全髋关节置换与股骨头置换治疗老年人股骨颈骨折的成本疗效分析

Cost-effectiveness Analysis of Total Hip Replacement and Femoral Head Replacement in the Treatment of Femoral Neck Fracture of the Elderly Patients

目的:对全髋关节置换(THR)与股骨头置换(FHR)治疗老年股骨颈骨折进行成本-疗效分析。方法:回顾分析我院2019年1月至2020年1月收治的股骨颈骨折老年患者90例,按照手术方式不同分为THR组(n=46),FHR组(n=44),比较两组患者的手术情况、髋部功能及各项费用等指标。采用髋部骨折功能恢复量表(functional recovery scale,FRS)和直观模拟评分表(Visual Analogue Scale,VAS)评估手术疗效及预后,通过我院电子诊疗系统和电话随访等途径收集患者伤后1年各费用和疗效,根据疗效和费用结果对两种术式进行成本-疗效分析。结果:90例患者均顺利完成手术及随访,两组患者在术前等待时间、住院天数及术中出血量方面均无差异(P>0.05);FHR组手术时间低于THR组,两组比较差异有统计学意义(P<0.05);末次随访VAS评分THR组低于FHR组,FHR组术后并发症高于THR组,两组比较差异均具有统计学意义(P<0.05);采用非等距重复测量的方差分析对THR与FHR术后3个月、6个月及12个月FRS评分比较显示:①不同时间点间的FRS评分有差别(F=944.306,P<0.001);②FHR和THR组在3个月与6个月时FRS评分差异无统计学意义(P>0.05),在12个月时THR组FRS评分高于FHR组,差异具有统计学意义(P<0.05);③组间与时间不存在交互作用(F=2.178,P=0.137);1年内骨折相关总费用FHR组低于THR组,两组比较差异具有统计学意义(P<0.05);THR相对于FHR每多获得1分疗效需花费3869.02元。结论:全髋关节置换对治疗老年股骨颈骨折具有更好的远期疗效与预后,结合成本-疗效分析,对于大部分健康且活动量大的老年人而言,全髋关节置换虽然费用较高,但能够较好提高其生活质量。

Objective:To conduct an cost-effect analysis of total hip replacement(THR)and femoral head replacement(FHR)in the treatment of femoral neck fractures in the elderly.Methods:A total of 90 elderly patients with femoral neck fracture admitted to our hospital from January 2019 to January 2020 were retrospectively analyzed and divided into THR group(n=46)and FHR group(n=44)according to different surgical methods.The surgical performance,hip function and various expenses of the two groups were compared.The hip fracture functional recovery scale(FRS)and Visual Analogue scale(VAS)were used to evaluate the surgical efficacy and prognosis.The costs and efficacy of patients one year after injury were collected through the electronic diagnosis and treatment system of our hospital and telephone follow-up,and the cost-effectiveness analysis of the two surgical procedures was conducted according to the results of efficacy and cost.Results:All the 90 patients successfully completed the operation and follow-up.There were no statistically significant differences between the two groups in terms of preoperative waiting time,length of hospital stay and intraoperative blood loss(P>0.05).The operation time of FHR group was lower than THR group,and the difference was statistically significant(P<0.05).At the last follow-up,the VAS score in the THR group was lower than that in the FHR group,and the postoperative complications in the FHR group were higher than that in the THR group,with statistical significance(P<0.05).Compared with THR and FHR FRS scores at 3 months,6 months and 12 months after surgery,non-equidistant repeated measurement ANALYSIS of variance was used:①FRS scores were different at different time points(F=944.306,P<0.001).②FRS scores of FHR group and THR group were not different at 3 months and 6 months(P>0.05),and THR group had higher FRS scores than FHR group at 12 months(P<0.05).③There was no interaction between groups and time(F=2.178,P=0.137).The total fracture related cost in 1 year in FHR group was lower than that in THR group(P<0.05).Compared with FHR,it costs 3869.02 yuan for each additional point of efficacy obtained by THR.Conclusion:Total hip replacement has better long-term efficacy and prognosis for the treatment of femoral neck fracture in the elderly.Combined with cost-effectiveness analysis,total hip replacement can better improve the quality of life for the majority of healthy and active elderly people.