| 髓内钉及钢板治疗开放性胫骨骨折患者临床特点及成本效果分析 |
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投稿时间：2021-03-24
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| 期刊信息：《中国骨伤》2022年，第35卷，第6期，第512-520页 |
| DOI：10.12200/j.issn.1003-0034.2022.06.003 |
| 基金项目: |
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中文摘要:
目的:探讨胫骨开放性骨折患者手术治疗的临床特点并对最终不同内固定方式之间的成本效果进行分析。
方法:回顾性分析2018年1月至2019年6月接受手术治疗的55例开放性胫骨骨折患者的临床资料,根据内固定方式不同分为髓内钉(intramedullary nailing,IMN)固定组(IMN组)和锁定加压钢板(locking compression plate,LCP)固定组(LCP组)。其中IMN组35例,男27例,女8例;年龄25~69(49.0±10.6)岁;骨折Gustilo-Anderson分型,Ⅰ型1例,Ⅱ型19例,Ⅲ型15例;内固定方式为髓内钉固定。钢板螺钉组20例,男15例,女5例;年龄46~72(53.4±14.7)岁;Gustilo-Anderson分型,Ⅰ型2例,Ⅱ型11例,Ⅲ型7例;内固定方式为锁定加压钢板固定。观察并比较两组患者各项指标,包括术前等待时间、清创手术次数、术中出血量、手术时间、是否输血及白蛋白、细菌培养、并发症情况;随访资料包括骨折愈合时间,术后1年根据Johner-Wruhs评分评价患者术后骨折愈合和功能恢复情况,术后1年的总治疗成本(包括住院费用及术后1年费用)。对影响治疗成本的相关因素先进行单因素分析,结果有统计学差异的再进行多重线性回归分析,同时对两组的总治疗成本情况进行成本效果和增量成本效果分析。
结果:55例患者均获得随访,时间14~27(16.4±7.1)个月。IMN组术中出血量、手术时间分别为(243.18±118.82) ml,(247.50±57.94) min;LCP组分别为(467.86±490.53) ml,(350.00±178.77) min,两组比较差异有统计学意义(P<0.05)。两组在术前等待时间、清创手术次数、输血及白蛋白、细菌培养、合并并发症、骨折愈合时间方面比较差异无统计学意义(P>0.05)。影响治疗成本单因素分析显示吸烟饮酒(P=0.042),合并基础疾病(P=0.045),高能量损伤(P=0.012),清创手术次数>2次(P=0.001),术中出血量>400 ml (P<0.001),细菌培养(P=0.000),有并发症(P=0.035),以及输血和白蛋白(P=0.027)患者治疗成本显著增高,多重线性回归结果为吸烟饮酒组[β=-0.256,t=-2.628,95% CI (-29 667.09,-4 997.47),P=0.014]差异有统计学意义。总治疗成本IMN组(136 435.90±39 093.98)元,LCP组(140 034.62±56 821.12)元。成本效果分析表明IMN组和LCP组平均每获得1%的Johner-Wruhs评分优良率分别需花费1 705.45、1 647.46元。LCP与IMN相比每多获得1%的优良率需多花费的成本为719.74元。
结论:IMN和LCP固定作为开放性胫骨骨折的最终内固定治疗方案均可以获得较好的中远期疗效,IMN固定在术中出血量及手术时间方面优于LCP固定。同时合并吸烟饮酒、受伤原因、合并基础疾病、清创手术次数、术中出血量、进行细菌培养、输血及白蛋白及并发症存在对治疗成本的影响也不容忽视。 |
| 【关键词】胫骨骨折|骨折,开放性|骨折固定术,内|费用效益分析 |
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| Clinical characteristics and cost-effectiveness of intramedullary nail and plate for the treatment of open tibial fractures |
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ABSTRACT
Objective: To analyze clinical characteristics and cost-effectiveness of different final surgical options for treating patients with open tibial fractures.
Methods: A retrospective analysis was conducted by enrolling 55 surgically treated patients with open tibial fractures from January 2018 to June 2019. All the patients were categorized in intramedullary nailing (IMN) group and locking compression plate(LCP) group according to the final fixation option. There were 35 cases in group IMN including 27 males and 8 females,aged from 25 to 69 years old with an average of (49.0±10.6) years old. Based on Gustilo-Anderson classification,there were 1 case of typeⅠ,19 cases of typeⅡand 15 cases of type Ⅲ. There were 20 cases in group LCP including 15 males and 5 females,aged from 46 to 72 years old with an average age of (53.4±14.7) years old. Based on Gustilo-Anderson classification,there were 2 cases of typeⅠ,11 cases of type Ⅱand 7 cases of type Ⅲ. Preoperative waiting time,surgical debridement times,intraoperative bleeding loss,blood and albumin transfusion,operation time,bacterial cultures and complications,bone union time,Johner-Wruhs criteria at 1 year after operation and total cost within 1 year after surgery between two groups were compared. The variables recorded between two groups were statistically analyzed and compared respectively,then the factors affecting hospital costs were evaluated by univariate and multiple linear regression analysis respectively,finally the cost-effectiveness analysis was performed.
Results: Total 55 patients were enrolled with an average follow-up time of(16.4±7.1) months ranged from 14 to 27 months postoperatively. There were no significantly statistical differences of the demographic materials between the two groups. The intraoperative bleeding loss were(243.18±118.82) ml and (467.86±490.53) ml respectively in group IMN and LCP,the significantly statistical difference was discovered(P<0.05). The surgical duration were(247.50±57.94) min and(350.00±178.77) min respectively in group IMN and LCP,the significantly statistical difference was discovered(P<0.05). There were no significantly statistical differences of the average days before operation,surgical debridement times,received blood and albumin transfusion,wound cultures,complications and bone union time between the two groups(P>0.05). The univariate analysis of the factors affecting the hospital costs indicated that patients with smoke or alcohol (P=0.042),high energy damage (P=0.012),patients with comorbidity diseases(P=0.045),surgical debridement over 2 times (P=0.001),intraoperative bleeding loss over 400 ml (P<0.001),blood and albumin transfusion (P=0.027),wound cultures (P=0.000) and complications (P=0.035) were the factors. The multiple linear regression analysis demonstrated the smoke or alcohol using[β=-0.256,t=-2.628,95%CI(-29 667.09,-4 997.47),P=0.014] was the only factor affecting the total cost. The excellent and good rate were 80% and 85% respectively based on the Johner-Wruhs criteria. The average total cost within 1 year after surgery was (136 435.90±39 093.98) CNY in group IMN and (140 034.62±56 821.12) CNY in group LCP. The total surgical duration and total intraoperative bleeding loss were significant lower in group IMN than in group LCP. The average total costs of was significantly higher. The average cost for every 1% of excellent and good rate was 1 705.45 CNY in group IMN and 1 647.46 CNY in group LCP. Each 1% increasing of excellent and good rate cost 719.74 CNY more in group LCP compared with group IMN.
Conclusion: Both IMN and LCP could provide a satisfactory outcome for open tibial fractures. Meanwhile considering the total cost,patients with smoke or alcohol history,traffic accident,comorbidity diseases,surgical debridement over 2 times,intraoperative bleeding loss over 400 ml,and complications should not be ignored. |
| KEY WORDS Tibial fractures|Fractures,open|Fracture fixation,internal|Cost-benefit analysis |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 许毅博,杨立锋,马腾,任程,刘德印,路遥,李明,李忠,张堃.髓内钉及钢板治疗开放性胫骨骨折患者临床特点及成本效果分析[J].中国骨伤,2022,35(6):512~520 |
| 英文格式: | XU Yi-bo,YANG Li-feng,MA Teng,REN Cheng,LIU De-yin,LU Yao,LI Ming,LI Zhong,ZHANG Kun.Clinical characteristics and cost-effectiveness of intramedullary nail and plate for the treatment of open tibial fractures[J].zhongguo gu shang / China J Orthop Trauma ,2022,35(6):512~520 |
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