| 内固定术与髋关节置换术治疗股骨粗隆间骨折疗效的Meta分析 |
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投稿时间：2014-03-07
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| 作者 | Author | 单位 | Address | E-Mail |
| 董建彬 |
DONG Jian-bin |
山西医科大学, 山西太原 030001 |
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| 王智勇 |
WANG Zhi-yong |
山西医科大学, 山西太原 030001 |
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| 芦浩 |
LU Hao |
山西医科大学, 山西太原 030001 |
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| 田渊 |
TIAN Yuan |
山西医科大学, 山西太原 030001 |
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| 王鑫瑞 |
WANG Xin-rui |
山西医科大学, 山西太原 030001 |
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| 张志强 |
ZHANG Zhi-qiang |
山西医科大学第二医院骨科, 山西太原 030001 |
Department of Orthopaedics, the Sencond Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi, China |
13393430930@163.com |
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| 期刊信息：《中国骨伤》2015年，第28卷，第3期，第245-251页 |
| DOI：10.3969/j.issn.1003-0034.2015.03.012 |
| 基金项目: |
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中文摘要:
目的:探讨内固定术(包括PFNA和PFN)与髋关节置换术(包括全髋人工关节置换术及人工股骨头置换术)治疗股骨粗隆间骨折的疗效差异。
方法:利用Cochrane数据库、PUBMED数据库、中国生物医学文献数据库、中国知网、万方数据库以及手动检索相关文献,所有检索文献截止2013年1月1日。收集内固定术及髋关节置换术治疗股骨粗隆间骨折随机对照试验的英文及中文文献,严格评价纳入研究的方法学质量及提取资料,运用RevMan5.0 软件统计分析收集的所有数据。
结果:共纳入7项随机对照试验。资料分析显示,与内固定两种手术方式相比,髋关节置换术手术时间缩短[WMD=-2.66,95%CI(-5.25,-0.06),P=0.05],术中失血量减少 [WMD=-24.20,95%CI(-30.38,-18.02),P<0.000 01],住院时间减少[WMD=-4.72,95%CI(-5.18,-4.25),P<0.000 01],下床时间缩短[WMD=-29.54,95%CI(-30.77,-28.31),P<0.000 01],总并发症发生率升高[WMD=0.15,95%CI(0.11,0.22),P<0.000 01].两种手术方式在术后Harris评分提高[WMD=1.09,95%CI(0.54,1.32),P>0.05]和术后双下肢深静脉发生率上[WMD=1.09,95%CI(0.47,2.55),P>0.05]差异均无统计学意义。
结论:与内固定手术相比,髋关节置换手术组在手术时间、住院时间和下床时间方面优于内固定组,明显减少了患者因为卧床而引起的肺部感染、泌尿系统感染及褥疮等并发症,提高患者的生活质量,但是对于股骨粗隆间骨折手术方式的选择应根据患者的年龄、骨质情况、骨折类型以及合并症做出科学的选择。 |
| 【关键词】股骨骨折 骨折固定术,内 关节成形术,置换,髋 Meta分析 |
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| Meta-analysis of internal fixation versus hip replacement in the treatment of trochanteric fractures |
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ABSTRACT
Objective:To compare the efficacy of internal fixation (including PFNA and PFN) versus hip replacement (including FHR or THA) in the treatment of trochanteric fractures in adults.
Methods:Reports of studies using randomized controlled trials (RCT) to compare internal fixationg with hip replacement in the management of intertrochanteric fractures were retrieved (up to January 1,2013) from the Cochrane Library,PUBMED Data,CNKI(China National Knowledge infrastructure),Elsevier,the Chinese Biomedical Database,Wanfang Data,and manually. Methodological quality of the trials was critically assessed,and relevant data were extracted. Statistical software RevMan 5.0 was used for data-analysis.
Results:Seven articles were included in the meta-analysis. The results showed that,compared internal fixation with hip replacement,there were statistical significance in the duration of surgery time[WMD=-2.66,95%CI(-5.25,-0.06),P=0.05],intra-operative blood loss[WMD=-24.20,95%CI(-30.38,-18.02),P<0.000 01],hospital stays time [WMD=-4.72,95%CI(-5.18,-4.25),P<0.000 01],bearing load time [WMD=-29.54,95%CI(-30.77,-28.31),P<0.000 01],total complications rate [WMD=0.15,95%CI(0.11,0.22),P<0.000 01],the good rate of Harris scores [WMD=1.09,95%CI(0.54,1.32),P<0.05]. However,there were no statistical significance in the rate of deep venous thrombosis[WMD=1.09,95%CI(0.47,2.55),P>0.05].
Conclusion:Hip replacement (containing FHR or THA) for the treatment of intertrochanteric fractures is superior to internal fixation in regards to the duration of surgery time,the mean duration of hosipital stays,mean post-operative down time,intra-operative blood loss,the rate of post-operative good Harris scores. But there is not enough evidence to show any difference between hip replacement(containing THA or FHR) and internal fixation in regards to the rate of deep venous thrombosis. However,internal fixation for the treatment of intertrochanteric fractures is superior to hip replacement (containing FHR or THA) in regards to total complications rate. |
| KEY WORDS Femoral fractures Fracture fixation,internal Arthroplasty,replacement,hip Meta-analysis |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 董建彬,王智勇,芦浩,田渊,王鑫瑞,张志强.内固定术与髋关节置换术治疗股骨粗隆间骨折疗效的Meta分析[J].中国骨伤,2015,28(3):245~251 |
| 英文格式: | DONG Jian-bin,WANG Zhi-yong,LU Hao,TIAN Yuan,WANG Xin-rui,ZHANG Zhi-qiang.Meta-analysis of internal fixation versus hip replacement in the treatment of trochanteric fractures[J].zhongguo gu shang / China J Orthop Trauma ,2015,28(3):245~251 |
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