本文選題：骨折固定術(shù)　切入點(diǎn)：髓內(nèi)　出處：《山西醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：背景:肱骨近端骨折極為常見(jiàn),老年人高發(fā)。而人口的老齡化正一步步逼近,這也導(dǎo)致肱骨近端骨折的患病率進(jìn)一步提升,相關(guān)研究表明,未來(lái)30年,其患病率將增加3倍。兩部分骨折在肱骨近端骨折中最為常見(jiàn),對(duì)于那些存在明顯移位、不穩(wěn)定的兩部分骨折,若無(wú)絕對(duì)手術(shù)禁忌證,通常需要手術(shù)治療,從而盡早恢復(fù)肩關(guān)節(jié)功能。手術(shù)的方式多樣,主要取決于患者的年齡、骨骼質(zhì)量以及對(duì)肩關(guān)節(jié)功能的要求。如髓內(nèi)釘內(nèi)固定、鎖定板內(nèi)固定,兩者均能獲得較理想的效果,各有優(yōu)劣,但目前對(duì)于采用何種手術(shù)方式仍存爭(zhēng)議。目的:考慮到不同骨折類型之間的差異及相應(yīng)的骨折特點(diǎn),本研究通過(guò)限定一種骨折類型,即肱骨近端兩部分骨折,采用循證醫(yī)學(xué)這一可信度較高的方法,用以對(duì)比髓內(nèi)釘與鎖定板的效果,并比較其優(yōu)缺點(diǎn),從而得出更有針對(duì)性的結(jié)果,以進(jìn)一步指導(dǎo)臨床實(shí)踐。方法:檢索Pub Med、Springer Link、EMBASE、The Cochrane Library、Medline、Science Direct、中國(guó)知識(shí)資源總庫(kù)、萬(wàn)方數(shù)據(jù)庫(kù)、維普數(shù)據(jù)庫(kù),檢索時(shí)間從1996年至2016年。英文檢索詞為:proximal humeral nail、Intramedullary Nail、locking plates、LPHP、Two-Part proximal humerus fractures、Two-Part Proximal Humeral Surgical Neck Fractures。中文檢索詞為:髓內(nèi)釘、交鎖髓內(nèi)釘、肱骨近端、鎖定板、鎖定接骨板、外科頸骨折、兩部分骨折。查找相關(guān)文獻(xiàn),內(nèi)容均為髓內(nèi)釘和鎖定板治療的效果對(duì)比,設(shè)定入選標(biāo)準(zhǔn)選擇文獻(xiàn),并對(duì)入選的文獻(xiàn)進(jìn)行質(zhì)量的高低評(píng)價(jià),統(tǒng)計(jì)學(xué)上采用Rev Man 5.0軟件,由國(guó)際Cochrane協(xié)作組供應(yīng)。結(jié)果:總共有7篇文獻(xiàn)入選,病人的總例數(shù)是295例,其中髓內(nèi)釘病例136例,鎖定板病例159例。Meta分析的結(jié)果表明,評(píng)價(jià)指標(biāo)中,髓內(nèi)釘組在手術(shù)時(shí)間(WMD=-27.71,95%CI( 36.07,-19.35),P0.05)、術(shù)中出血量(WMD=-114.18,95%CI( 169.91,-58.45),P0.0001)、術(shù)后骨折愈合時(shí)間(WMD= 2.91,95%CI( 5.80,-0.01),P=0.05)上明顯優(yōu)于鎖定板組,而兩組在Constant評(píng)分(WMD=-2.84,95%CI( 5.90,0.22),P=0.07)、術(shù)后并發(fā)癥率(OR=0.89,95%CI(0.43,1.84),P=0.76)方面差異無(wú)統(tǒng)計(jì)學(xué)意義。結(jié)論:髓內(nèi)釘在手術(shù)時(shí)間、術(shù)中出血量和骨折愈合時(shí)間上比鎖定鋼板有優(yōu)勢(shì),然而Constant評(píng)分和術(shù)后并發(fā)癥率仍存爭(zhēng)議和討論。因此,對(duì)于髓內(nèi)釘與鎖定板治療肱骨近端兩部分骨折的效果,仍需要更多大樣本量、前瞻性研究來(lái)進(jìn)一步證實(shí)。
[Abstract]:Background: proximal humeral fractures are extremely common, with a high incidence in the elderly. Population ageing is approaching, which leads to a further increase in the prevalence of proximal humeral fractures. The morbidity rate will increase threefold. Two parts of fractures are most common in proximal humerus fractures, and for those with obvious displacement and instability, surgery is usually required without an absolute contraindication. In order to restore shoulder function as soon as possible, the operation is varied, depending on the patient's age, bone quality and the requirements for shoulder function. If intramedullary nail fixation, locking plate fixation, both can achieve satisfactory results, There are some advantages and disadvantages, but there is still controversy about the operative method. Objective: considering the differences between different fracture types and the corresponding fracture characteristics, this study defined a fracture type, that is, the proximal humerus fracture, two parts of the humerus fracture. Evidence-based medicine, a reliable method, was used to compare the effect of intramedullary nail and locking plate, and to compare its advantages and disadvantages, so as to obtain more targeted results. Methods: to search Pub Medspinger Linkler EMBASEN the Cochrane Library Medline Medline Science Direct, China knowledge Resources General Database, Wanfang Database, Weip Database, The search time is from 1996 to 2016. The English key words are: proximal humeral nailary locking plates and LPHPTwo-part proximal humerus fracturespart Proximal Humeral Surgical Neck fractures. The Chinese key words are: intramedullary nail, interlocking intramedullary nail, proximal humerus, locking plate, locking plate, surgical neck fracture, surgical neck fracture, surgical neck fracture, intramedullary nail, interlocking intramedullary nail, proximal humeral nail, locking plate, locking plate, surgical neck fracture, Two parts fracture. Looking up the related literature, the contents are the comparison of the effect of intramedullary nail and locking plate, setting the selection standard and evaluating the quality of the selected document. The software of Rev Man 5.0 was used in statistics. Results: the total number of patients was 295, including 136 cases of intramedullary nail and 159 cases of locked plate. In the intramedullary nail group, WMD-27.71C95CII (36.07- 19.35) was significantly better than the locking plate group (WMD-114.1895CI) (169.91- 58.45), and the fracture healing time (WMD= 2.91) was significantly better than that in the locking plate group (5.80- 0.01P0.05), and the intramedullary nail group was significantly better than the locking plate group at the operative time of WMD-27.71C95CI (36.07U -19.35U), and the intramedullary intramedullary nailing group (WMD-114.1895CI) was significantly better than the locking plate group (P 0.0001). However, there was no significant difference between the two groups in the Constant score of WMD-2.84 / 95CI (5.90 / 0.22) and the rate of postoperative complications were 0.431.84 / 0.76. Conclusion: intramedullary nail has an advantage over locking plate in operative time, intraoperative blood loss and healing time of fracture, and there is no significant difference between the two groups in operative time, intramedullary blood loss and healing time of fracture. However, the Constant score and the rate of postoperative complications remain controversial and discussed. Therefore, the effect of intramedullary nail and locking plate in the treatment of proximal humeral fractures still needs to be further confirmed by prospective studies.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R687.3

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