内固定与人工股骨头置换治疗老年移位型股骨颈骨折的费用和疗效  

The comparison of cost and effectiveness between internal fixation and hemiarthroplasty in the treatment of displaced femoral neck fracture for the elderly

作　　者：李基新 姜云虎 杨建磊[1] 魏增伯 吴宏华[2] 

机构地区：[1]天津市北辰医院骨科,300400 [2]北京积水潭医院创伤骨科,100035

出　　处：《实用医学杂志》2017年第13期2164-2168,共5页The Journal of Practical Medicine

摘　　要：目的比较空心钉内固定(IF)和人工股骨头置换术(HA)治疗老年移位型股骨颈骨折的总体费用和疗效。方法收集2013年10月至2015年5月期间接受治疗的60岁以上移位型股骨颈骨折患者85例,按手术方式将患者分IF组和HA组,其中IF组患者40例,HA组45例。根据我院病案科资料、电话随访及标准费用法收集患者1年内因骨折产生的总体费用,末次随访时采用Harris评分和EQ-5D指数评估患者髋部功能和生活质量。结果所有患者均顺利完成手术。费用结果显示IF组患者首次治疗费用低、出院后费用高,1年内两组患者总体费用分别为44 556.1元和72 198.0元,HA组的费用约为IF组的1.6倍。末次随访时IF组和HA组患者Harris评分分别为(71.1±12.1)和(74.3±10.3),EQ-5D指数分别为(0.74±0.15)和(0.76±0.13),两组比较差异均无统计学意义(P>0.05)。结论空心钉内固定和人工股骨头置换术均是治疗老年移位型股骨颈骨折的有效方案,内固定的总体费用明显偏低,更有助于减少患者的医疗负担。Objective To analyze the total cost and clinical effectiveness of internal fixation and hemiar- throplasty in the treatment of femoral neck fracture for the elderly. Methods From October 2013 to May 2015, 85 patients above 60-year old who were diagnosed as displaced femoral neck fracture and received operation in our hospital. All the patients were divided into internal fixation （IF） group and hemiarthroplasty （HA） group respectively. There were 40 cases in the IF group and 45 cases in the HA group. The total cost associated with fracture in a year was collected by medical record, telephone interview and standard methods. At the last follow-up, we applied Harris scores to evaluate the clinical outcome for each group. Results All the patients completed the operation successfully. During 1 year follow-up the total cost in the IF group was less than that in the HA group including higher primary hospitalization cost and less post-discharge cost. The total cost was 44,556.1 Yuan in the IF group and 72,198.0 Yuan in the HA group respectively. The data showed that the total cost of HA was 1.6 times higher than that of IF. At the last follow-up the mean Harris scores was 71.1±12.1 in the IF group and 74.3±10.3 in the HA group while the EQ-5D index was 0.74±0.15 and 0.76±0.13 respectively which showed no significant difference （P 〉 0.05）. Conclusions Both internal fixation and hemiarthroplasty have effective treatment for elderly patients with femoral neck fracture. Compared to hemiarthroplasty IF can provide similar clinical effectiveness with less total cost. Therefore IF may contribute to decrease the economic burden for elderly patients in China.

关 键 词：股骨颈骨折 内固定 关节置换 

分 类 号：R687.3[医药卫生—骨科学]