空心钉内固定和关节置换术治疗移位型股骨颈骨折的成本效用分析  

Internal fixation and hemiarthroplasty for the treatment of displaced femoral neck fracture： a cost-utility analysis

作　　者：徐斌 王群 金华 李敬祥 刘昊楠[2] 毛玉江[2] 危杰[2] 

机构地区：[1]枣庄矿业集团公司中心医院创伤骨科,山东省枣庄市277800 [2]北京积水潭医院创伤骨科

出　　处：《中华医学杂志》2017年第21期1650-1654,共5页National Medical Journal of China

摘　　要：目的 对空心钉内固定和人工股骨头置换术治疗移位型股骨颈骨折的疗效进行对比分析。方法 将2014年1月至2015年8月期间于枣庄矿业集团公司中心医院创伤骨科接受手术治疗的87例老年移位型股骨颈骨折患者纳入研究，按手术方式分为两组，其中空心钉内固定组（IF）患者41例，人工股骨头置换组（HA）患者46例。通过我院医疗记录及电话随访的方式收集患者伤后1年内与骨折相关的总体费用。末次随访时采用欧洲五维健康量表（EQ－5D）评估患者的生活质量并计算相应的质量调整生命年（QALY），而后采用成本效用分析的原理比较两种术式的成本效用比。结果 两组患者均顺利完成手术。1年内IF组和HA组患者的总体费用分别为45 796元和56 657元（P〈0.05），QALY分别为0.79和0.83（P〉0.05），成本效用比分别57 970元/QALY和68 261元/QALY（P〈0.05），即与HA相比IF组患者每增加1QALY可节省10 292元。结论 空心钉内固定和人工股骨头置换术治疗老年移位型股骨颈骨折短期内疗效相当，但空心钉内固定的成本较低，更有助于节省医疗资源。Objective To compare the cannulated screw internal fixation （IF） and hemiarthroplasty （HA） for displaced femoral neck fracture with cost-utility analysis （CUA）. Methods From January 2014 to August 2015, a total of 87 patients above 60 years old with displaced femoral neck fracture were admitted into the study and divided into 2 groups according to surgery type. There were 41 cases in IF group and 46 cases in HA group. During 1 year follow-up we collected the total cost due to fracture and applied EQ-SD index to evaluate the clinical effects. The value of EQ-SD index will be transformed to quality adjusted life year （QALY）. Eventually the data including cost and QALY were used to calculate the cost utility ratio （CUR） for patients in each group. Results All the patients completed the operation successfully. The total cost of IF and HA was 45 796 yuan and 56 657 yuan （ P 〈 0. 05 ） , while the QALY was 0. 79 and 0. 83 respectively （P 〉0. 05）. The CUR showed that patients in IF and HA group spent 57 970 yuan and 68 261 yuan for each QALY which means patients in HA group spent more 10 292 yuan for each QALY than that in IF group. Conclusions Both IF and HA can provide satisfactory clinical outcome in 1 year follow-up, however the total cost of IF was obviously less than HA. Therefore IF may be more cost-effective for the treatment of displaced femoral neck fracture in terms of health economics.

关 键 词：骨折固定术 内 关节成形术 置换 髋 股骨颈骨折 成本效用分析 

分 类 号：R687.3[医药卫生—骨科学]