老年股骨粗隆间骨折髓内固定术后髋关节功能恢复影响因素的Meta分析OA
Factors affecting recovery of hip function after intramedullary fixation of femoral intertrochanteric fractures in the elderly:A Meta-Analysis
目的 系统评价老年股骨粗隆间骨折髓内固定术后髋关节功能恢复障碍的影响因素.方法 系统检索The Co-chrane Library、EMbase、PubMed、Web of Science、中国知网、中国生物医学数据库、万方数据库、维普数据库中公开发表的关于老年股骨粗隆间骨折髓内固定术后髋关节功能恢复影响因素的研究,检索时限为2017年1月1日至2023年3月10日.由2名研究员根据纳入和排除标准独立进行文献筛选和数据提取,进行质量评价后使用Review Manager 5.4软件进行Meta分析.结果 最终纳入7篇文献.Meta分析结果显示,骨折类型(OR=4.81,95％CI 1.64～14.11,P=0.004＜0.01)、超早期负重(OR=29.95,95％CI 16.05～55.88,P＜0.00001)、年龄(OR=4.32,95％CI 1.48～12.54,P=0.007＜0.01)、骨密度(OR=7.36,95％CI 1.91～28.34,P=0.004＜0.01)、ASA 分级(OR=3.40,95％CI 2.15～5.38,P＜0.00001)、血浆蛋白(OR=6.80,95％CI 1.99～23.22,P=0.002＜0.01)、康复师指导(OR=4.59,95％CI 2.08～10.14,P=0.0002＜0.01)、复位质量(OR=12.24,95％CI 3.84～38.98,P＜0.00001)、术后并发症(OR=4.15,95％CI 1.79～9.63,P=0.0009＜0.00001)、合并基础疾病(OR=12.28,95％CI 8.91～16.92,P＜0.00001)、麻醉方式(全麻)(OR=5.19,95％CI 3.15～8.54,P＜0.00001)、麻醉方式(椎管内麻醉)(OR=14.69,95％CI 8.23～26.23,P＜0.00001)为髋关节功能恢复的影响因素.手术时机(OR=2.65,95％CI 0.16～43.16,P=0.49＞0.01)不是术后髋关节功能恢复的影响因素.结论 稳定型骨折、超早期负重、年龄＜70岁、骨密度＞-2.5SD、ASA分级低风险、血浆蛋白水平＞30g/L、有康复师指导、良好复位、术后并发症发生率低、合并基础疾病少、选择全麻或椎管内麻醉均为老年股骨粗隆间骨折髓内固定术后髋关节功能恢复的促进因素,尚无较多证据证明手术时机为髋关节功能恢复的影响因素.
Objective To systematically evaluate the factors influencing the impairment of hip function recovery after intramedul-lary fixation of femoral intertrochanteric fractures in the elderly.Methods the Cochrane Library,EMbase,PubMed,Web of Science,CNKI,China Biomedical Database,Wanfang Database,and VIP Database were systematically searched for publicly published studies on factors influencing the recovery of hip function after intramedullary fixation of femoral intertrochanteric fractures in the elderly,with a search time frame of January 1,2017 to March 10,2023.Two researchers independently performed literature screening,data extraction according to inclusion and exclusion criteria,and quality evaluation before conducting Meta-analysis using Review Manager 5.4 software.Meta-analysis results showed that fracture type(OR=4.81,95％CI 1.64～14.11,P=0.004＜0.01),ultra-early weight bearing(OR=29.95,95％CI 16.05～55.88,P＜0.00001),age(OR=4.32,95％CI 1.48～12.54,P=0.007＜0.01),bone mineral density(OR=7.36,95％CI 1.91～28.34,P=0.004＜0.01),ASA classification(OR=3.40,95％CI 2.15～5.38,P＜0.00001),plasma protein(OR=6.80,95％CI 1.99～23.22,P=0.002＜0.01),rehabilitation instructor instruction(OR=4.59,95％CI 2.08～10.14,P=0.0002＜0.01),reset quality(OR=12.24,95％CI 3.84～38.98,P＜0.00001),postoperative complications(OR=4.15 OR=4.15,95％CI 1.79～9.63,P=0.0009＜0.00001),combined underlying disease(OR=12.28,95％CI 8.91～16.92,P＜0.00001),mode of anesthesia(general anesthesia)(OR=5.19,95％CI 3.15～8.54,P＜0.00001),mode of anesthesia(intralesional anesthesia)(OR=14.69,95％CI 8.23～26.23,P＜0.00001)were influential factors for recov-ery of hip function.The timing of surgery(OR=2.65,95％CI 0.16～43.16,P=0.49＞0.01)was not an influencing factor for postoperative hip function recovery.Conclusion Stable fractures,ultra-early weight bearing,age＜70 years,BMD＞-2.5 SD,low risk of ASA classification,plasma protein level＞30 g/L,guidance by a rehabilitation officer,good repositioning,low incidence of postoperative complications,few comorbid underlying diseases,and choice of general anesthesia or intralesional anesthesia were all contributing factors for recovery of hip function after intramedullary fixation of intertrochanteric femoral fractures in the elderly,and there is no evidence that the timing of surgery is an influential factor in the recovery of hip function.
袁建坤;杨怡;李璇;王峻
云南中医药大学 650500大理大学 671003云南大学附属医院 650031
老年人股骨粗隆间骨折股骨转子间骨折髓内固定功能恢复影响因素二次分析
elderlyintertrochanteric fracturefemoral intertrochanteric fractureintramedullary nail fixationrecovery of func-tionrisk factorssecondary analysis
《中国老年保健医学》 2024 (002)
35-40 / 6
云南省教育厅科学研究基金项目(老年股骨粗隆骨折髓内固定术后超早期康复负重训练方案构建研究,编号:2023Y0494)
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