一例老年股骨粗隆間骨折患者的循證治療_《中國循證醫學雜志》

作者：

鄧洲銘 ,  蔡林

武漢大學中南醫院骨外科（武漢?430071）;

關鍵詞：

老年患者股骨粗隆間骨折循證治療

DOI：

10.7507/1672-2531.20100533

視頻：

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目的 ?為1例股骨粗隆間骨折的老年患者確定循證治療方案。
方法 ?根據患者的具體情況，提出所要解決的臨床問題，全面檢索美國國家指南交換中心NGC（2000～2009）、Cochrane圖書館（2009年第4期）、TRIP Database、PubMed（1966～2009）及中國生物醫學文獻數據庫（1978～2009），以獲得相關的證據。依據循證醫學三結合原則（最佳研究證據、醫師的臨床經驗和病人的意愿相結合）制定治療方案。
結果 ?共納入3篇臨床指南、14篇系統評價/Meta分析和2篇RCT。當前證據表明：對于老年患者的不穩定型股骨粗隆間骨折應首選手術治療；不同的手術內固定方式相比較，滑動髖螺釘（SHS）的療效最佳，尚無足夠證據支持手術后傷口常規放置閉合引流；早期手術能夠縮短住院時間，降低死亡率；術前預防應用抗生素能減少術后感染的發生率；為預防深靜脈血栓形成，藥物預防應自入院起就開始應用，術后應輔助物理預防；住院期間高營養飲食有助于促進患者康復；術后應盡早進行康復訓練。參照指南及相關證據，并根據患者的具體情況，制定合理的治療方案。經過3個月隨訪，證實該方案適合本患者。
結論 ?應用循證醫學的方法，采用高質量的證據為患者制定個性化治療方案，能顯著提高治療效果，改善患者的預后。

引用本文： 鄧洲銘,蔡林. 一例老年股骨粗隆間骨折患者的循證治療. 中國循證醫學雜志, 2010, 10(8): 1004-1008. doi: 10.7507/1672-2531.20100533 復制

1.	Guyatt GH, Rennie D, Editors. The Evidence-Based Medicine Working Group.Users’Guides to the Medical literature:A Mannual for Evidence-Based Clinical Practice. Chicago. AMA Press 2002.
2.	楊學寧, 吳一龍. 臨床證據水平分級和推薦級別. 循證醫學, 2003, 3(2): 111-113.
3.	米登海, 姜雷, 楊克虎, 等. 一例廣泛期小細胞肺癌的循證治療. 中國循證醫學雜志, 2009, 9(4): 4884-4488.
4.	Scottish intercollegiate guideline network management of hip fracture in older people. scottish intercollegiate guideline network 2009 (cited 2009 dec 29 ). Available from :URL : http://www.sign. ac.uk/pdf/sign111.pdf.
5.	Handoll HH, Parker MJ. Conservative versus operative treatment for hip fractures in adults. Cochrane Database Syst Rev, 2008(3): CD000337.
6.	Parker MJ, Handoll HH. Gamma and other cephalocondylic intramedullary nails versus extramedullary implants for extracapsular hip fractures in adults. Cochrane Database Syst Rev, 2008, (3): CD000093.
7.	Ding XF, Pei GX, Lin J, et al. [Postoperative implant-related complications after treatment of intertrochanteric fracture by gamma nail or by sliding hip screw: a meta-analysis]. Zhonghua Yi Xue Za Zhi, 2008, 88(33): 2364-2368.
8.	劉嵬, 雪原, 趙宏, 等. 我國高齡不穩定型轉子問骨折經人工關節置換術與內固定術治療的Meta分析. 天津醫科大學學報, 2009, 15(1): 70-73.
9.	Parker MJ, Handoll HH. Replacement arthroplasty versus internal fixation for extracapsular hip fractures in adults. Cochrane Database Syst Rev, 2006, (2): CD000086.
10.	Parker MJ, Handoll HH. Extramedullary fixation implants for extracapsular hip fractures. Cochrane Database Syst Rev, 2002, (2): CD000339.
11.	Chinoy MA, Parker MJ. Fixed nail plates versus sliding hip systems for the treatment of trochanteric femoral fractures: a meta analysis of 14 studies. Injury, 1999, 30(3): 157-163.
12.	Parker MJ, Clifton R, McKee A. Closed suction surgical wound drainage after orthopaedic surgery. Cochrane Database Syst Rev, 2007, (3): CD001825.
13.	Clifton R, Haleem S, McKee A, et al. Closed suction surgical wound drainage after hip fracture surgery: a systematic review and meta-analysis of randomised controlled trials. Int Orthop, 2008, 32(6): 723-727.
14.	Shiga T, Wajima Z, Ohe Y. Is operative delay associated with increased mortality of hip fracture patients? Systematic review, meta-analysis, and meta-regression. Can J Anaesth, 2008, 55(3): 146-154.
15.	Al-Ani AN, Samuelsson B, Tidermark J, et al. Early operation on patients with a hip fracture improved the ability to return to independent living. A prospective study of 850 patients. J Bone Joint Surg Am, 2008, 90(7): 1436-1442.
16.	Southwell-Keely JP, Russo RR, March L, et al. Antibiotic prophylaxis in hip fracture surgery: a meta analysis. Clin Orthop Relat Res, 2004, (419): 179-184.
17.	Gillespie WJ, Walenkamp G. Antibiotic prophylaxis for surgery for proximal femoral and other closed long bone fractures. Cochrane Database Syst Rev, 2001, (1): CD000244. .
18.	中華醫學會. 中國骨科大手術靜脈血栓栓塞癥預防指南. 中華骨科雜志, 2009, 29(6): 602-604.
19.	Snow V, Qaseem A, Barry P, et al. Management of venous thromboembolism: a clinical practice guideline from the American College of Physicians and the American Academy of Family Physicians. Ann Intern Med, 2007, 146(3): 204-210.
20.	Segal JB SM, Hofmann LV, Thornton K, et al. Management of venous thromboembolism: a systematic review for a practice guideline. Ann Intern Med, 2007, 146(3): 211-222.
21.	Avenell A, Handoll HH. Nutritional supplementation for hip fracture aftercare in older people. Cochrane Database Syst Rev, 2006, (4): CD001880.
22.	Oldmeadow LB, Edwards ER, Kimmel LA, et al. No rest for the wounded: early ambulation after hip surgery accelerates recovery. ANZ J Surg, 2006, 76(7): 607-611.

1. Guyatt GH, Rennie D, Editors. The Evidence-Based Medicine Working Group.Users’Guides to the Medical literature:A Mannual for Evidence-Based Clinical Practice. Chicago. AMA Press 2002.
2. 楊學寧, 吳一龍. 臨床證據水平分級和推薦級別. 循證醫學, 2003, 3(2): 111-113.
3. 米登海, 姜雷, 楊克虎, 等. 一例廣泛期小細胞肺癌的循證治療. 中國循證醫學雜志, 2009, 9(4): 4884-4488.
4. Scottish intercollegiate guideline network management of hip fracture in older people. scottish intercollegiate guideline network 2009 (cited 2009 dec 29 ). Available from :URL : http://www.sign. ac.uk/pdf/sign111.pdf.
5. Handoll HH, Parker MJ. Conservative versus operative treatment for hip fractures in adults. Cochrane Database Syst Rev, 2008(3): CD000337.
6. Parker MJ, Handoll HH. Gamma and other cephalocondylic intramedullary nails versus extramedullary implants for extracapsular hip fractures in adults. Cochrane Database Syst Rev, 2008, (3): CD000093.
7. Ding XF, Pei GX, Lin J, et al. [Postoperative implant-related complications after treatment of intertrochanteric fracture by gamma nail or by sliding hip screw: a meta-analysis]. Zhonghua Yi Xue Za Zhi, 2008, 88(33): 2364-2368.
8. 劉嵬, 雪原, 趙宏, 等. 我國高齡不穩定型轉子問骨折經人工關節置換術與內固定術治療的Meta分析. 天津醫科大學學報, 2009, 15(1): 70-73.
9. Parker MJ, Handoll HH. Replacement arthroplasty versus internal fixation for extracapsular hip fractures in adults. Cochrane Database Syst Rev, 2006, (2): CD000086.
10. Parker MJ, Handoll HH. Extramedullary fixation implants for extracapsular hip fractures. Cochrane Database Syst Rev, 2002, (2): CD000339.
11. Chinoy MA, Parker MJ. Fixed nail plates versus sliding hip systems for the treatment of trochanteric femoral fractures: a meta analysis of 14 studies. Injury, 1999, 30(3): 157-163.
12. Parker MJ, Clifton R, McKee A. Closed suction surgical wound drainage after orthopaedic surgery. Cochrane Database Syst Rev, 2007, (3): CD001825.
13. Clifton R, Haleem S, McKee A, et al. Closed suction surgical wound drainage after hip fracture surgery: a systematic review and meta-analysis of randomised controlled trials. Int Orthop, 2008, 32(6): 723-727.
14. Shiga T, Wajima Z, Ohe Y. Is operative delay associated with increased mortality of hip fracture patients? Systematic review, meta-analysis, and meta-regression. Can J Anaesth, 2008, 55(3): 146-154.
15. Al-Ani AN, Samuelsson B, Tidermark J, et al. Early operation on patients with a hip fracture improved the ability to return to independent living. A prospective study of 850 patients. J Bone Joint Surg Am, 2008, 90(7): 1436-1442.
16. Southwell-Keely JP, Russo RR, March L, et al. Antibiotic prophylaxis in hip fracture surgery: a meta analysis. Clin Orthop Relat Res, 2004, (419): 179-184.
17. Gillespie WJ, Walenkamp G. Antibiotic prophylaxis for surgery for proximal femoral and other closed long bone fractures. Cochrane Database Syst Rev, 2001, (1): CD000244. .
18. 中華醫學會. 中國骨科大手術靜脈血栓栓塞癥預防指南. 中華骨科雜志, 2009, 29(6): 602-604.
19. Snow V, Qaseem A, Barry P, et al. Management of venous thromboembolism: a clinical practice guideline from the American College of Physicians and the American Academy of Family Physicians. Ann Intern Med, 2007, 146(3): 204-210.
20. Segal JB SM, Hofmann LV, Thornton K, et al. Management of venous thromboembolism: a systematic review for a practice guideline. Ann Intern Med, 2007, 146(3): 211-222.
21. Avenell A, Handoll HH. Nutritional supplementation for hip fracture aftercare in older people. Cochrane Database Syst Rev, 2006, (4): CD001880.
22. Oldmeadow LB, Edwards ER, Kimmel LA, et al. No rest for the wounded: early ambulation after hip surgery accelerates recovery. ANZ J Surg, 2006, 76(7): 607-611.

《中國循證醫學雜志》

一例老年股骨粗隆間骨折患者的循證治療

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一例老年股骨粗隆間骨折患者的循證治療

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