本文選題：跟骨骨折　切入點：植骨　出處：《昆明醫(yī)科大學》2015年碩士論文

【摘要】：研究背景SandersⅢ型和Ⅳ型跟骨骨折均累及距下關(guān)節(jié),導致距下關(guān)節(jié)跟骨關(guān)節(jié)面的骨質(zhì)缺損。目前此類嚴重跟骨骨折的主要治療方式是切開復位(ORIF)結(jié)合鋼板螺釘內(nèi)固定手術(shù),但在手術(shù)過程中對骨質(zhì)缺損的處理仍然存在植骨與不植骨的爭議。本研究旨在通過系統(tǒng)評價和Meta分析,對SandersⅢ、Ⅳ型跟骨骨折治療中植骨與不植骨進行比較,探討這兩種治療方式在手術(shù)時間、術(shù)后并發(fā)癥、功能疼痛評分、影像學測量值等方面的差異。目的通過系統(tǒng)評價和Meta分析,了解SandersⅢ、Ⅳ型跟骨骨折治療中植骨與不植骨在手術(shù)時間、術(shù)后并發(fā)癥、功能疼痛評分、影像學測量值等方面的差異。為其治療方式的選擇提供循證醫(yī)學的證據(jù),以供臨床治療進行參考。研究方法按照納入與排除標準檢索文獻,對文獻進行篩選及質(zhì)量評估,提取數(shù)據(jù)并以系統(tǒng)評價和Meta分析的方法分析數(shù)據(jù)從而得到循證醫(yī)學證據(jù)。檢索方法：計算機結(jié)合手工檢索美國國立醫(yī)學圖書館國際綜合生物醫(yī)學信息書目數(shù)據(jù)庫(Medline)、荷蘭Elsevier Science醫(yī)學信息書目數(shù)據(jù)庫(EMBase)、實證醫(yī)學對照試驗中心注冊庫(CENTRAL)、Ⅰ臨床決策循證數(shù)據(jù)庫(Foreign Evidence-Based Medicine, FEBM)、西文生物醫(yī)學期刊文獻數(shù)據(jù)庫(Foreign Medical Journal Service, FMJS)等權(quán)威外文數(shù)據(jù)庫(至2015年3月),檢索中文期刊網(wǎng)數(shù)據(jù)庫(CNKI)、中國生物醫(yī)學文獻數(shù)據(jù)庫(CBM)、維普期刊資源整合服務平臺、萬方中文學位論文數(shù)據(jù)庫等權(quán)威中文數(shù)據(jù)庫(至2015年3月),檢索收集國內(nèi)外公開發(fā)表的臨床隨機對照(RCT)研究文獻。檢索世界衛(wèi)生組織國際臨床試驗注冊平臺(WHO ICTRP)、臨床試驗數(shù)據(jù)庫(ClinicalTrials.gov Database)、中國臨床試驗注冊中心(ChiCTR)查找目前進行中的相關(guān)研究。通過OvidTechnologies數(shù)據(jù)庫、中國知識基礎(chǔ)設(shè)施工程(CNKI)、萬方中國學術(shù)會議論文(CACP)、萬方中國學位論文數(shù)據(jù)庫(CDDB)檢索骨與創(chuàng)傷協(xié)會的年會檔案、未正式發(fā)表的論文及學位論文等灰色文獻。檢索過程中不限制時間或語言,多途徑多渠道廣泛收集相關(guān)文獻。選擇標準：對比切開復位內(nèi)固定術(shù)(ORIF)結(jié)合植骨與不植骨治療跟骨關(guān)節(jié)內(nèi)移位骨折(DIACFs)的隨機或半隨機臨床對照研究。數(shù)據(jù)收集與分析：由兩名評估員獨立的進行檢索、篩選檢索結(jié)果、評估偏倚風險、確定可納入的文獻及樣本。以Review Manager (RevMan)軟件及R軟件對手術(shù)時間、術(shù)后并發(fā)癥、功能疼痛評分、影像學測量值等進行異質(zhì)性檢驗、合并效應量等分析。并使用GREADprofile (GREADpro)軟件對證據(jù)進行分級。結(jié)果最終納入文獻7篇,其中英文文獻3篇、中文文獻4篇。共納入嚴重跟骨關(guān)節(jié)內(nèi)移位骨折(SandersⅢ、Ⅳ型)患者431例(共431足),其中植骨組223足,非植骨組208足。經(jīng)改良Jadad評分量表評估：低質(zhì)量文獻5篇、高質(zhì)量文獻2篇；經(jīng)Cochrane協(xié)作網(wǎng)的偏倚風險評價工具評估：3篇高偏倚風險文獻,4篇偏倚風險不清楚的文獻。將納入文獻的數(shù)據(jù)通過Meta分析得到結(jié)果：植骨組與非植骨組在術(shù)后1年內(nèi)及2年的功能疼痛評分優(yōu)良率和評價為“差”率均無統(tǒng)計學差異(P0.05),術(shù)后并發(fā)癥無統(tǒng)計學差異(P0.05),術(shù)后1年的Bohler's角、Gissane角、跟骨長度、高度及術(shù)后2年的Bohler's角、Gissane角無統(tǒng)計學差異(P0.05),植骨組手術(shù)時間較非植骨組手術(shù)時間延長(P0.05)。通過系統(tǒng)評價得到結(jié)果：植骨組與非植骨組在骨折愈合時間、健康相關(guān)生活質(zhì)量方面無統(tǒng)計學差異(P0.05),但植骨組失血量多于非植骨組(P0.05)。結(jié)論在SandersⅢ、Ⅳ型跟骨骨折的手術(shù)治療中,植骨組與非植骨組在術(shù)后功能疼痛評分、術(shù)后并發(fā)癥、骨折愈合時間、健康相關(guān)生活質(zhì)量及影像學測量值方面不具有有統(tǒng)計學差異(P0.05)。植骨組與非植骨組相比,植骨組的手術(shù)時間更長(MD=15.79min, 95%CI[13.62～17.96]min, P0.05)、術(shù)中失血量更多 ((MD=36.09ml, 95%CI[28.68～43.50]ml, P0.05)。據(jù)此,本研究認為在SandersⅢ、Ⅳ型跟骨骨折的手術(shù)治療中,植骨并不具有優(yōu)勢,其預后與不植骨者并無統(tǒng)計學差異,植骨操作反而增加了不必要的手術(shù)時間和術(shù)中失血量。
[Abstract]:On the background of Sanders type III and type IV calcaneal fractures were subtalar joint, leading to subtalar articular surface of the calcaneus bone defect. The main treatment at present such serious calcaneal fracture is open reduction (ORIF) combined with internal fixation, but during the operation process of bone defect and bone graft is still controversial without bone graft. The purpose of this study is to through the system evaluation and Meta analysis, the Sanders III, compared with treatment of bone graft without bone graft type IV calcaneal fractures, to investigate the two treatments at the time of surgery, postoperative complications, functional pain score, difference imaging measurement value. Through objective analysis system evaluation and Meta, Sanders III, treatment of bone graft and bone graft at the time of surgery type IV calcaneal fractures, postoperative complications, functional pain score, difference imaging measurement value. For the treatment Provide evidence-based choice for clinical treatment for reference. Methods according to the inclusion and exclusion criteria document retrieval, screening and quality evaluation of literature, data extraction and analysis method in system evaluation and Meta analysis data to obtain evidence of evidence-based medicine. Retrieval methods: manual retrieval of international comprehensive biomedical information the bibliographic database of the National Library of medicine combined with computer (Medline), Holland Elsevier Science medical information bibliographic database (EMBase), empirical medical central register of controlled trials (CENTRAL), clinical evidence-based decision-making database (Foreign Evidence-Based Medicine, FEBM), Western biomedical journal literature database (Foreign Medical Journal Service, FMJS) and other authoritative foreign language the database (March 2015), retrieved Chinese journal net database (CNKI), Chinese biomedical literature database (CBM), The VIP information resource integration service platform, Chinese Wanfang dissertation database etc Chinese database (March 2015), randomized clinical searches were published at home and abroad (RCT) research literature retrieval. WHO international clinical trial registration platform (WHO ICTRP), the clinical trial database (ClinicalTrials.gov Database), Chinese clinical trial registration center (ChiCTR) find related research in progress at present. Through the OvidTechnologies database, Chinese knowledge infrastructure (CNKI), Wanfang Chinese Symposium (CACP), Wanfang China Dissertations Database (CDDB) retrieval of bone and Trauma Association annual meeting, archives, papers and Dissertations of grey literature have not formally published. The time or the language does not limit the retrieval process, multi-channel extensive collection of relevant literature. Selection criteria: open reduction and internal fixation comparison (ORIF) Combined with bone graft and bone graft in the treatment of intra-articular calcaneal fracture (DIACFs) control study of randomized or quasi randomized. Data collection and analysis: by two independent assessors of the retrieval, filtering the retrieval results, assessed the risk of bias, and to determine the sample can be incorporated into. Review (RevMan) and Manager software R software for the operation time, postoperative complications, functional pain score, heterogeneity test imaging measurements were analyzed, the combined effect of the amount. And use the GREADprofile software (GREADpro) to classify the evidence. The final literatures of 7 papers, including 3 papers English, 4 literatures were included. Chinese serious intra-articular calcaneal fracture (Sanders III, IV) in 431 patients (431 feet), of which 223 foot bone graft group, non bone graft group 208. The modified Jadad scores were evaluated: 5 literatures of low quality, high quality 2 articles; the Cochrane Co The net bias risk assessment tool for assessment of 3 high risk of bias of literature, 4 articles are not clear. The risk of bias will be included in the literature data obtained by Meta analysis results: bone graft group and non bone graft group after 1 years and 2 years of pain score excellent rate and evaluation function is poor "there was no statistical difference (P0.05), there was no significant difference in postoperative complications (P0.05, Bohler's) 1 years after operation angle, Gissane angle and calcaneal length, Bohler's height and 2 years after operation angle, Gissane angle had no significant difference (P0.05), bone graft group operation time is non graft bone lengthening group the operation time (P0.05). The results obtained through the system evaluation: bone graft group and non bone graft group in the healing time, no significant differences in health-related quality of life (P0.05), but the bone graft group blood loss than non bone graft group (P0.05). Conclusion in Sanders III, surgical treatment of type IV calcaneal fractures in, Bone graft group and non bone graft group score function in postoperative pain, postoperative complications, fracture healing time, health-related quality of life and imaging measurements do not have significant difference (P0.05). Bone graft group compared with non bone graft group, the operation time is longer the bone graft group (MD= 15.79min, 95%CI[13.62 to 17.96]min, P0.05), intraoperative blood loss more ((MD=36.09ml, 95%CI[28.68 ~ 43.50]ml, P0.05). Therefore, this study suggests that the Sanders III, surgical treatment of type IV calcaneal fractures, bone graft does not have the advantage, the prognosis and the bone graft operation there was no significant difference between the increased loss of blood. The operative time and unnecessary weight.

【學位授予單位】：昆明醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R687.3

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本文編號：1656637