闭合撬拨复位和切开复位内固定治疗SandersⅡ型跟骨骨折成本-效果分析的临床对照试验  

Controlled clinical trials of cost-effectiveness analysis on poking reduction and open reduction for the treatment of Sanders typeⅡcalcaneal fractures

作　　者：戚树斌[1] 孙鲁[2] 王明喜[2] 

机构地区：[1]山东中医药大学,山东济南250014 [2]山东省中医院

出　　处：《中国骨伤》2009年第12期886-889,共4页China Journal of Orthopaedics and Traumatology

基　　金：山东省中医管理局科学技术发展计划项目(编号:2007031)

摘　　要：目的:通过成本-效果分析评价闭合撬拨复位和切开复位钢板内固定两种术式治疗SandersⅡ型跟骨骨折的优劣性,为SandersⅡ型跟骨骨折的规范化治疗提供依据。方法:选取2006年10月至2008年10月在山东省中医院骨科住院患者中SandersⅡ型跟骨骨折80例,应用闭合撬拨复位和切开复位内固定两种方式治疗,撬拨组40例,其中男26例,女14例,平均年龄(36.60±3.15)岁;切复组40例,其中男30例,女10例,平均年龄(37.10±3.45)岁。术后1年复查时,测量B觟hler角、Gissane角、跟骨中部的宽度、步态周期中的站立相、HM-HL、足弓指数、距下关节灵活性,应用Maryland足部功能评分确定优良率,用成本-效果分析的方法进行比较。结果:撬拨组和切复组的B觟hler角分别为(30.32±1.72)°及(30.54±3.13)°;Gissane角分别为(133.73±6.73)°及(134.86±4.90)°;跟骨中部的宽度分别为(30.18±1.59)mm及(30.24±1.25)mm;步态周期中的站立相分别为(0.679±0.070)s及(0.715±0.090)s;HM-HL分别为-(36.49±7.56)N及-(34.32±6.50)N;足弓指数分别为(30.26±2.69)及(30.47±1.89);距下关节灵活性分别为(10.53±2.30)°及(10.89±1.86)°;Maryland足部功能评分分别为(81.78±17.11)分及(82.95±11.93)分。撬拨组的成本效果比为6.06,切复组的成本效果比为136.19。结论:对于SandersⅡ型跟骨骨折,闭合撬拨复位术无论在住院天数、住院费用还是在术后并发症等方面都优于切开复位钢板内固定术,为跟骨骨折的治疗提供了一种简便、有效、经济的方法。Objective：To evaluate cost effectiveness of poking reduction and open reduction for the treatment of Sanders typeⅡcalcaneal fractures,in order to provide evidence for standard treatment.Methods：From 2006.10 to 2008.10,80 patients with Sanders typeⅡcalcaneal fractures were selected from Shandong Provincial Hospital of Traditional Chinese Medicine and randomly divided into poking reduction group and open reduction group with 40 cases in each group.There were 26 males and 14 females in poking reduction group and 30 males and 10 females in open reduction group.The average age of patients in poking reduction group was（36.60±3.15） years,and（37.10±3.45） years in open reduction group.Bhler angle,Gissane angle,the width of central calcaneus,stance phase of gait,HM-HL,arch index and subtalair joint flexibility were measured.The clinical results and expenses of the two treatment schemes were compared and concluded with the method of cost-effeetiveness analysis.Results：In the poking reduction group and open reduction group,the Bhler angle were （30.32±1.72） degree and （30.54±3.13） degree,Gissane angle were （133.73±6.73） degree and （134.86±4.90） degree,the width of central calcaneus were（30.18±1.59） mm and（30.24±1.25） mm,stance phase of gait were（0.679±0.070） s and（0.715±0.090） s,HM-HL were （36.49±7.56） N and-（34.32±6.50） N,arch index were （30.26±2.69） and （30.47±1.89）,and subtalair joint flexibility were （10.53±2.30） degree and（10.89±1.86） degree respectively.The cost effectiveness ratio（C /E）were 6.06 and 136.19 respectively.Conclusion：Cost effectiveness ratio of the poking reduction is superior to that of the open reduction in treating Sanders typeⅡcalcaneal fractures.Poking reduction is a useful method to treat Sanders type Ⅱcalcaneal fractures with rapid wound healing and less cost.

关 键 词：跟骨 骨折 骨折固定术 内 成本及成本分析 临床对照试验 

分 类 号：R683.42[医药卫生—骨科学] R684.7[医药卫生—外科学]