骨质疏松性脊柱压缩骨折PVP微创手术与药物治疗的卫生经济学评价

发布时间：2018-05-08 10:45

本文选题：骨质疏松性脊柱压缩骨折 + 经皮椎体成形术　；参考：《新疆医科大学》2015年硕士论文

【摘要】：目的:通过对骨质疏松性脊柱压缩骨折患者不同治疗方案进行成本-效果评价,为临床医师制定符合最佳成本—效价的骨质疏松性脊柱压缩骨折的医疗卫生决策提供理论依据并指导实施。方法:收集并回顾性分析225例骨质疏松性脊柱压缩骨折患者的三种不同治疗方案,其中74例患者行单纯PVP微创手术治疗,82例患者行PVP微创手术并结合唑来膦酸注射液治疗,69例患者行常规药物保守治疗。比较三组患者以下临床疗效指标及经济学指标,包括治疗前后不同时期的压缩椎体高度丢失率、骨密度值、疼痛视觉模拟评分(visual analogue scale,VAS)、镇痛药物使用评分及脊柱活动能力评分,以及住院天数、住院总费用、住院期间康复费用、出院后康复期费用;将三组患者住院天数、住院总费用及康复期费用与治疗前后脊椎功能活动评分差值及脊椎压缩骨折的X线影像分级之间进行相关性分析。结果:PVP微创组患者住院天数最短,药物保守组住院天数最长(F=329.608,P0.05);治疗后3个月及12个月,三组患者的骨密度值、VAS评分及压缩椎体高度丢失率之间两两比较均具有统计学差异(P0.05),其中保守组的骨密度值最低,VAS评分及椎体高度丢失率最高;治疗后3个月,三组患者镇痛药物使用评分均减低(F=146.580、186.324、135.110,P0.05),其中PVP微创+药物组的评分最低;三组患者脊柱活动能力均有所改善(F=282.872、173.446、313.856,P0.05),其中PVP微创+药物组的脊柱活动能力要优于其余两组。经济学指标分析显示:保守组的住院费用最低,住院期间康复费及出院后康复期费用较高(F=630.869、796.695、123.306,P=0.000)。保守组的住院天数、住院总费用及康复期费用分别与治疗前后脊柱活动能力评分差值及X线影像分级之间具有正相关性,其余两组仅住院总费用与X线影像分级呈正相关性(P0.05)。结论:经成本-效果分析,PVP微创并结合唑来膦酸药物治疗骨质疏松性脊柱压缩骨折是疗效最好的方法,但是经济成本最高,适用于脊柱压缩骨折程度较重和经济条件较好的患者;单纯PVP微创手术治疗的成本-效价较好,适用于任何程度的脊柱压缩骨折,可在临床中推广应用;药物保守治疗虽然成本低,但是疗效一般,仅适合于压缩程度较轻的患者,或者无法耐受微创手术和经济条件一般的患者。
[Abstract]:Objective: to evaluate the cost-effectiveness of different treatments in patients with osteoporotic spinal compression fracture. To provide a theoretical basis for clinicians to make the best cost-titer of osteoporotic spinal compression fracture medical and health decisions and guide the implementation. Methods: two hundred and twenty-five patients with osteoporotic spinal compression fracture were collected and analyzed retrospectively. Among them, 74 patients were treated with PVP minimally invasive surgery and 82 patients were treated with PVP minimally invasive operation and 69 patients with zoledronic acid injection were treated with routine drug conservative therapy. The following clinical and economic indexes were compared among the three groups, including the loss rate of compressed vertebral body height, bone mineral density, visual analogue scale, analgesic drug use score and spinal activity score before and after treatment. And the days of hospitalization, the total cost of hospitalization, the cost of rehabilitation during hospitalization, the cost of recovery after discharge; the days of hospitalization of the three groups of patients, The correlation analysis was made between the total cost of hospitalization and the cost of convalescence and the difference in the score of spinal functional activity before and after treatment and the X-ray image classification of vertebral compression fracture. Results the minimal invasive group had the shortest hospitalization days, while the drug conservative group had the longest stay in hospital, 3 months and 12 months after the treatment, and the patients in the drug conservative group had the longest hospitalization days of 329.608, 3 and 12 months after treatment. The BMD and VAS scores of the three groups were significantly different from those of the compression vertebral height loss rate (P 0.05), and the conservative group had the lowest VAS score and the highest vertebral height loss rate, 3 months after treatment. The scores of analgesic drug use in the three groups were all decreased, among which the PVP minimally invasive drug group had the lowest score, and the spinal mobility of the three groups was improved by 282.872173.446A313.856U P0.05, among which the PVP minimally invasive drug group was superior to the other two groups. The economic index analysis showed that the cost of hospitalization in conservative group was the lowest, the cost of rehabilitation during hospitalization and the cost of recovery period after discharge were higher than that of FY630.869796.695A123.306m. There was a positive correlation between the days of hospitalization, the total cost of hospitalization and the cost of convalescence before and after treatment, respectively, and the difference between the score of spinal mobility and X-ray image grading before and after treatment. The other two groups only had a positive correlation with the total cost of hospitalization and the grade of X-ray image. Conclusion: minimally invasive PVP combined with zoledronic acid is the best method for the treatment of osteoporotic spinal compression fracture, but the economic cost is the highest. It is suitable for the patients with severe spinal compression fracture and better economic condition, the cost and titer of PVP minimally invasive surgery is better, it is suitable for any degree of spinal compression fracture, and can be popularized and applied in clinic. Conservative drug therapy, although low in cost, is generally effective and is only suitable for patients with less compression, or can not tolerate minimally invasive surgery and economic conditions.
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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