成人股骨干骨折两种治疗方式的卫生经济学评价

发布时间：2018-02-12 05:23

  本文关键词： 股骨干骨折 经皮微创钢板 交锁髓内钉 术中出血量 骨折愈合 最小成本 成本-效果比　出处：《承德医学院》2017年硕士论文　论文类型：学位论文

【摘要】：目的:从临床和经济学的角度对比经皮微创钢板与交锁髓内钉内固定术在成人股骨干骨折治疗中的优劣,为成人股骨干骨折的治疗提供理论依据。方法:遵循回顾、配对、对照的设计方案,选取2014年1月至2015年3月就诊于保定市第二医院的新鲜成人闭合股骨干骨折患者,将行经皮微创钢板内固定术(Minimally invasive percutaneous plate osteosynthesis,MIPPO)治疗者设为MIPPO组,行交锁髓内钉内固定术治疗者设为髓内钉组,按照性别、骨折AO分型、工作性质相同,年龄(±3岁)、身体质量指数(±2Kg/m2)、随访时间(12个月)相近6个条件进行1∶1配对,共配成35对。经Excel采用双人双机平行录入、专人核对的方式记录入组患者的基线资料(年龄、身体质量指数、随访时间、受伤至手术时间、性别、股骨干骨折AO分型和侧别、工作性质、致伤原因、基础病、骨折的性质)、临床指标(切口总长度、手术时间、术中出血量、术后住院时间、骨折愈合时间,术前和术后第1、7天及出院前1天血清超敏C反应蛋白,术前和术后第1、2、3、7天及出院前1天晨起体温,术后第1、2、3、4、5、6、7天及出院前1天止痛药使用率,临床疗效及并发症)、经济学指标(医疗成本、最小成本、成本-效果比及其敏感度)等,用SPSS20.0分析组间及组内资料的差异性,P0.05认为比较存在统计学差异。结果:(1)两组基线资料均衡性良好(P0.05),有可比性。截止到随访日,共剔除6例患者(MIPPO组3例,髓内钉组3例),91.43%的患者完成研究,随访时间(12-25)个月,中位随访时间14.6个月。(2)临床疗效:MIPPO组中,23例优,7例良,2例差,优良率93.75%;髓内钉组中,21例优,8例良,3例差,优良率90.625%。两组临床疗效相当(P0.05)。(3)MIPPO组手术时间、术中出血量、骨折愈合时间少于髓内钉组(P0.05);两组切口总长度、术后住院时间相当(P0.05)。(4)血清超敏C反应蛋白:两组间无统计学差异(P0.05),两组术后第1天较本组术前明显升高,至术后第7天恢复稳定。(5)晨起体温:组间及组内对比未体现出统计学差异(P0.05)。(6)止痛药使用率:MIPPO组术后第1、2、3天为81.25%、78.125%、71.875%,低于髓内钉组的93.75%、90.625%、84.375%(P0.05);MIPPO组术后第4、5、6、7天及出院前1天为62.50%、50.00%、15.625%、3.125%、3.125%,与髓内钉组71.875%、56.25%、21.875%、6.25%、3.125%的差异无统计学意义(P0.05)。(7)并发症:MIPPO组中,1例浅层感染,1例单枚螺钉松动,1例下肢深静脉血栓,发生率为9.375%;髓内钉组中,1例浅层感染,1例下肢深静脉血栓,1例延迟愈合,1例轻度创伤性关节炎,发生率为12.50%。两组并发症发生率相近(P0.05)。(8)经济学指标:两组医疗成本构成比分布接近(P0.05),两组材料费、药品费、检查费、治疗费、其它费用等直接医疗成本接近(P0.05),MIPPO组间接医疗成本低于髓内钉组(P0.05);MIPPO组最小成本、成本-效果比分别为(37.37±7.28)千元、422.89,低于髓内钉组的(44.51±6.69)千元、533.35(P0.05);误工费和材料费上、下浮动10%后敏感度分析显示,MIPPO组的最小成本分和成本-效果比均优于髓内钉组。结论:经皮微创钢板与交锁髓内钉内固定术均能有效治疗新鲜闭合成人股骨干骨折,且经皮微创钢板有出血少、术后疼痛轻、骨折愈合快、最小成本和成本-效果比低等优势。
[Abstract]:Objective: from the angle of economics and clinical comparison of minimally invasive percutaneous plate and interlocking intramedullary nail fixation in the treatment of adult femoral fractures, and provide theoretical basis for treatment of femoral shaft fractures. Methods: following the review, pairing, design control, were selected from January 2014 to March 2015 in Baoding city the hospital closed second fresh adult femoral shaft fracture underwent minimally invasive percutaneous plate fixation (Minimally invasive percutaneous plate osteosynthesis, MIPPO) treatment were divided into group MIPPO treated with interlocking intramedullary nail fixation treatment as the intramedullary nail group, according to gender, AO type of fracture, the nature of the work the same (+ 3 years), age, body mass index (2Kg/m2), follow-up period (12 months). 1: 1 matched 6 conditions, with a total of 35 by Excel. Using a double double machine parallel input, by way of recording in check Baseline data of patients (age, body mass index, follow-up time, time from injury to surgery, gender, femoral shaft fracture AO type and side, the nature of the work, the cause of injury, basic disease, fracture properties), clinical indicators (total length of incision, operation time, bleeding volume, operation time after operation, fracture healing time, 1,2,3,7 days 1,7 days before and after surgery and 1 days before the serum high-sensitivity C reactive protein, preoperative and postoperative discharge before and after the 1 day morning temperature, 1,2,3,4,5,6,7 days after operation and discharged 1 days before the analgesic use rate, clinical efficacy and complications) Economics, index (medical costs, minimum cost, cost effectiveness ratio and sensitivity), with SPSS20.0 analysis of differences between group and group data, P0.05 believes that there is significant difference. Results: (1) the balance of baseline data of the two groups (P0.05), has good comparability. Until the follow-up a total of 6 cases were excluded. 鎮ｈ，

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