Endo-ULBD与MIS-TLIF治疗单节段腰椎管狭窄症的成本-效果分析  

Cost-effectiveness analysis of Endo-ULBD and MIS-TLIF in the treatment of single-segment lumbar spinal stenosis

作　　者：阚世虎 马力 王浩军 刘昌昊 王业伟 蓝中江 焦延亮 杜怡斌 KAN Shihu;MA Li;WANG Haojun;LIU Changhao;WANG Yewei;LAN Zhongjiang;JIAO Yanliang;DU Yibin(Department of Spine Surgery,the Third Affiliated Hospital of Anhui Medical University,Hefei 230092,Anhui,China)

机构地区：[1]安徽医科大学第三附属医院脊柱外科,安徽合肥230092

出　　处：《右江医学》2024年第10期876-882,共7页Chinese Youjiang Medical Journal

基　　金：合肥市卫健委2021年度应用医学研究项目(2021001)。

摘　　要：目的通过观察皮内窥镜单侧椎板切开双侧减压术(Endo-ULBD)与微创经椎间孔入路腰椎融合术(MIS-TLIF)治疗单节段腰椎管狭窄症的效果-成本分析,探讨不同术式所带来的社会效益差异。方法收集了2022年1月1日至2023年8月1日的86例单节段腰椎管狭窄症的患者行手术治疗,其中31例患者采用Endo-ULBD手术治疗,作为实验组;另外55例采用MIS-TLIF治疗,作为对照组。所有患者术后均随访3个月,统计术后改善情况和患者所有医疗费用,计算不同手术方式治疗单节段腰椎管狭窄症的成本-效果(C/E)值=医疗总费用/术后改善成功率。结果两组患者术后不同时期的视觉模拟疼痛评分(VAS)和Oswestry功能障碍指数(ODI)较术前均明显改善,但组间比较差异无统计学意义(P>0.05)。两组手术时间、术中出血量、术后住院时间,实验组明显优于对照组(P<0.05)。观察两组术后3个月患者门诊复查情况,实验组术后手术成功率为93.55%(29/31),对照组术后手术成功率为94.55%(52/55),实验组的人均医疗总费用为7657.90元,对照组人均医疗总费用为14703.05元;比较两组人均医疗总费用和术后手术成功率,实验组的C/E值为81.86,对照组C/E值为155.51。两组均未发生死亡、不可逆神经损伤,甚至瘫痪。结论Endo-ULBD手术的临床疗效与MIS-TLIF手术并无显著差异,而Endo-ULBD治疗腰椎管狭窄症具有创伤小、手术时间短、恢复快和费用低等优点,具有更好的社会效益,是治疗腰椎管狭窄症的有效替代方法。Objective To explore differences in social benefits brought by different surgical procedures by observing the cost-effectiveness analysis of endoscopic unilateral laminotomy for bilateral decompression(Endo-ULBD)and minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)in the treatment of single-segment lumbar spinal stenosis.Methods 86 patients with single-segment lumbar spinal stenosis who underwent surgical treatment from January 1,2022 to August 1,2023 were collected.Among them,31 patients treated with Endo-ULBD surgery were selected as experimental group.In addition,55 cases treated with MIS-TLIF were selected as control group.All patients were followed up for 3 months after surgery.Postoperative improvement and all the medical costs of the patients were counted to calculate the cost-effectiveness analysis(C/E)value=total medical costs/postoperative improvement success rate for the treatment of single-segment lumbar stenosis under different surgical procedures.Results The visual analog pain scale(VAS)and Oswestry dysfunction index(ODI)of the two groups at different postoperative stages showed significant improvement compared to those before treatment,but difference was not statistically significant between groups(P>0.05).The operation time,intraoperative blood loss and postoperative hospital stay time of the experimental group were significantly better than those of the control group(P<0.05).By observing the outpatient follow-up of the two groups at 3 months after surgery,it was found that the success rate of operation in the experimental group was 93.55%(29/31),while that in the control group was 94.55%(52/55).Total medical expenses per capita in the experimental group were 7657.90 yuan,and the total medical expenses per capita in the control group were 14703.05 yuan.By comparing the per capita total medical expenses and operation success rates between two groups,it was found that the C/E value of the experimental group was 81.86,while the C/E value of the control group was 155.51.No death,irre

关 键 词：经皮内窥镜单侧椎板切开双侧减压术 微创经椎间孔入路腰椎融合术 单节段 腰椎管狭窄症 成本-效果分析 

分 类 号：R681.5[医药卫生—骨科学]