(shù)后優(yōu)良率、術(shù)后并發(fā)癥等的森林圖、漏斗圖，分析發(fā)表性偏倚。 結(jié)論 通過最終評價并納入文獻(xiàn)10篇，其中英文文獻(xiàn)4篇，中文文獻(xiàn)6篇。共納入股骨粗隆間骨折患者885例，其中DHS組患者445例，PFNA組患者440例。經(jīng)Meta軟件分析后，結(jié)果顯示：接受PFNA治療的患者相對接受DHS治療的患者比較：接受PFNA手術(shù)治療，術(shù)后股骨干骨折風(fēng)險(xiǎn)增高、手術(shù)時間較短、手術(shù)出血較少，結(jié)論有顯著性意義（P＜0.05)；接受PFNA手術(shù)治療，其術(shù)后優(yōu)良率，住院時間，術(shù)后傷口感染等方面無明顯性差異（P＞0.05）。說明老年性股骨粗隆間骨折，接受PFNA手術(shù)治療相對DHS手術(shù)治療，其術(shù)后股骨干骨折風(fēng)險(xiǎn)較高、但手術(shù)出血量及手術(shù)時間更短。
[Abstract]:Intertrochanteric fracture in the elderly. The Chinese aging population, according to the relevant data show that about 6 million 600 thousand hip fractures, of which about 250-300 million for intertrochanteric fracture incidence after femoral neck fracture, the average age of all fractures accounted for about 3-4%. of the patients was 70 years, with female than male. Theageing population increase, elderly care system development lags behind, and the traffic development of the construction industry, the incidence rate increased year by year. The elderly femoral intertrochanteric fracture conservative treatment often prone to complications, and can not obtain satisfactory curative effect. It is easy to bedsore, hypostatic pneumonia, deep vein thrombosis, high mortality. Because of the broken end of cancellous bone, abundant blood supply, rarely appear nonunion. But becauseof osteoporosis, internalfixationfailurereasons, prone to hip varus. Even bone Fracture healing, its function is often due to hip varus, muscle atrophy cannot get a good recovery. So, if there is no surgical contraindications, select the appropriate surgical approach for surgical treatment, early postoperative functional exercise on the recovery of hip function, reduce the mortality rate, has important significance to prevent the occurrence of complications.
objective
Based on the past 10 years have been published on senile intertrochanteric fractures with proximal femoral antirotation clinical curative effect between treatment and operative of dynamic hip screw nail of follow-up study of literature Meta analysis, in order to understand the quality of literature, find out the relevant evidence to comprehensive evaluation senile femoral intertrochanteric fracture by operation time PFNA or DHS internal fixation surgery, intraoperative bleeding, postoperative rate, and complications, hospitalization time, hospitalization costs and other clinical problems, and provide a basis for clinical treatment decisions and future research.
Materials and methods
The retrieval of Medline (international integrated biomedical information bibliographic database), EMBASE, CENTRAL (The Cochrane Central Register of controlledtrials), and other authoritative foreign language database retrieval, Chinese journal net database (CNKI), Chinese PSTP, Wei Pu (VIP), Wanfang China Symposium (CACP), Wanfang China degree the database (CDDB) and Chinese database. Randomized clinical research literatures published in China and abroad, while the use of computer retrieval Medline (Ovid search engine 2000-2013.3) database, search engine manual retrieval by Ovid, and other magazines. Multi channel, multi way extensive collection of relevant literature. Strict screening retrieved the screening, to meet the requirements of the information will be filtered documents after improving Jadad score, the score can be determined in the Literature and related samples. Meta analysis software was downloaded, heterogeneity test and effect combination statistics were used to analyze and draw the forest chart and funnel plot of operation time, bleeding volume, postoperative excellent rate, postoperative complications and so on.
conclusion
The final evaluation and 10 articles were included, of which 4 articles English, Chinese 6 literatures were included. 885 patients with femoral intertrochanteric fracture, including 445 cases of DHS patients, 440 PFNA patients. By Meta software analysis, the results show that: compared PFNA treated patients treated with DHS relative the patients received PFNA surgery, postoperative femoral shaft fracture risk increased, shorter operation time, less bleeding, significant conclusions (P < 0.05); PFNA received surgical treatment, the postoperative excellent rate, hospitalization time, postoperative wound infection and other aspects of no significant difference (P > 0.05). The senile intertrochanteric fracture treated with PFNA compared with DHS surgery, the higher risk of postoperative femoral shaft fractures, but operation bleeding volume and operation time shorter.

【學(xué)位授予單位】：湖北中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R687.3

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