老年股骨颈骨折患者总体费用和生活质量的关系

Preliminary analysis of total cost and life quality for elder patients with femoral neck fracture

目的 比较不同手术方式治疗股骨颈骨折的总体费用和手术疗效.方法 2013年8至12月北京积水潭医院创伤骨科收治年龄≥60岁股骨颈骨折患者105例,其中接受空心钉内固定术52例（IF组）,接受人工股骨头置换术53例（HA组）.记录患者入院前诊疗和住院费用;出院后采用费用记录结合电话随访方式记录患者1年内总费用,末次随访时采用欧洲五维健康量表（EQ-5D）评估患者生活质量.比较两种手术总体费用和疗效差异.结果 IF组骨折愈合率100％,两组无患者行翻修手术.股骨颈骨折患者1年内总体费用为59 584.9元,其中医疗成本比例79.1％,非医疗成本20.9％.骨折治疗费用分别占医疗费用和总费用的84.1％和66.6％.非医疗成本中家庭护理费用比例最高,约为90.7％.IF组医疗费用和总费用分别为HA组的39.0％和48.8％,两组非医疗成本差异无统计学意义（P＞0.05）.末次随访时两组患者生活质量和恢复行走能力差异无统计学意义（P＞0.05）.结论 空心钉内固定术和人工股骨头置换术均可取的良好的临床疗效.患者1年内总费用主要为骨折治疗费用,空心钉内固定术的总费用显著低于人工股骨头置换术,可能是治疗股骨颈骨折更经济的方法.

Objective To analyze the total cost and life quality of the femoral neck fracture patients who received different surgery and supplement comprehensive data of osteoporotic fracture.Methods One hundred and five patients above 60-year old who were diagnosed femoral neck fracture and received operation in Department of Orthopedics ＆amp; Traumatology,Beijing Jishuitan Hospital were admitted into our study from August 2013 to December.According to the type of surgery there were 52 and 53 cases in internal fixation （IF） group and hemiarthroplasty （HA） group respectively.At first we collected the medical expense of the patients before and during hospitalization.And then the 1-year medical and non-medical expenses were collected by the cost diary ever 3 months after discharge.At the last follow-up we evaluated the life quality by the EuroQol-5 Dimensions （EQ-5D） and calculated the total cost.Outcome All the patients completed the operation successfully.No nonunion or delayed union cases in IF group,and no cases received revision surgery in both groups.The total average cost was 59 584.9 yuan including 79.1% medical cost and 20.9% non-medical cost.The primary treatment cost accounts for 84.1% of the medical cost.The cost for home care accounts for 90.7% of the non-medical care.The total and medical cost of IF group just account for 40.3% and 38.5% of the HA group and the non-medical showed no significant difference between the 2 groups （P 〉 0.05）.In addition the data of life quality and walking capability also showed no significant difference.Conclusion The main cost for the femoral neck fracture is medical expense in 1-year follow-up.Both surgeries can provide satisfactory outcome,however IF may be more cost-effective compared to the HA because of the less total cost.