首页|老年桡骨远端不稳定骨折不同治疗方式的成本效益分析

老年桡骨远端不稳定骨折不同治疗方式的成本效益分析

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目的 比较老年桡骨远端不稳定骨折手术和保守治疗的临床疗效和总费用，为临床医师选择有效的治疗方式提供依据。方法 将 2019 年 12 月—2023 年 3 月于浙江中医药大学附属富阳中医骨伤医院就诊的 88 例老年不稳定型桡骨远端骨折患者纳入研究。按治疗方式不同分为手术组(n=44)和夹板组(n=44)。记录患者住院期间和治疗后 1 年门诊复查费用、腕关节功能评分量表(gartland-werlery，GW)、腕关节患者自行评估量表(patient-rated wrist evaluation，PRWE)、影像学检查、并发症，从卫生经济学角度进行成本-效果比(cost-effectiveness ratio，CER)和增量成本-效果比(incremental cost-effectiveness ratio，ICER)。结果 2 组腕关节功能恢复优良率及PRWE评分比较，差异无统计学意义(P＞0。05)。术后 1 年随访，2 组影像学参数均有改善;2 组影像学参数比较，差异有统计学意义(P＜0。05)。手术组并发症总发生率低于夹板组(P＜0。05)。手术组总体费用和住院费用分别为(23 080。71±2 180。37)、(23 728。35±2 246。57)元，均高于夹板组(5 333。80±1 843。87)、(6 614。61±1 763。00)元(P＜0。05)，但门诊费用则低于夹板组(P＜0。05)。手术组和夹板组CER分别为 1 383。51 元/分和 3 31。89 元/分;与夹板组比较，手术组PRWE评分每降低 1 分需多花费 5 648。10 元。结论＞60岁老年不稳定型桡骨远端骨折患者中，夹板固定与切开复位内固定术均具有良好的疗效，但前者可能是一种更为经济有效的治疗方案。
The Cost-Effectiveness Analysis of the Different Treatment Options for Unstable Distal Radial Fractures in Elderly Patients
Objective To compare the clinical efficacy and total cost of operation and conservative treatment for unstable distal radius fractures in elderly patients,and to provide evidence for clinicians to choose effective treatment.Methods A total of 88 elderly patients with unstable distal radius fractures who were admitted to Fuyang Orthopaedics and Traumatology Affiliated Hospital of Zhejiang Chinese Medical University from December 2019 to March 2023 were included in the study.According to the therapeutic methods,they were divided into operation group(n=44)and splint group(n=44).The cost of outpatient review during hospitalization and 1 year after treatment,gartland-werlery(GW),patient-rated wrist evaluation(PRWE),imaging examination,and complications were recorded.The cost-effectiveness ratio(CER)and incremental cost-effectiveness ratio(ICER)were studied from the perspective of health economics.Results There was no significant difference in the recovery rate of wrist joint function and PRWE score between two groups(P>0.05).After 1 year follow-up,the imaging parameters of both groups were improved.Comparison of imaging parameters between the two groups showed statistically significant difference(P<0.05).The total complication rate of operation group was lower than that of splint group(P<0.05).The total cost and hospitalization cost of operation group were(23 080.71±2 180.37)and(23 728.35±2 246.57)yuan,respectively,which were higher than that of splint group(5 333.80±1 843.87)and(6 614.61±1 763.00)yuan(P<0.05).However,the outpatient cost was lower than that of splint group(P<0.05).The cost-effectiveness ratio(CER)of operation group and splint group was 1 383.51 yuan/points and 3 31.89 yuan/points,respectively.Compared with the splint group,the surgery group cost 5 648.10 yuan more for every 1 point reduction in PRWE score.Conclusion In patients>60 years of age with unstable distal radius fractures,splinting and open reduction are both effective,but the former may be a more cost-effective treatment option.

olderunstable distal radial fracturesopen reduction and internal fixationclosed reduction and splint immobilizationcost-effectiveness ratioincremental cost-effectiveness ratio

陶其杰、柴君雷、孔令成、陈扬

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浙江中医药大学附属富阳中医骨伤医院关节科,浙江杭州 310043

老年 不稳定型桡骨远端骨折 切开复位内固定 闭合复位夹板固定 成本-效果比 增量成本-效果比

杭州市科技计划引导项目

20191231Y198

2024

10.3969/j.issn.1674-9316.2024.10.020

中国卫生标准管理
《中国卫生标准管理》杂志社

中国卫生标准管理

影响因子：1.374
ISSN：1674-9316
年,卷(期)：2024.15(10)
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