单节段颈前路带锁钢板内固定的费用——效益分析

The cost-effectiveness analysis of cervical mono-segmental fusion with locking plate fixation

目的从费用—效益分析角度探讨在单节段颈前路融合术中带锁钢板内固定的应用价值。方法随访调查32例颈前路单节段融合钢板内固定及38例单节段单纯植骨融合的颈椎病病人,比较两组之间术后并发症、恢复各项活动的时间、各项住院花费等指标的差别,得出钢板内固定的费用—效益比值(CE值),平均随访时间为18.4个月。结果所有并发症经保守治疗缓解或痊愈,两组并发症发生概率差别无统计学意义;钢板组病人恢复各项活动的时间均较对照组短,而手术室费用较对照组明显增多;病人恢复工作的费用—效益比值是钢板组病人人均日收入的6.4倍,平均日总收入的2.9倍。结论在单节段颈椎病的手术治疗中应用前路钢板内固定是一种安全、有效的方法,但由于费用方面原因,此术式应有选择地进行。

Objective: To discuss the value of cervical locking plate fixation in anterior mono-segmental fusion by cost-effectiveness analysis. Methods:Thirty-two patients with single level degenerative cervical disorders were treated with anterior decompression, autograft, and cervical locking plate fixation. We compared the complications, time of rehabilitation, and costs with patients treated with anterior decompression and autograft without plate fixation. The incremental cost effectiveness(CE) was calculated. The average period of follow-up was 18.4 months. Results: All of the complications were remitted or disappeared while treated with conservative treatment. The distribution of complications had no statistic difference between 2 groups. Patients who underwent plating rehabilitated sooner than thoe without plated, accordingly the charges of operation were higher. The incremental cost effectiveness to return to work was 6.4 times as much as the average income of the plated patients and 2.9 times as much as the average total income respectively. Conclusion: Anterior locking plate fixation is a safe, effective measure in the treatment of mono-segmental cervical degenerative disorders, but it should be adopted selectively because of its expensive price.