【摘要】：目的：收集肱骨近端移位3,4部分骨折保留關節(jié)與關節(jié)置換治療的隨機對照試驗,對兩種治療方法的療效差異進行Meta分析。方法：檢索Medline(1966年1月至2013年12月)、Pubmed(1980年1月至2013年12月)、Embase(1990年1月至2013年12月)、Science(1990年1月至2013年12月)、Springer(1990年1月至2013年12月)、CNKI(1994至2013年)、萬方數(shù)據(jù)庫(1982至2013年)等數(shù)據(jù)庫中關于肱骨近端3,4部分骨折保留關節(jié)與關節(jié)置換治療的隨機對照試驗,納入符合標準的文獻,提取相關數(shù)據(jù)輸入Comprehensive Meta-Analysis Software (CMA)軟件進行Meta分析。結(jié)果：共7篇文獻符合納入標準,共計320例患者(165例行保留關節(jié)治療,155例行關節(jié)置換治療),均為英文文獻,經(jīng)改良的Jadad評分判定均為高質(zhì)量研究。Meta分析結(jié)果顯示,總Constant平均值為55.9(95%CI：50.7-61.1,P0.001),保留關節(jié)治療組的Constant評分值高于關節(jié)置換組(P0.01)。研究的異質(zhì)性顯著(I2=88%,Q統(tǒng)計量=107.6,Q=13,P0.001),在Meta分析時肩關節(jié)Constant評分值隨著男女性別比增長、肱骨結(jié)節(jié)骨吸收率增加而下降。結(jié)論：提示保留關節(jié)肱骨近端移位3,4部分骨折患者治療后期可較關節(jié)置換得到較高的Constant平分值。此外年齡、骨折類型、性別比和并發(fā)癥發(fā)生率是影響Constant值的顯著因子。鑒于研究的異質(zhì)性和方差,需要有更多更好的隨機對照試驗進一步證明。
[Abstract]:Objective: to collect the randomized controlled trial on the treatment of 3 parts of humeral proximal displacement fracture with reserved joint and joint replacement, and to analyze the difference of the curative effect between the two methods by Meta. Methods: Medline (January 1966-December 2013), Medline (January 1980 to December 2013), Medline (January 1990 to December 2013), Wanfang database (1982 to 2013) and other databases were searched. A randomized controlled trial on the treatment of partial fracture of proximal humerus, preserving joint and joint replacement, The relevant data are extracted and input into Comprehensive Meta-Analysis Software (CMA) software for Meta analysis. Results: a total of 7 articles were in accordance with the inclusion criteria. A total of 320 patients (165 patients with retained joint therapy and 155 patients with joint replacement therapy) were all in English. The modified Jadad scores were all classified as high quality research. Meta-analysis showed that, The average value of total Constant was 55.9 (95 CI: 50.7-61.1 P0.001), and the Constant score in the reserving joint treatment group was higher than that in the joint replacement group (P0.01). The heterogeneity of the study was significant (I _ 2 / 888 / Q statistic 107.6 / Q ~ (13) P ~ 0.001). The Constant score of shoulder joint decreased with the increase of sex ratio between male and female, and the absorption rate of humeral tubercle increased with the increase of sex ratio of male and female. Conclusion: preservation of proximal humerus displacement in patients with partial fracture of the humerus may result in higher Constant score at the later stage of treatment than that in joint replacement. In addition, age, fracture type, sex ratio and incidence of complications were significant factors affecting Constant value. In view of the heterogeneity and variance of the study, more and better randomized controlled trials are needed.
【學位授予單位】：新疆醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R687.4
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本文編號：2158364