Neer分型二、三部分肱骨近端骨折不同治疗方式的临床经济学随访分析  

Different treatments for two-part and three-part proximal humeral fractures by Neer classification: follow-up results analyzed using clinical economics

作　　者：邱忠鹏[1] 李珂 李刚[1] 刘克宇[1] 杜新辉[1] 孟德峰[1] 史晨辉[1] 王维山[1] Qiu Zhongpeng;Li Ke;Li Gang;Liu Keyu;Du Xinhui;Meng Defeng;Shi Chenhui;Wang Weishan(Orthopedic Center, the First Affiliated Hospital of the Medical College, Shihezi University, Shihezi 832002, Xinjiang Uygur Autonomous Region, China)

机构地区：[1]石河子大学医学院第一附属医院骨科中心,新疆维吾尔自治区石河子市832002

出　　处：《中国组织工程研究》2019年第8期1188-1195,共8页Chinese Journal of Tissue Engineering Research

基　　金：国家自然科学基金资助课题(81660374);项目负责人:史晨辉;国家自然科学基金资助课题(81760404);项目负责人:王维山;兵团中青年科技创新领军人才队伍建设基金资助课题(2016BC001);项目负责人:王维山~~

摘　　要：背景:医保总额预付制对医院医疗费用控制的影响进一步加强,给患者提供适宜技术,提高医疗资源使用效率,减轻患者负担,控制医疗成本,同时保障医疗质量,已经成为医院管理很重要的决策考量因素,并且深刻影响临床医生的临床医疗决策及服务行为。目的:探讨二、三部分肱骨近端骨折不同治疗方式的临床疗效和总体成本,利用临床经济学方法对不同治疗方案进行对比研究。方法:将2011年1月至2016年12月于石河子大学医学院第一附属医院骨科接受治疗的130例二、三部分肱骨近端骨折患者纳入研究,按治疗方式分为4组,保守治疗组(n=40)、微创手术组(n=22)、锁定钢板组(n=32)和髓内钉内固定组(n=36)。保守治疗组患者给予悬吊皮肤牵引或骨折手法复位石膏固定,各手术干预组患者均接受不同内固定手术,使用标准费用法统计患者治疗后1年内因治疗产生的总体费用。治疗后使用Constant-Murley评分、目测类比评分、Neer评分对患者进行评估登记,使用临床经济学分析的方法对不同治疗组患者进行最小成本分析和成本效果分析。结果与结论:(1)成本效果分析结果显示,对于Neer二部分肱骨近端骨折,各手术干预组与保守治疗组疗效差异无显著性意义,但保守治疗组患者治疗支付成本更低。对于Neer三部分肱骨近端骨折,各手术干预组治疗效果优于保守治疗组,但手术干预组患者治疗支付成本高于保守治疗组;(2)根据增量成本效果比结果,对于Neer三部分肱骨近端骨折,微创手术组、锁定钢板组、髓内钉组患者肩关节功能Constant-Murley评分每提高1分需分别花费854.25,3 573.84,4 730.35元;(3)最小成本分析结果显示,对于Neer二部分肱骨近端骨折,4组患者疗效差异无显著性意义,但各手术干预组治疗成本较高,保守治疗组成本较低,保守治疗组具有与手术组相同的疗效和更好的经济学效果;(4)综上�BACKGROUND: The impact of the total medical insurance prepayment system on hospital medical expenses control is further strengthened. Providing appropriate technologies for patients, improving the efficiency of medical resources, reducing the burden on patients, controlling medical costs, and ensuring medical quality have become important decision-making factors for hospital management, which profoundly affect the clinical medical decision-making and service behavior. OBJECTIVE: To explore the clinical efficacy and total cost of different treatments for two-part and three-part proximal humeral fractures, and to evaluate the different treatment options using clinical economics. METHODS: One hundred and thirty patients with two-part and three-part proximal humeral fractures admitted at the First Affiliated Hospital of the Medical College, Shihezi University, from January 2011 to December 2016 were enrolled, and then divided into conservative group (n=40) and minimally invasive group (n=22), the locking compression plate group (n=32) and intramedullary nail group (n=36). Patients in the conservative group were treated with skin traction or manual reduction with cast immobilization. Patients in each surgical group received open reduction and internal fixation, separately. The total cost of treatment for 1 year after fracture was calculated using the standard cost method. The Constant-Murley score, Visual Analogue Scale, and Neer score were used to evaluate functional outcome after treatment. The minimum cost and cost-effectiveness of patients in different groups were analyzed by the clinical economic method. RESULTS AND CONCLUSION:(1) There was no significant difference in the clinical efficacy for two-part proximal humeral fractures among groups, but the cost for treatment in the conservative group was slowest. The clinical efficacy for two-part proximal humeral fractures in each surgical group was superior to the conservative group, but the cost was higher than that in the conservative group.(2) The cost-effect ana

关 键 词：肱骨骨折 内固定器 组织工程 肱骨近端骨折 保守治疗 内固定 临床经济学分析 器械耗材费 成本-效益分析 国家自然科学基金 

分 类 号：R459.9[医药卫生—治疗学]