老年股骨粗隆间骨折手术与非手术治疗的并发症及费用比较

Complication and economic costs of elderly femoral intertrochanteric fracture with operation or nonoperation

目的:探讨手术与非手术治疗老年股骨粗隆间骨折的住院期间并发症及费用状况,以利选择治疗方式。方法:采用回顾性对比研究,依据下列标准选择病例: ( 1 )年龄为≥60岁; (2)非手术治疗包括骨牵引、皮牵引、牵引后半髋石膏固定,且住院时间不少于 6周; (3)手术治疗指应用Gamma钉、动力髋螺钉(DHS)、动力髁螺钉(DCS)、“L”形角度钢板治疗者。入选病例依治疗方式划分两组,手术治疗者为A组, 70例,非手术治疗者为B组, 58例;比较两组间年龄、住院时间、住院医疗费用、并发症及合并疾患。结果:两组间在合并疾患(A组 78. 6%,B组 84. 5%,x2 =0. 729,P>0. 05)、年龄〔A组为 (78±9. 6)岁,B组为 (81±11. 1)岁,t=1. 63,P>0.05〕、每例住院医疗总费用〔A组为(14. 1±4. 5)千元,B组为(12. 8±3. 4)千元,t=1. 82,P>0. 05〕差异上无显著性意义,而在并发症(A组 31. 4%,B组 72. 4%,x2 =21. 32,P<0. 001)、住院时间〔A组为(27±6. 2)d,B组为(57±7. 1)d,t=25.53,P<0. 001〕差异上有非常显著性意义。结论:合理选择对老年股骨粗隆间骨折的治疗手段,不但能促进骨折恢复,减少并发症,也是减少医疗费用的重要一环。

Objective:To investigate complications and economic costs of elderly femoral intertrochanteric fracture with operation or nonoperation.Method: This study was a retrospective analysis of trauma registry data.The criteria, for inclusion in study were as follows: (1) patients age were equal or more than 60 years;(2) nonoperation included bone traction,skin traction, half coax plaster fixation after traction and hospital length of stay were equal or more than six weeks; (3) treatment with operation included Gamma nail, DHS, DCS, angled blade plate.These patients were divided into two groups based on treatment method, treatment with operation were group A, treatment with nonoperation were group B.Result:During the study period,128 patients met the criteria for the investigation, group A were 70 patients, group B were 58 patients.No differences between groups were found by associated preexisting medical diseases (group A were 78.6%, groupB were 84.5%, x 2 =0.729, P >0.05), years of patient (group A were 78±9.6 years, group B were 81±11.1 years, t =1.63, P >0.05),average medical treatment total costs (group A were 14.1±4.5 thousand yuan,group B were12.8±3.4 thousand yuan, t =1.82, P >0.05).There was significant difference in complications(group A were 31.4%,group B were 72.4%, x 2 =21.32, P <0.001),hospital length of stay(group A were 27±6.2d, group B were 57±7.1d, t =25.53, P <0.001)between two groups.Conclusion: Treatment method selected in reason for elderly femoral intertrochanteric fracture are very important, there are effectiveness in promote fracture recovery and reduce medical treatment total costs.