老年桡骨远端不稳定骨折不同治疗方式的成本效益分析

The Cost-Effectiveness Analysis of the Different Treatment Options for Unstable Distal Radial Fractures in Elderly Patients

目的 比较老年桡骨远端不稳定骨折手术和保守治疗的临床疗效和总费用,为临床医师选择有效的治疗方式提供依据。方法 将2019年12月—2023年3月于浙江中医药大学附属富阳中医骨伤医院就诊的88例老年不稳定型桡骨远端骨折患者纳入研究。按治疗方式不同分为手术组(n=44)和夹板组(n=44)。记录患者住院期间和治疗后1年门诊复查费用、腕关节功能评分量表(gartland-werlery,GW)、腕关节患者自行评估量表(patient-ratedwristevaluation,PRWE)、影像学检查、并发症,从卫生经济学角度进行成本-效果比(costeffectivenessratio,CER)和增量成本-效果比(incrementalcost-effectivenessratio,ICER)。结果 2组腕关节功能恢复优良率及PRWE评分比较,差异无统计学意义(P>0.05)。术后1年随访,2组影像学参数均有改善;2组影像学参数比较,差异有统计学意义(P<0.05)。手术组并发症总发生率低于夹板组(P<0.05)。手术组总体费用和住院费用分别为(23080.71±2180.37)、(23728.35±2246.57)元,均高于夹板组(5333.80±1843.87)、(6614.61±1763.00)元(P<0.05),但门诊费用则低于夹板组(P<0.05)。手术组和夹板组CER分别为1383.51元/分和331.89元/分;与夹板组比较,手术组PRWE评分每降低1分需多花费5648.10元。结论 >60岁老年不稳定型桡骨远端骨折患者中,夹板固定与切开复位内固定术均具有良好的疗效,但前者可能是一种更为经济有效的治疗方案。

Objective To compare the clinical efficacy and total cost of operation and conservative treatment for unstable distal radius fractures in elderly patients,and to provide evidence for clinicians to choose effective treatment.Methods A total of 88 elderly patients with unstable distal radius fractures who were admitted to Fuyang Orthopaedics and Traumatology Affiliated Hospital of Zhejiang Chinese Medical University from December 2019 to March 2023 were included in the study.According to the therapeutic methods,they were divided into operation group(n=44)and splint group(n=44).The cost of outpatient review during hospitalization and 1 year after treatment,gartland-werlery(GW),patient-rated wrist evaluation(PRWE),imaging examination,and complications were recorded.The cost-effectiveness ratio(CER)and incremental cost-effectiveness ratio(ICER)were studied from the perspective of health economics.Results There was no significant difference in the recovery rate of wrist joint function and PRWE score between two groups(P>0.05).After 1 year follow-up,the imaging parameters of both groups were improved.Comparison of imaging parameters between the two groups showed statistically significant difference(P<0.05).The total complication rate of operation group was lower than that of splint group(P<0.05).The total cost and hospitalization cost of operation group were(23080.71±2180.37)and(23728.35±2246.57)yuan,respectively,which were higher than that of splint group(5333.80±1843.87)and(6614.61±1763.00)yuan(P<0.05).However,the outpatient cost was lower than that of splint group(P<0.05).The cost-effectiveness ratio(CER)of operation group and splint group was 1383.51 yuan/points and 331.89 yuan/points,respectively.Compared with the splint group,the surgery group cost 5648.10 yuan more for every 1 point reduction in PRWE score.Conclusion In patients>60 years of age with unstable distal radius fractures,splinting and open reduction are both effective,but the former may be a more cost-effective treatment option.