本文選題：髖關(guān)節(jié)置換 + 轉(zhuǎn)子間骨折�。� 參考：《山西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:由于我國60歲以上人口的不斷增加,高齡人群發(fā)生的ITF在臨床工作中越來越常見,并且展現(xiàn)出逐年遞增態(tài)勢。轉(zhuǎn)子間骨折有其自身的特點,如股骨轉(zhuǎn)子間多為松質(zhì)骨,暴力作用于該部位是常常造成粉碎性的不穩(wěn)定型股骨轉(zhuǎn)子間骨折骨折;該部位滋養(yǎng)血管較為豐富,骨折發(fā)生后多能較好的愈合;由于發(fā)生股骨轉(zhuǎn)子間骨折時常累及股骨后內(nèi)側(cè)壁和股骨距,所以容易引起髖內(nèi)翻畸形。高齡轉(zhuǎn)子間骨折由于其并發(fā)癥的存在,其死亡率一直很高,一年的死亡率高達30%,還有40%的病人喪失獨立活動的能力,所以為減少病人死亡并且提升其生活品質(zhì),采用手術(shù)的方式已經(jīng)得到大家的廣泛認(rèn)同。目前臨床較為主流的方法是PFNA、DHS以及人工關(guān)節(jié)置換等。由于各種治療方法各具其自身的優(yōu)缺點,所以選取哪種方式治療股骨轉(zhuǎn)子間骨折一直存在比較大的爭議。所以本文以Meta分析方式分別對比DHS與THA以及PFNA與THA治療該類骨折療效的差別。方法:機檢PubMed、中國知網(wǎng)、萬方、VIP等資料庫,同時人工查閱相關(guān)專科雜志等發(fā)表的文章。搜集國內(nèi)關(guān)于老年ITF經(jīng)PFNA與髖關(guān)節(jié)置換治療的隨機對照試驗的文獻以及老年ITF經(jīng)DHS與髖關(guān)節(jié)置換治療的隨機對照試驗的文獻。根據(jù)制定好的相關(guān)標(biāo)準(zhǔn)排除不符合標(biāo)準(zhǔn)的資料,納入符合標(biāo)準(zhǔn)的資料,并對最終采納的資料使用Jadad評分量表進行評分。評價指標(biāo)包括手術(shù)時長、出血量、下地負(fù)重時間、住院天數(shù)、并發(fā)癥、關(guān)節(jié)功能評分。由第一作者采用Cochrane協(xié)作網(wǎng)提供的Revman5.3軟件進行分析。計數(shù)資料采用優(yōu)勢比(odds ration,OR)及其95%的可信區(qū)間(confidenceinterval,CI)表示。計量資料采用加權(quán)均數(shù)差(weightedmean difference,WMD)。同質(zhì)性判定使用OR Cochrane Q檢驗(卡方),P0.1表示無異質(zhì)性,P0.1表示存在異質(zhì)性。異質(zhì)性的定量分析使用I2,當(dāng)I250%表明有異質(zhì)性。對于同質(zhì)性較好的宜采用Fixed effect model分析,對于有異質(zhì)性的研究,應(yīng)采用Random effect model分析。結(jié)果:PFNA組與THA組的對比。手術(shù)時間:P0.05沒有意義,尚不能認(rèn)為倆者在手術(shù)時長上存在差別;術(shù)中出血量:P0.05,有意義,認(rèn)為THA術(shù)中出血量大于PFNA;住院時間:P0.05,有意義,認(rèn)為THA住院天數(shù)小于PFNA組;術(shù)后下地負(fù)重時間:P0.05,認(rèn)為THA下地負(fù)重時間小于PFNA;并發(fā)癥:P0.05,認(rèn)為THA并發(fā)癥少于PFNA;術(shù)后Harris評分(6個月):P0.05,認(rèn)為THA 6個月時關(guān)節(jié)功能評分優(yōu)于PFNA組;術(shù)后Harris評分(術(shù)后12個月):P0.05,認(rèn)為THA12個月時關(guān)節(jié)功能評分優(yōu)于PFNA。DHS組與THA組各項觀察指標(biāo)的比較。手術(shù)時間:P0.05,認(rèn)為THA在手術(shù)時長上好于DHS的。術(shù)中出血量:P0.05,尚不能認(rèn)為DHS組與THA組在出血量上存在差別。住院時間:P0.05,THA在住院時間好于DHS。術(shù)后下地負(fù)重時間:P0.05,THA下地負(fù)重時間好于DHS。并發(fā)癥:P0.05,表明THA并發(fā)癥少于DHA。術(shù)后3個月Harris評分:P0.05,表明THA術(shù)后關(guān)節(jié)功能評分優(yōu)于動力髖螺釘。結(jié)論:PFNA組與髖關(guān)節(jié)置換組的各項觀察指標(biāo)的比較,從手術(shù)時間上來說,本次分析結(jié)果顯示髖關(guān)節(jié)置換組與PFNA組在手術(shù)時間上的差異無統(tǒng)計學(xué)意義。從出血量來說,PFNA在出血量上優(yōu)于THA。從住院天數(shù)、負(fù)重時間、并發(fā)癥發(fā)生率、關(guān)節(jié)功能評分這幾方面來說,THA是優(yōu)于PFNA。DHS和THA各項觀察指標(biāo)對比,除出血量這一項觀察指標(biāo)DHS和THA的差別無意義以外,在其他觀察項目如住院天數(shù)、負(fù)重時間、關(guān)節(jié)功能評分等THA組是優(yōu)于DHS組的。
[Abstract]:Objective: due to the increasing population of 60 years and older in China, the ITF in the elderly is becoming more and more common in the clinical work and shows an increasing trend year by year. The intertrochanteric fracture has its own characteristics, such as the most of the intertrochanteric femoral intertrochanteric, and the violent intertrochanteric fracture is often made into a comminuted and unstable femoral intertrochanteric fracture. Fracture, which has abundant nourishing blood vessels and better healing after the fracture, often causes the deformity of the coxa varus because of the femoral intertrochanteric fracture often involving the medial wall of the femur and the thighbone distance, and the death rate of the intertrochanteric fracture of the elderly is high, the death rate is up to 30%, and 40% in one year. Patients lose their ability to be independent, so to reduce patients' death and improve their quality of life, the method of operation has been widely recognized. The main main clinical methods are PFNA, DHS, and artificial joint replacement. The treatment of intertrochanteric fractures of the femur has been quite controversial. Therefore, this paper compares the difference between DHS and THA and PFNA and THA for the treatment of this type of fracture by Meta analysis. Methods: PubMed, Chinese knowledge network, Wanfang, VIP and other articles published in the relevant journals. Literature on randomized controlled trials of FNA and hip replacement therapy and a randomized controlled trial of the elderly ITF via DHS and hip replacement therapy. According to the relevant standards, the data were excluded from the standard, and the final adopted data were scored by the Jadad scale. It includes the length of operation, the amount of bleeding, the time of down the ground, the days of hospitalization, the complications, and the score of joint function. The first author uses the Revman5.3 software provided by the Cochrane cooperation network. The count data is represented by the odds ration (OR) and its 95% confidence interval (confidenceinterval, CI). The weight mean difference (Wei) is used in the measurement data. Ghtedmean difference, WMD). The homogeneity determination uses OR Cochrane Q test (chi square), P0.1 indicates no heterogeneity, P0.1 indicates heterogeneity. The quantitative analysis of heterogeneity uses I2 and I250% indicates heterogeneity. Analysis. Results: comparison between group PFNA and group THA. Operation time: P0.05 has no significance. There is no difference between the two in the operation. The amount of bleeding in the operation is P0.05, it is meaningful, it is considered that the amount of bleeding in THA is greater than PFNA; the time of hospitalization: P0.05, it is meaningful, that the number of THA is less than that of the PFNA group; the time after operation is: P0.05, THA under P0.05. The time of ground weight negative was less than PFNA; complication: P0.05, the complication of THA was less than PFNA; Harris score (6 months) after operation was P0.05, and the joint function score of THA was better than that of PFNA group at 6 months, and the postoperative Harris score (12 months after operation): P0.05. Room: P0.05, think that THA is better than DHS during operation. The amount of intraoperative hemorrhage: P0.05, it is not still thought that there is a difference between the DHS group and the THA group in the amount of bleeding. The time of hospitalization is P0.05, and the time of hospitalization is better than that of the THA after the operation of DHS.: P0.05, THA down time is better than that of DHS. complications: it shows that the complications are less than 3 months after the operation. RIS score: P0.05, indicating that the joint function score after THA is better than that of the dynamic hip screw. Conclusion: the comparison between the observation indexes of the group PFNA and the hip replacement group, from the time of operation, this analysis shows that there is no statistical difference between the hip replacement group and the PFNA group in the operation time. From the amount of bleeding, the amount of PFNA is on the amount of bleeding. THA is superior to THA. from the number of hospitalization days, weight bearing time, complication rate and joint function score, which is superior to the observation indexes of PFNA.DHS and THA. Except for the difference of the difference of the observation index of hemorrhage, DHS and THA, the THA group in other observation items such as the days of hospitalization, the time of weight bearing, and the joint function score are superior to those of the other observation items. Group DHS.
【學(xué)位授予單位】：山西醫(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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