本文選題：股骨轉(zhuǎn)子間骨折　切入點(diǎn)：骨質(zhì)疏松　出處：《天津醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:本文的主要研究目的是通過回顧性分析,來搜集符合條件的臨床患者病歷資料,探討股骨轉(zhuǎn)子間骨折的發(fā)病情況及其流行病學(xué)分布特點(diǎn),用Meta分析來比較國內(nèi)外老年髖部骨折死亡危險(xiǎn)因素,從而進(jìn)一步為股骨轉(zhuǎn)子間骨折的預(yù)防和治療提供科學(xué)指導(dǎo)。方法:本研究先從臨床病例觀察來回顧性分析股骨轉(zhuǎn)子間骨折的發(fā)病情況并結(jié)合國內(nèi)外大量文獻(xiàn)來分析其流行病學(xué)分布特點(diǎn),并通過Meta分析來評估有關(guān)髖部骨折死亡的危險(xiǎn)因素。第一部分:本研究所選用的病例來自天津醫(yī)科大學(xué)總醫(yī)院于2013年1月至2015年12月以來收治的股骨轉(zhuǎn)子間骨折患者,按照納入標(biāo)準(zhǔn)和排除標(biāo)準(zhǔn),篩選出符合要求的股骨轉(zhuǎn)子間骨折住院患者共179例,其中男性66例,女性113例;年齡介于52-96歲之間,平均年齡為(76.98±9.74)歲。記錄并比較其年齡、性別、致傷原因、骨折類型、主要伴發(fā)病的分布以及治療方式、住院天數(shù)等資料。其中計(jì)數(shù)資料以率或百分比(%)表示,樣本間比較采用χ2檢驗(yàn);計(jì)量資料以mean±SD表示,樣本間比較采用t檢驗(yàn)。應(yīng)用SPSS13.0統(tǒng)計(jì)學(xué)軟件分析調(diào)查數(shù)據(jù),進(jìn)行統(tǒng)計(jì)學(xué)分析,描述性統(tǒng)計(jì)病例特點(diǎn)。第二部分:計(jì)算機(jī)檢索Cochrane數(shù)據(jù)庫、PubMed、中國知網(wǎng)、萬方數(shù)據(jù)庫、EMBASE、Medline等一些較大的網(wǎng)絡(luò)數(shù)據(jù)庫,篩選出那些和老年髖部骨折死亡危險(xiǎn)因素相關(guān)的中英文參考文獻(xiàn),同時(shí)我們還人工篩選出那些符合納入和排除標(biāo)準(zhǔn)的參考文獻(xiàn)。同時(shí)根據(jù)隨機(jī)對照實(shí)驗(yàn)Meta分析的質(zhì)量報(bào)告規(guī)范(QUOROM)給出的建議標(biāo)準(zhǔn),由2名獨(dú)立的評價(jià)員分別對文獻(xiàn)的題目和摘要進(jìn)行初步檢索,符合標(biāo)準(zhǔn)的則閱讀全文,不符合標(biāo)準(zhǔn)的予以排除,對數(shù)據(jù)資料進(jìn)行提取和質(zhì)量評價(jià),采用Revman5.0統(tǒng)計(jì)學(xué)軟件進(jìn)行Meta分析。用I2和卡方檢驗(yàn)對所納入的文獻(xiàn)進(jìn)行異質(zhì)性檢驗(yàn),采用定性和定量的方法同時(shí)評估,當(dāng)P㩳0.05為差異有統(tǒng)計(jì)學(xué)意義。若I250%,存在異質(zhì)性,采用隨機(jī)效應(yīng)模型,當(dāng)異質(zhì)性不高且I2≤50%時(shí),采用固定效應(yīng)模型進(jìn)行定量分析。此外,對于那些因?yàn)閮煞N不同的治療方式可能會(huì)對結(jié)果產(chǎn)生影響的變量,我們采用亞組分析。P㩳0.05為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果:第一部分:被納入179例股骨轉(zhuǎn)子間骨折的基本情況為:男性66人,女性113人;平均年齡(76.98±9.74)歲;患者數(shù)量居前3位的年齡段分別為81~90歲(71例,39.66%)、71~80歲(50例,27.93%)和61~70歲(36例,20.11%);造成髖部骨折前3位的致傷因素分別為摔傷(86.03%)、墜落傷(8.38%)和車禍(4.47%);按照AO分型,31-A1型83例,占46.37%;31-A2型55例,占30.73%;31-A3型41例,占22.91%;Evans分型中,Ⅰ、Ⅱ、Ⅲ、Ⅳ、Ⅴ型骨折依次減少,分別為90例(50.28%)、48例(26.82%)、27例(15.08%)、10例(5.59%)和4例(2.23%)。全組手術(shù)治療占93.30%(167/179),非手術(shù)治療占6.70%(12/179)。在各種合并癥中,合并一種疾病的占32.4%(58/179),合并兩種疾病的占29.1%(52/179),合并三種疾病的占12.3%(22/179),合并四種疾病的占6.1%(11/179),合并五種疾病的占1.1%(2/179)。在所有轉(zhuǎn)子間骨折患者中,有下肢靜脈血栓的占12.8%(23/179)。第二部分:根據(jù)納入和排除標(biāo)準(zhǔn),我們共納入20篇研究文獻(xiàn),包括59462例患者,總體結(jié)果的發(fā)表偏倚用漏斗圖進(jìn)行了測量,漏斗圖提示基本對稱,不存在大的偏倚。Meta分析結(jié)果顯示:在各種危險(xiǎn)因素中,年齡大于60歲、男性、ASA評分、骨折前糖尿病、骨折前心血管疾病、骨折前呼吸系統(tǒng)疾病、骨折前腦血管疾病、骨質(zhì)疏松、高血壓病、癡呆的研究結(jié)果有統(tǒng)計(jì)學(xué)差異,提示以上這些危險(xiǎn)因素是老年髖部骨折后死亡的主要危險(xiǎn)因素,而骨折類型、體質(zhì)量指數(shù)(BMI)、骨折到手術(shù)時(shí)間的研究結(jié)果無統(tǒng)計(jì)學(xué)差異,說明這三種因素不是老年髖部骨折死亡的危險(xiǎn)因素。結(jié)論:(1)股骨轉(zhuǎn)子間骨折是以老年人占絕大多數(shù)、以跌倒為主要致傷原因的骨質(zhì)疏松性骨折。(2)隨著年齡的增長,股骨轉(zhuǎn)子間骨折的發(fā)生概率有逐年增加的趨勢,且女性患者多于男性。(3)在AO分型中,31-A1型最多;在Evans分型中,Ⅰ型最多。股骨轉(zhuǎn)子間骨折以手術(shù)治療為主。在各種合并癥中,高血壓的發(fā)病率最高,其次為糖尿病。下肢靜脈血栓以81-90歲年齡段最多。(4)Meta分析的結(jié)果顯示男性、年齡、ASA評分、骨折前糖尿病、骨折前心血管疾病、骨折前呼吸系統(tǒng)疾病、骨折前腦血管疾病、骨質(zhì)疏松、高血壓病和癡呆是老年髖部骨折后死亡的主要危險(xiǎn)因素,因此老年人髖部骨折的治療與預(yù)防是臨床醫(yī)師面臨的主要問題。(5)老年髖部骨折患者死亡率高可能是老年人生理狀況、骨折前患有慢性疾病等多種因素共同作用的結(jié)果,治療前應(yīng)充分了解患者身體機(jī)能和健康狀況,充分評估手術(shù)風(fēng)險(xiǎn),選擇適宜手術(shù)類型,提高患者術(shù)后機(jī)能恢復(fù)效果,降低并發(fā)癥發(fā)生的可能。
[Abstract]:Objective: the aim of this study is the retrospective analysis of clinical data to collect patient records to meet the conditions, to investigate the intertrochanteric fracture incidence and epidemiology, Meta analysis was used to compare the domestic and foreign elderly hip fracture risk factors of death, so as to provide scientific guidance for the prevention and treatment of femoral intertrochanteric fractures. Methods: This study first from the clinical observation to retrospective analysis of the incidence of femoral intertrochanteric fracture combined with a large number of domestic and foreign literature to analyze the epidemiological characteristics and through the cloth, Meta analysis to assess the risk factors for hip fracture in death. The first part: the study selected cases from General Hospital Affiliated to Tianjin Medical University in January 2013 since December 2015 were intertrochanteric fracture patients, according to the inclusion and exclusion criteria, selected The femoral fracture between inpatients were 179 cases, including 66 cases of male, female 113 cases; age ranged from 52-96 years old, the average age was (76.98 + 9.74) years old. Recorded and compared the age, gender, cause of injury, type of fracture, mainly with the disease distribution and treatment, hospitalization days the data. The count data at the rate or percentage (%), compared with 2 test samples; measurement data with mean + SD, samples were compared by t test. Analyze the survey data using SPSS13.0 statistical software, statistical analysis, descriptive statistical characteristics of the cases. The second part: Cochrane database, PubMed China, CNKI, Wanfang database, EMBASE, Medline and other large network database, and filter out those elderly hip fracture risk factors of death in English related references, we also screened the artificial With some references to the inclusion and exclusion criteria. According to the analysis of randomized controlled trials of Meta quality report (QUOROM) recommendations are given, the primary retrieval by 2 independent reviewers of the document title and abstract standard is to read the full text, does not meet the criteria to be excluded, extraction and to evaluate the quality of the data, Meta analysis was performed using Revman5.0 statistical software. We test on the test for heterogeneity in literature by I2 and card, the methods of quantitative and qualitative evaluation at the same time, when P? 0.05 for the difference was statistically significant. If I250%, the heterogeneity, the random effects model, when heterogeneity is not high and the I2 is less than or equal to 50%, using fixed effect model for quantitative analysis. In addition, because for those two different treatments may affect the results of the variables, we use sub components 鏋，

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