Chinese Journal of Tissue Engineering Research ›› 2018, Vol. 22 ›› Issue (19): 3110-3116.doi: 10.3969/j.issn.2095-4344.0253
Comparison of efficacy of lateral decubitus and supine position in treatment of elderly unstable intertrochanteric fractures with proximal femoral nail antirotation
Lü Yang1, Wang Hai-zhou1, Zhong De-gui2, Liu Jun1, Chen Hai-yun1, Pan Jian-ke1
- 1The Second Affiliated Hospital of Guangzhou University of Chinese Medicine/Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou 510120, Guangdong Province, China; 2The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510006, Guangdong Province, China
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Online:2018-07-08Published:2018-07-08 -
Contact:Chen Hai-yun, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine/ Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou 510120, Guangdong Province, China -
About author:Lü Yang, Physician, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine/ Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou 510120, Guangdong Province, China -
Supported by:the Science and Technology Project of Guangdong Province, No. 2012B061700037; the Medical Science and Technology Research Fund Project of Guangdong Province, No. A2017215; a grant from the Guangdong Provincial Finace Department, No. [2014]157; the Special Foundation for the Science and Technology Research Traditional Chinese Medicine of Guangdong Provincial Hospital of Traditional Chinese Medicine, No. YK2013B2N19.
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Lü Yang, Wang Hai-zhou, Zhong De-gui, Liu Jun, Chen Hai-yun, Pan Jian-ke. Comparison of efficacy of lateral decubitus and supine position in treatment of elderly unstable intertrochanteric fractures with proximal femoral nail antirotation[J]. Chinese Journal of Tissue Engineering Research, 2018, 22(19): 3110-3116.
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2.1 文献检索及质量评价 最终纳入8篇相关文献[9-16]，其中侧卧位人工牵引组330例，平卧位牵引床牵引组331例，共计661例。纳入研究的基线特征如表1所示，利用英国牛津证据分级进行预评价，其中3篇1b级证据，5篇2b等级证据。图2所示为纳入研究的偏倚风险评估。"
2.2 Meta分析结果 2.2.1 手术时间 共8篇文献报告了平均手术时间[9-16]，由于研究间存在异质性，进行敏感性分析未见明显异常，分别对5篇纳入老年股骨转子间骨折的文献[9-12，14]，以及3篇单独纳入老年股骨转子间骨折伴有肥胖的文献进行亚组分 析[13，15-16]，异质性检验I2分别为0%和35%，均采用固定效应模型综合分析，分别得到[SMD=-2.92，95%CI(-3.28，-2.55)，Z=15.67，P < 0.001] 和[SMD=-0.81，95%CI (-1.01，-0.61)，Z=7.89，P < 0.000 1]，两者差异均有显著性意义，见图3。 2.2.2 术前准备时间 共2篇报道了术前准备时间[9-10]，研究存在异质性(I2＝97%)，而此Meta分析只纳入2个研究，不进行敏感性分析，各研究无临床异质性，纳入随机效应模型提示组间差异有显著性意义[MD=-7.58，95%CI (-14.42，-0.74)，P=0.03 < 0.05]，见图4。 2.2.3 术中透视次数 5个研究报道了术中平均透视相关指标[9-12，15]，其中3篇文献提供了与术中平均透视次数的平均数和标准差[10，12，15]，研究间存在统计学异质性(I2=87%)，而此Meta分析只纳入3个研究，不进行敏感性分析，各研究无临床异质性，纳入随机效应模型提示结果具有统计学意义[MD=2.82，95%CI(0.91，4.72)，P=0.004 < 0.01]，见图5。其余2篇文献亦报道平卧位牵引床对术中透视时间/放射量低于平卧位人工牵引[9，11]，且差异有显著性意义，但考虑两者单位不一致，未能合并进行综合分析。"
2.2.4 伤口长度 共4篇报道了平均伤口长度[10，13-15]，人工牵引组与牵引床牵引进行Meta分析，研究间不存在异质性(I2=0%)，纳入固定效应模型提示结果差异有显著性意义[MD=-1.92，95%CI(-2.17，-1.67)，P < 0.000 1]，见图6。 2.2.5 术中出血量 共6篇报道了平均伤口长度[9-10，12，14-16]，2组研究间存在异质性(I2=96%)，进行敏感性分析未见异常，分别对2篇单独纳入老年股骨转子间骨折伴有肥胖的文献[12-13]，以及4篇纳入老年股骨转子间骨折的文献进行亚组分析[9，10，12，14]，异质性检验I2分别为0%和95%，前者使用固定效应模型得到[MD=-49.86，95%CI(-57.07，-42.65)，Z=13.58，P < 0.000 1]，后者使用随机效应模型得到[MD=-22.90，95%CI(-14.63，-4.57)，Z=3.74，P=0.000 2]，两者差异均有显著性意义，见图7。 2.2.6 术后6个月Harris功能评分 共4篇报道了术后6个月Harris功能评分[9-10，12，14]，研究存在异质性(I2=79%)，敏感性分析剔除其中1个无临床异质性的研究[14]，剩余研究间不存在异质性(I2=0%)，纳入固定效应模型提示结果差异无显著性意义[MD=0.55，95%CI(-0.77，1.86)，P > 0.05]，见图8。"
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