马尔科夫模型下内固定和半髋关节置换治疗骨质疏松性股骨粗隆骨折的质量调整生命年的比较研究

A comparative study of quality-adjusted life years in the treatment of osteoporotic femoral trochanteric fractures with internal fixation and hemiarthroplasty under markov model

目的比较内固定和半髋关节置换治疗老年骨质疏松性股骨粗隆骨折获得的质量调整生命年的总和,为治疗方法的决策制定和经济效益分析提供依据。方法时间跨度设定为10年,既从2018~2028年,建立内固定和半髋关节置换治疗老年股骨粗隆骨折马尔科夫模型。对数个数据库进行检索,纳入比较内固定和半髋关节置换治疗老年股骨粗隆骨折的研究,提取模型所需要的临床结果概率数据。利用决策软件计算两种治疗方法获得的质量调整生命年总和,并对结果进行敏感度分析。结果老年股骨粗隆骨折患者接受半髋关节置换手术10年后获得的质量调整生命年总和为5.062年,接收内固定治疗10年后获得的质量调整生命年总和为5.745年。患者经内固定治疗比经半髋关节置换获得的质量调整生命年多。单因素和双因素敏感度分析支持模型结果。结论在预期10年寿命的患者中,半髋关节置换与内固定治疗相比不具备优势。老年股骨粗隆骨折患者经半髋关节置换治疗后的质量调整生命年系数需达到0.8,获得的质量调整生命年总和才会比内固定治疗高。

Objective To compare the sum of quality-adjusted life years obtained by internal fixation and hemiarthroplasty in the treatment of senile osteoporotic femoral trochanteric fractures, and to provide a basis for decision-making and economic benefit analysis of treatment methods. Methods The time span was set to 10 years, from 2018 to 2028, to establish a Markov model for the treatment of elderly femoral trochanteric fractures with internal fixation and hemiarthroplasty. Several databases were searched for the study of internal fixation and hemiarthroplasty for the treatment of elderly femoral trochanteric fractures, and the required clinical outcome probability data were extracted. The decision-making software was used to calculate the sum of the quality-adjusted life years obtained by the two treatment methods, and the results were analyzed for sensitivity. Results In the elderly patients with femoral trochanteric fractures, the total quality-adjusted life years obtained after 10 years of hemiarthroplasty were 5.062 years, and the total quality-adjusted life years obtained after receiving internal fixation for 10 years was 5.745 years. Patients undergoing internal fixation got more quality-adjusted life years than those undergoing hemiarthroplasty. Single factor and two factor sensitivity analysis supported the model results. Conclusion Among patients with a 10-year life expectancy, hemiarthroplasty has no advantage over internal fixation. In patients with old femoral trochanteric fractures, the quality-adjusted life-year coefficient after treatment with hemiarthroplasty needs to be 0.8 when the sum of quality-adjusted life years obtained will be higher than that of internal fixation.