本文選題：針刀 + 股骨頭缺血性壞死��； 參考：《廣西中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的:通過應(yīng)用循證醫(yī)學(xué)的方法和臨床指南的方法,將全數(shù)據(jù)庫收集到的高質(zhì)量數(shù)據(jù)與專家咨詢稿整理的數(shù)據(jù)進(jìn)行整合,以此為基礎(chǔ)編寫出《針刀治療股骨頭缺血性壞死臨床診療操作方案推薦方案》。以提高臨床針刀醫(yī)生治療股骨頭缺血性壞死的診療效率,減少診療事故,為推動針刀治療股骨頭缺血壞死的科學(xué)化、規(guī)范化和標(biāo)準(zhǔn)化研究提供借鑒。方法:本次研究是基于循證醫(yī)學(xué)方法中的meta分析和證據(jù)分級法,結(jié)合專家共識法和統(tǒng)計(jì)學(xué)的頻數(shù)法共同完成的。Meta分析方法:應(yīng)用循證醫(yī)學(xué)的方法明確所要研究的臨床問題,依據(jù)臨床問題在PICO的原則下制定出檢索詞和檢索式,將檢索詞和檢索式輸入數(shù)據(jù)庫,進(jìn)行全數(shù)據(jù)庫檢索,檢索時力爭做到檢索的“全”而“準(zhǔn)”。將檢索到的數(shù)據(jù)輸入EndnoteX7文獻(xiàn)管理軟件中進(jìn)行去重,將符合納入標(biāo)準(zhǔn)的文獻(xiàn)按照J(rèn)adad質(zhì)量評分標(biāo)準(zhǔn)進(jìn)行評分,最終共納入11篇符合納入標(biāo)準(zhǔn)的高質(zhì)量文獻(xiàn);提取高質(zhì)量文獻(xiàn)數(shù)據(jù),將數(shù)據(jù)輸入Review Manager5.2統(tǒng)計(jì)學(xué)軟件進(jìn)行統(tǒng)計(jì)學(xué)分析,通過森林圖和倒漏斗圖的分析,比較針刀組與對照組治療股骨頭缺血性壞死總療效、Harris評分和骨內(nèi)壓的差異。臨床診療推薦方案方法:采用OCEBM證據(jù)分級標(biāo)準(zhǔn)表對檢索到的證據(jù)進(jìn)行評價分級,共獲得11篇A級證據(jù)。通過對高質(zhì)量證據(jù)中數(shù)據(jù)的提取,選取頻數(shù)高的數(shù)據(jù),參照《WHO西太區(qū)循證針灸臨床實(shí)踐指南推薦方案專家意見表》的格式編寫成《針刀治療股骨頭缺血性壞死臨床診療操作推薦方案(初稿)》。參考專家共識的方法針對性的對《針刀治療股骨頭缺血性壞死臨床診療操作推薦方案(初稿)》中存在的分歧編寫成《針刀治療股骨頭缺血性壞死臨床診療操作推薦方案(專家咨詢稿)》。通過《針刀治療股骨頭缺血性壞死臨床診療操作推薦方案(專家咨詢稿)》的發(fā)放、回收,并將收集到的數(shù)據(jù)采用Microsoft Excel軟件進(jìn)行頻數(shù)分析,并繪制出數(shù)據(jù)統(tǒng)計(jì)圖;最終將專家咨詢稿數(shù)據(jù)與《針刀治療股骨頭缺血性壞死臨床診療操作推薦方案(初稿)》進(jìn)行數(shù)據(jù)整合,使初稿中存在的分歧達(dá)成一致的結(jié)論,如仍存有部分分歧則再次通過咨詢專家的方式協(xié)商解決。結(jié)果:1、meta分析結(jié)果:(1)總有效率meta分析異質(zhì)性檢驗(yàn)Chi2=16.42,自由度(df)=7時,P=0.02,I2=57%,P0.1拒絕H0,接受H1,統(tǒng)計(jì)學(xué)分析差異有統(tǒng)計(jì)學(xué)意義;合并效應(yīng)檢驗(yàn)Z=3.06,P=0.002,P0.05拒絕H0,接受H1,統(tǒng)計(jì)學(xué)分析差異有統(tǒng)計(jì)學(xué)意義,總效應(yīng)95%CI=3.94[1.46,9.49]。(2)亞組Harris評分meta分析異質(zhì)性檢驗(yàn)Chi2=5.36,自由度(df)=1時,P=0.02,I2=81%,P0.1拒絕H0,接受H1,統(tǒng)計(jì)學(xué)分析差異有統(tǒng)計(jì)學(xué)意義;合并效應(yīng)檢驗(yàn)Z=2.96,P=0.003,P拒絕H0,接受H1,統(tǒng)計(jì)學(xué)分析差異有統(tǒng)計(jì)學(xué)意義,總效應(yīng)的95%CI=6.12[2.06,10.17]。(3)骨內(nèi)壓meta分析異質(zhì)性檢驗(yàn)Chi2=12.28,自由度(df)=2時,P=0.02,I2=84%,P0.1拒絕H0,接受H1,統(tǒng)計(jì)學(xué)分析差異有統(tǒng)計(jì)學(xué)意義;合并效應(yīng)兩檢驗(yàn)Z=0.72,P=0.47,P0.05拒絕H1,接受H0,統(tǒng)計(jì)學(xué)分析差異無統(tǒng)計(jì)學(xué)意義。2、將《針刀治療股骨頭缺血性壞死臨床診療操作推薦方案(初稿)》和針刀治療股骨頭缺血性壞死臨床診療操作推薦方案(專家咨詢稿)》數(shù)據(jù)整合后編寫成了《針刀治療股骨頭缺血性壞死臨床診療操作推薦方案》結(jié)論:1、通過對針刀治療股骨頭缺血性壞死的meta分析驗(yàn)證了針刀治療股骨頭缺血性壞死是有效的。2、通過《針刀治療股骨頭缺血壞死的臨床診療操作推薦方案(初稿)》數(shù)據(jù)和《針刀治療股骨頭缺血壞死的臨床診療操作推薦方案(專家咨詢稿)》數(shù)據(jù)的整合最終完成了《針刀治療股骨頭缺血壞死的臨床診療操作推薦方案》,為臨床醫(yī)生針刀治療股骨頭缺血性壞死提供了一定的指導(dǎo)和參考價值。3、本次的研究是在遵循循證醫(yī)學(xué)的方法結(jié)合專家共識的方式完成針刀治療股骨頭缺血性壞死的標(biāo)準(zhǔn)化診療方案的編寫嘗試,同樣也為今后針刀診療操作的標(biāo)準(zhǔn)化研究提供一定的參考意義和方法學(xué)借鑒。
[Abstract]:Objective: to integrate the high quality data collected by the whole database and the data collected by expert consultation by using the method of evidence-based medicine and the method of clinical guide, so as to prepare a proposal for the treatment of the clinical diagnosis and treatment of avascular necrosis of the femoral head by Acupotomy. The diagnosis and treatment efficiency of bloody necrosis and the reduction of diagnosis and treatment accidents will provide a reference for the scientific, standardized and standardized research of acupotomy for the treatment of avascular necrosis of the femoral head. Method: This study is based on the meta analysis and the evidence classification method in the evidence-based medicine method, combined with the expert consensus method and the statistical frequency method to complete the.Meta analysis side. Method: the method of evidence-based medicine is used to clarify the clinical problems to be studied. According to the clinical problems, the retrieval words and retrieval forms are formulated under the principle of PICO. The retrieval words and retrieval types are entered into the database for full database retrieval, and the "complete" and "quasi" of the retrieval is achieved when the retrieval is retrieved. The retrieved data is entered into the EndnoteX7 document management. The software is carried out in the software, and the documents which conform to the standard are scored according to the Jadad quality standard, and 11 high quality documents are included in the literature. The high quality literature data is extracted and the data are entered into Review Manager5.2 statistics software for statistical analysis, and the comparison needle is compared through the analysis of the forest map and the funnel plot. The total curative effect of avascular necrosis of the femoral head and the difference between the Harris score and the internal pressure in the treatment of the avascular necrosis of the femoral head. The recommendation scheme of the clinical diagnosis and treatment: the evaluation and classification of the retrieved evidence by the OCEBM evidence classification standard table, and a total of 11 A-level evidence were obtained. The high frequency data were selected by the extraction of the high quality evidence and the reference to . Reference expert consensus method pertinent to the disagreement in the clinical treatment recommendation scheme (preliminary draft) of acupotomy for avascular necrosis of the femoral head (first draft) > The clinical diagnosis and treatment recommendations (expert consultation) of acupotomy for avascular necrosis of the femoral head (expert consultation) >. The issuance of the recommendation scheme (expert consultation) for the treatment of avascular necrosis of the femoral head by acupotomy, recovery, and the data collected by the Microsoft Excel software for frequency analysis and data Statistics Figure; finally, integrate the expert consultation data with the Acupotomy treatment for the clinical diagnosis and treatment of avascular necrosis of the femoral head (first draft), to make the conclusion of the differences in the first draft, if there are still some differences in the way of consulting experts to solve them again. Results: 1, the results of meta analysis: (1) the total efficiency of meta Analysis of heterogeneity test Chi2=16.42, degree of freedom (DF) =7, P=0.02, I2=57%, P0.1 refuse H0, accept H1, statistical analysis difference is statistically significant; the combination effect test Z=3.06, P=0.002, P0.05 H0, statistical analysis difference is statistically significant, total effect (2) subgroup Chi2=5.36, degree of freedom (DF) =1, P=0.02, I2=81%, P0.1 refuse H0, accept H1, statistical analysis difference is statistically significant; the combination effect test Z=2.96, P=0.003, P H0, statistical analysis difference is statistically significant, total effect (3) intrabone pressure analysis heterogeneity test, freedom degree At the time, P=0.02, I2=84%, P0.1 refused H0, accepted H1, and statistical analysis was statistically significant; combined effect two test Z=0.72, P=0.47, P0.05 refused H1, accepted H0, and statistical analysis was not statistically significant.2, "Acupotomy for the treatment of avascular necrosis of the femoral head (first draft) > and Acupotomy for avascular necrosis of the femoral head." Clinical diagnosis and treatment operation recommendation scheme (expert consultation) > data integration was compiled into < needle knife treatment of femoral head avascular necrosis of clinical diagnosis and treatment scheme > conclusion: 1, through the needle knife treatment of avascular necrosis of the femoral head meta analysis verifies that Acupotomy for ischemic necrosis of the femoral head is an effective.2, through the "needle knife treatment of femoral head" Recommendations for clinical diagnosis and treatment of ischemic necrosis (preliminary draft) > data and < needle knife treatment for clinical diagnosis and treatment of femoral head ischemic necrosis (expert consultation) > data integration finally complete the clinical diagnosis and treatment recommendation of acupotomy for avascular necrosis of the femoral head, for the treatment of avascular necrosis of the femoral head by a clinician. It provides a certain guide and reference value.3. This study is to follow the method of evidence-based medicine combined with expert consensus to complete the preparation of a standardized treatment scheme for Acupotomy for avascular necrosis of the femoral head. It also provides some reference and methodology for the standardization of needle knife diagnosis and treatment in the future.
【學(xué)位授予單位】：廣西中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R246.9

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