本文選題：股骨轉子間骨折　切入點：骨質疏松　出處：《天津醫(yī)科大學》2017年碩士論文　論文類型：學位論文

【摘要】：目的:本文的主要研究目的是通過回顧性分析,來搜集符合條件的臨床患者病歷資料,探討股骨轉子間骨折的發(fā)病情況及其流行病學分布特點,用Meta分析來比較國內外老年髖部骨折死亡危險因素,從而進一步為股骨轉子間骨折的預防和治療提供科學指導。方法:本研究先從臨床病例觀察來回顧性分析股骨轉子間骨折的發(fā)病情況并結合國內外大量文獻來分析其流行病學分布特點,并通過Meta分析來評估有關髖部骨折死亡的危險因素。第一部分:本研究所選用的病例來自天津醫(yī)科大學總醫(yī)院于2013年1月至2015年12月以來收治的股骨轉子間骨折患者,按照納入標準和排除標準,篩選出符合要求的股骨轉子間骨折住院患者共179例,其中男性66例,女性113例;年齡介于52-96歲之間,平均年齡為(76.98±9.74)歲。記錄并比較其年齡、性別、致傷原因、骨折類型、主要伴發(fā)病的分布以及治療方式、住院天數(shù)等資料。其中計數(shù)資料以率或百分比(%)表示,樣本間比較采用χ2檢驗;計量資料以mean±SD表示,樣本間比較采用t檢驗。應用SPSS13.0統(tǒng)計學軟件分析調查數(shù)據,進行統(tǒng)計學分析,描述性統(tǒng)計病例特點。第二部分:計算機檢索Cochrane數(shù)據庫、PubMed、中國知網、萬方數(shù)據庫、EMBASE、Medline等一些較大的網絡數(shù)據庫,篩選出那些和老年髖部骨折死亡危險因素相關的中英文參考文獻,同時我們還人工篩選出那些符合納入和排除標準的參考文獻。同時根據隨機對照實驗Meta分析的質量報告規(guī)范(QUOROM)給出的建議標準,由2名獨立的評價員分別對文獻的題目和摘要進行初步檢索,符合標準的則閱讀全文,不符合標準的予以排除,對數(shù)據資料進行提取和質量評價,采用Revman5.0統(tǒng)計學軟件進行Meta分析。用I2和卡方檢驗對所納入的文獻進行異質性檢驗,采用定性和定量的方法同時評估,當P㩳0.05為差異有統(tǒng)計學意義。若I250%,存在異質性,采用隨機效應模型,當異質性不高且I2≤50%時,采用固定效應模型進行定量分析。此外,對于那些因為兩種不同的治療方式可能會對結果產生影響的變量,我們采用亞組分析。P㩳0.05為差異有統(tǒng)計學意義。結果:第一部分:被納入179例股骨轉子間骨折的基本情況為:男性66人,女性113人;平均年齡(76.98±9.74)歲;患者數(shù)量居前3位的年齡段分別為81~90歲(71例,39.66%)、71~80歲(50例,27.93%)和61~70歲(36例,20.11%);造成髖部骨折前3位的致傷因素分別為摔傷(86.03%)、墜落傷(8.38%)和車禍(4.47%);按照AO分型,31-A1型83例,占46.37%;31-A2型55例,占30.73%;31-A3型41例,占22.91%;Evans分型中,Ⅰ、Ⅱ、Ⅲ、Ⅳ、Ⅴ型骨折依次減少,分別為90例(50.28%)、48例(26.82%)、27例(15.08%)、10例(5.59%)和4例(2.23%)。全組手術治療占93.30%(167/179),非手術治療占6.70%(12/179)。在各種合并癥中,合并一種疾病的占32.4%(58/179),合并兩種疾病的占29.1%(52/179),合并三種疾病的占12.3%(22/179),合并四種疾病的占6.1%(11/179),合并五種疾病的占1.1%(2/179)。在所有轉子間骨折患者中,有下肢靜脈血栓的占12.8%(23/179)。第二部分:根據納入和排除標準,我們共納入20篇研究文獻,包括59462例患者,總體結果的發(fā)表偏倚用漏斗圖進行了測量,漏斗圖提示基本對稱,不存在大的偏倚。Meta分析結果顯示:在各種危險因素中,年齡大于60歲、男性、ASA評分、骨折前糖尿病、骨折前心血管疾病、骨折前呼吸系統(tǒng)疾病、骨折前腦血管疾病、骨質疏松、高血壓病、癡呆的研究結果有統(tǒng)計學差異,提示以上這些危險因素是老年髖部骨折后死亡的主要危險因素,而骨折類型、體質量指數(shù)(BMI)、骨折到手術時間的研究結果無統(tǒng)計學差異,說明這三種因素不是老年髖部骨折死亡的危險因素。結論:(1)股骨轉子間骨折是以老年人占絕大多數(shù)、以跌倒為主要致傷原因的骨質疏松性骨折。(2)隨著年齡的增長,股骨轉子間骨折的發(fā)生概率有逐年增加的趨勢,且女性患者多于男性。(3)在AO分型中,31-A1型最多;在Evans分型中,Ⅰ型最多。股骨轉子間骨折以手術治療為主。在各種合并癥中,高血壓的發(fā)病率最高,其次為糖尿病。下肢靜脈血栓以81-90歲年齡段最多。(4)Meta分析的結果顯示男性、年齡、ASA評分、骨折前糖尿病、骨折前心血管疾病、骨折前呼吸系統(tǒng)疾病、骨折前腦血管疾病、骨質疏松、高血壓病和癡呆是老年髖部骨折后死亡的主要危險因素,因此老年人髖部骨折的治療與預防是臨床醫(yī)師面臨的主要問題。(5)老年髖部骨折患者死亡率高可能是老年人生理狀況、骨折前患有慢性疾病等多種因素共同作用的結果,治療前應充分了解患者身體機能和健康狀況,充分評估手術風險,選擇適宜手術類型,提高患者術后機能恢復效果,降低并發(fā)癥發(fā)生的可能。
[Abstract]:Objective: the aim of this study is the retrospective analysis of clinical data to collect patient records to meet the conditions, to investigate the intertrochanteric fracture incidence and epidemiology, Meta analysis was used to compare the domestic and foreign elderly hip fracture risk factors of death, so as to provide scientific guidance for the prevention and treatment of femoral intertrochanteric fractures. Methods: This study first from the clinical observation to retrospective analysis of the incidence of femoral intertrochanteric fracture combined with a large number of domestic and foreign literature to analyze the epidemiological characteristics and through the cloth, Meta analysis to assess the risk factors for hip fracture in death. The first part: the study selected cases from General Hospital Affiliated to Tianjin Medical University in January 2013 since December 2015 were intertrochanteric fracture patients, according to the inclusion and exclusion criteria, selected The femoral fracture between inpatients were 179 cases, including 66 cases of male, female 113 cases; age ranged from 52-96 years old, the average age was (76.98 + 9.74) years old. Recorded and compared the age, gender, cause of injury, type of fracture, mainly with the disease distribution and treatment, hospitalization days the data. The count data at the rate or percentage (%), compared with 2 test samples; measurement data with mean + SD, samples were compared by t test. Analyze the survey data using SPSS13.0 statistical software, statistical analysis, descriptive statistical characteristics of the cases. The second part: Cochrane database, PubMed China, CNKI, Wanfang database, EMBASE, Medline and other large network database, and filter out those elderly hip fracture risk factors of death in English related references, we also screened the artificial With some references to the inclusion and exclusion criteria. According to the analysis of randomized controlled trials of Meta quality report (QUOROM) recommendations are given, the primary retrieval by 2 independent reviewers of the document title and abstract standard is to read the full text, does not meet the criteria to be excluded, extraction and to evaluate the quality of the data, Meta analysis was performed using Revman5.0 statistical software. We test on the test for heterogeneity in literature by I2 and card, the methods of quantitative and qualitative evaluation at the same time, when P? 0.05 for the difference was statistically significant. If I250%, the heterogeneity, the random effects model, when heterogeneity is not high and the I2 is less than or equal to 50%, using fixed effect model for quantitative analysis. In addition, because for those two different treatments may affect the results of the variables, we use sub components 鏋，

本文編號：1576374