本文選題：骨水泥 + 股骨頸骨折��； 參考：《重慶醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:應(yīng)用Cochrane系統(tǒng)評價方法對半髖關(guān)節(jié)置換中骨水泥與非骨水泥假體選擇療效差異進行系統(tǒng)評價,為手術(shù)治療股骨頸骨折提供假體選擇基礎(chǔ)。方法:應(yīng)用電腦對各大中英文數(shù)據(jù)庫,如MEDLINE,Pub Med,Ovid及萬方,維普網(wǎng),知網(wǎng)等,檢索時間從建庫至2015年5月。再運用手動檢索相關(guān)雜志,和利用網(wǎng)上資源如谷歌學(xué)術(shù)等,擴大檢索范圍。按照擬定的納入排除標(biāo)準(zhǔn),選出有關(guān)骨水泥和非骨水泥半髖關(guān)節(jié)置換治療老年股骨頸骨折的隨機對照試驗文獻(Random Control Trials,RCTs)。由兩名人員單獨閱讀全文,提取擬定的評價指標(biāo)數(shù)據(jù),進行匯總,最后,使用Rev Man5.3軟件進行Meta分析。結(jié)果:最終共納入18篇隨機對照文獻,共計2308例髖,左側(cè)1178例,右側(cè)1130例,骨水泥組1157例,非骨水泥組1151例,結(jié)果得出骨水泥組較非骨水泥組手術(shù)時間長[MD=8.30,95%CI(6.86,9.74),P0.001],術(shù)中出血量多[MD=38.72,95%CI(0.11,77.32),P=0.05],假體并發(fā)癥少[RR=0.29,95%CI(0.18,0.45),P0.00001],術(shù)后1年大腿疼痛發(fā)生率少[OR=0.69,95%CI(0.55,0.87),P=0.002]。翻修率[O R=0.91,95%CI(0.59,1.41),P=0.68]、心腦血管并發(fā)癥[OR=1.03,95%CI(0.63,1.70),P=0.91]、死亡率[OR=0.89,95%CI(0.73,1.07),P=0.21]、深靜脈血栓形成率[OR=1.10,95%CI(0.43,2.86),P=0.84]方面兩者無統(tǒng)計學(xué)差異。結(jié)論:骨水泥需要更長手術(shù)時間,術(shù)中出血量更多,但在假體并發(fā)癥和大腿疼痛上,具有明顯優(yōu)勢,且骨水泥假體并沒有增加死亡率、翻修率及深靜脈血栓形成。
[Abstract]:Objective: to evaluate the difference between cement and non-bone cement prosthesis selection in hemihip arthroplasty with Cochrane system evaluation method, and to provide the basis for prosthesis selection for the surgical treatment of femoral neck fracture. Methods: the Chinese and English databases, such as MEDLINE, Pub MedOvid and Wanfang, Wiper, Knownet, etc., were searched by computer. The retrieval time was from the construction of the database to May 2015. Then use manual search related magazines, and the use of online resources such as Google academic, to expand the scope of search. According to the proposed exclusion criteria, random Control trialsof RCTs were selected for the treatment of femoral neck fractures in elderly patients with bone cement and uncemented semi-hip arthroplasty. The whole text is read separately by two people, the data of evaluation index is extracted and summarized. Finally, the Meta analysis is carried out by Rev Man5.3 software. Results: a total of 18 random controlled literatures were included. There were 2308 hips, 1178 left, 1130 right, 1157 bone cement and 1151 non-bone cement. The results showed that the operation time of bone cement group was longer than that of non-bone cement group [MDR 8.30 ~ 95CII 6.869.74 + P0.001], the amount of intraoperative bleeding was more [MDR 38.72 ~ 95CI0.1177.32 + P0. 05], the complications of prosthesis were less [RR0.2995CI0.180.45 + P0.00001], and the incidence of thigh pain was less one year after operation [OR0.6995CIT 0.550.87P 0.002]. There was no statistical difference between the two groups in revision rate (OR1.0395), mortality rate (OR0.89), deep vein thrombosis rate (OR1.1095CII 0.43) and deep venous thrombosis rate (OR1.1095CII 0.43 / 2.86P0.84), the revision rate was 0.69% (P = 0.68), cardiovascular and cerebrovascular complications (OR1.0395 / 95) were 0.631.70 / 0.91, mortality rate was 0.731.07 / 0.21, and there was no significant difference between the two groups in the rate of deep venous thrombosis (OR1.1095CII 0.43 / 2.86P0.84). Conclusion: bone cement needs longer operation time and more blood loss during operation, but it has obvious advantages in prosthesis complications and thigh pain, and does not increase mortality, revision rate and deep venous thrombosis.
【學(xué)位授予單位】：重慶醫(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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