手术治疗重度肋骨骨折的疗效及经济学分析

Effect and economic analysis of operative treatment of severe rib fracture

目的 评估手术内固定治疗重度肋骨骨折的经济学效益及临床意义,为提高肋骨骨折的救治水平提供客观依据.方法 回顾性分析2009年1月-2014年4月收治的50例重度肋骨骨折患者的临床资料,按治疗方式分为手术组（13例）和非手术组（37例）.对两组住院时间、住院总费用、通气支持时间、下地活动时间、抗生素使用时间及并发症发生率等指标进行统计并对成本-效果进行分析.结果 手术组住院时间（25.9 ±8.2）d、住院费用（121 676.2±10 991.1）元、通气支持时间（7.9±2.8）d、下地活动时间（14.3±4.9）d、抗生素使用时间（12.4±3.3）d,2例出现并发症.非手术组上述相应指标分别为（35.4±7.0）d、（148 724.5±21 254.3）元、（14.1±3.3）d、（26.1 ±6.5）d、（21.2±6.2）d,13例出现并发症.两组通气支持时间、下地活动时间、抗生素使用时间差异均有统计学意义（P＜0.05）.手术组主、客观显效的成本效果比（1 962.52,3 925.03）均优于非手术组（1 931.48,3 718.10）,提示手术治疗具有更大的经济效益.结论 相对非手术治疗,手术内固定可显著加快重度肋骨骨折患者的康复,降低治疗费用,值得临床推广.

Objective To evaluate economic benefits and clinical effects of internal fixation treatment of severe rib fracture so as to provide objective basis for improving medical treatment for rib fracture.Methods A retrospective review was made on clinical data of 50 patients with severe rib fracture hospitalized from January 2009 to April 2014.With varied treatment modalities,the patients were assigned to operative group （n =13） and non-operative group （n =37）.Variables were recorded including length of stay,total hospital charges,length of ventilatory support,off-bed time,duration of antibiotic use and incidence of complications and used to perform cost-efficiency analysis.Results Between operative and non-operative groups,length of hospital stay was （25.9 ± 8.2） days vs （35.4 ± 7.0） days,total hospital charges were （121 676.2 ± 10 991.1） yuan vs （148 724.5 ± 21 254.3） yuan,length of ventilatory support was （7.9 ± 2.8） days vs （14.1 ± 3.3） days,off-bed time was （14.3 ± 4.9） days vs （26.1 ± 6.5） days,duration of antibiotic use was （12.4 ± 3.3） days vs （21.2 ± 6.2） days and complications occurred in 2 cases vs 13 cases respectively.The findings were length of ventilatory support,off-bed time and duration of antibiotic use differed significantly between the two groups （P 〈 0.05）.Cost-effectiveness ratios based on subjective and objective measures were superior in operative group （1 962.52 and 3 925.03） over those in non-operative group （1 931.48 and 3 718.10）,suggesting operative treatment could yield higher economic returns.Conclusion Internal fixation can accelerate bone healing in patients with severer rib fracture and cut down medical expense,which should be promoted in medical treatment.