【摘要】：目的:通過Meta分析方法在較大樣本量的前提下,比較股骨近端空心鎖定板與空心加壓螺釘治療中青年股骨頸骨折的臨床療效和安全性。方法:通過計算機(jī)檢索Cochrane圖書館、Medline、Embase、中文期刊全文數(shù)據(jù)庫、萬方數(shù)據(jù)庫等資源中比較股骨近端空心鎖定板與空心加壓螺釘治療股骨頸骨折的各類型研究,依據(jù)納入與排除標(biāo)準(zhǔn)選取文獻(xiàn),并追查已納入文獻(xiàn)的參考文獻(xiàn),提取相關(guān)數(shù)據(jù),所得數(shù)據(jù)通過Rev Man5.3統(tǒng)計軟件完成Meta分析,比較股骨近端空心鎖定板組與空心加壓螺釘組的髖關(guān)節(jié)Harris功能評分優(yōu)良率、手術(shù)時間、骨折愈合率、骨折愈合時間、股骨頭壞死率、術(shù)中出血量、術(shù)后遠(yuǎn)期髖關(guān)節(jié)Harris功能評分、并發(fā)癥發(fā)生率等。結(jié)果:共納入11個臨床對照研究,共728例患者涉及本實驗研究。Meta分析發(fā)現(xiàn):股骨近端空心鎖定板組的手術(shù)時間[MD=6.41,95%CI為(-0.21,13.03),P=0.06]、術(shù)中出血量[MD=21.32,95%CI為(-1.34,43.98),P=0.07]、術(shù)后引流量[MD=-7.74,95%CI(-18.22,2.75),P=0.15]、骨折愈合時間[P=0.41,M D=-1.56,95%CI為(-5.24,2.13)]均與空心加壓螺釘組無明顯差別。而對于術(shù)后髖關(guān)節(jié)功能恢復(fù)的優(yōu)良率[OR=2.80,95%CI為(1.68,4.65)P0.0001],股骨近端空心鎖定板組則明顯高于空心加壓螺釘組�？偛l(fā)癥方面[OR=0.29,95%CI為(0.11,0,37),P0.00001],股骨近端空心鎖定板組則明顯低于空心加壓螺釘組。結(jié)論:股骨近端空心鎖定板組治療股骨頸骨折較空心加壓螺釘組具有更好的遠(yuǎn)期臨床效果,但手術(shù)持續(xù)時間、術(shù)中出血量、術(shù)后引流量、骨折愈合時間等無明顯差別,因此在臨床工作中對于治療方法的選擇應(yīng)該謹(jǐn)慎。由于納入研究數(shù)量少且質(zhì)量不高,論證強(qiáng)度較弱,尚需開展和設(shè)計大樣本隨機(jī)對照研究做進(jìn)一步驗證。
[Abstract]:Objective: to compare the clinical efficacy and safety of femoral proximal locking plate and hollow compression screw in the treatment of femoral neck fracture in young and middle-aged patients with large sample size by Meta analysis. Methods: Cochrane library, Medline,Embase, Chinese periodical full-text database and Wanfang database were searched by computer to compare the different types of femoral neck fractures treated by femoral proximal locking plate and hollow compression screw. According to the criteria of inclusion and exclusion, the literature is selected, and the relevant data are extracted by tracing the references that have been included in the literature. The obtained data are analyzed by Meta through Rev Man5.3 statistical software. The excellent and good rate of hip joint Harris score, operation time, fracture healing rate, fracture healing time, femoral head necrosis rate, intraoperative bleeding volume and long-term hip joint Harris functional score were compared between the proximal femoral locking plate group and the hollow compression screw group. Incidence of complications, etc. Results: a total of 11 clinical controlled trials were conducted, and 728 patients were involved in this study. Meta analysis showed that the operative time of the proximal femoral hollow locking plate group [MD=6.41,95%CI = (-0.21 鹵13.03), P < 0.06]. Intraoperative bleeding volume [MD=21.32,95%CI = (-1.34 鹵43.98), P < 0.07], postoperative drainage volume [MD=-7.74,95%CI (-18.22 鹵2.75), P0. 15], fracture healing time [P0. 41, P < 0. 41], There was no significant difference in CI (-5.24 鹵2.13) between the two groups. The excellent and good rate of hip joint function recovery after operation [OR=2.80,95%CI was (1.68 鹵4.65) P 0.0001], the proximal femoral hollow locking plate group was significantly higher than that of hollow compression screw group. The total complications [OR=0.29,95%CI (0.110.37), P0.00001] were significantly lower in the proximal femoral locking plate group than in the hollow compression screw group. Conclusion: the treatment of femoral neck fracture with femoral proximal hollow locking plate has better long-term clinical effect than that of hollow compression screw group, but there is no significant difference in operation duration, intraoperative blood loss, postoperative drainage, fracture healing time and so on. Therefore, the choice of treatment methods should be careful in clinical work. Because of the low quantity, low quality and weak demonstration intensity, it is necessary to carry out and design a large sample randomized controlled study for further verification.
【學(xué)位授予單位】：蚌埠醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R687.3

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