成人股骨干骨折两种治疗方式的卫生经济学评价

目的 从卫生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,为股骨干骨折的治疗提供一定的理论依据。方法 用回顾、配对(1∶1)、对照的方法筛选2014年1月至2015年3月就诊于保定市第二医院骨科的成人新鲜闭合股骨干骨折(AO分型:A型-B型)患者70例,依据手术方式的不同,将行经皮微创钢板内固定术治疗者设为MIPPO组,行交锁髓内钉内固定术治疗者设为髓内钉组。用Excel表格记录入组患者的卫生学指标(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、临床疗效及并发症)和经济学指标(术后住院花费、术后6个月和12个月返岗工作率),用SPSS 20.0对比组间资料的差异性。结果(1)病例完成情况:入组患者获得12~25个月随访,MIPPO组剔除4例,髓内钉组剔除3例。(2)卫生学指标对比情况:两组临床疗效优良率(93.55% vs 90.63%)、并发症发生率、切口总长度、术后住院时间均相当(P>0.05);与髓内钉组相比,MIPPO组手术时间短、术中出血少量、骨折愈合快(P<0.05)。(3)经济学指标对比情况:MIPPO组术后6个月返岗工作率高于髓内钉组(61.29% vs 40.63%,P<0.05);两组术后住院花费、术后12个月返岗工作率接近(P>0.05)。结论 经皮微创钢板与交锁髓内钉内固定术均能有效治疗(A-B)型新鲜闭合成人股骨干骨折,且经皮微创钢板有出血少、手术时间短、骨折愈合快、早期返岗工作率高等优势。

Health economic evaluation of two treatment modalities for femoral shaft fractures in adults

Objective To compare the advantages of minimally invasive percutaneous internal fixation of plate versus interlocking intramedullary nail for femoral shaft fractures in adults from the point of health economics，providing a rationale for treating femoral shaft fractures.Methods Seventy adult patients with freshly closed femoral shaft fractures（AO classification：A to B type） who were admitted to No.2 Hospital of Baoding between January 2014 and March 2015 were selected in a retrospective，matching(1:1) and controlled manner.Based on different surgical procedures，patients who received minimally invasive percutaneous plate fixation and interlocking intramedullary nail internal fixation were assigned to the MIPPO group and the intramedullary nail group respectively.Those patients enrolled were recorded in Excel regarding health (total incision length，operation time，intraoperative blood loss，postoperative hospital stay，union time and complications) and economic parameters (postoperative hospitalization expenses and rates of returning to work at 6 and 12 months postoperatively).Differences in intergroup data were compared with SPSS 20.0. Results (Ⅰ) Completion of cases:The patients enrolled were followed up for (12-25) months;four patients were excluded from the MIPPO group and three the intramedullary nail group，respectively.(Ⅱ) Comparison of health parameters:Both groups showed comparative clinical response rate (93.55% vs 90.63%)，incidence of complications，total incision length，and postoperative hospital stays (all P＞0.05).the MIPPO group showed shorter operation time，lower intraoperative blood loss and faster union than the intramedullary nail group (P＜0.05).(Ⅲ) Comparison of economic parameters:The MIPPO group had a higher rate of returning to work at 6 months than the intramedullary nail group (61.29% vs 40.63%，P＜0.05).Both groups showed comparative postoperative hospitalization expenses and rate of returning to work at 12 months (P＞0.05). Conclusion Both minimally invasive percutaneous internal fixations of plate and interlocking intramedullary nail can effectively treat adult patients with freshly closed femoral shaft fractures（A to B type）,minimally invasive percutaneous plate fixation is characterized by less bleeding，short operation time，fast union and a high rate of early returning to work.