本文關(guān)鍵詞： 股骨干骨折 經(jīng)皮微創(chuàng)鋼板 交鎖髓內(nèi)釘 術(shù)中出血量 骨折愈合 最小成本 成本-效果比　出處：《承德醫(yī)學(xué)院》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:從臨床和經(jīng)濟(jì)學(xué)的角度對(duì)比經(jīng)皮微創(chuàng)鋼板與交鎖髓內(nèi)釘內(nèi)固定術(shù)在成人股骨干骨折治療中的優(yōu)劣,為成人股骨干骨折的治療提供理論依據(jù)。方法:遵循回顧、配對(duì)、對(duì)照的設(shè)計(jì)方案,選取2014年1月至2015年3月就診于保定市第二醫(yī)院的新鮮成人閉合股骨干骨折患者,將行經(jīng)皮微創(chuàng)鋼板內(nèi)固定術(shù)(Minimally invasive percutaneous plate osteosynthesis,MIPPO)治療者設(shè)為MIPPO組,行交鎖髓內(nèi)釘內(nèi)固定術(shù)治療者設(shè)為髓內(nèi)釘組,按照性別、骨折AO分型、工作性質(zhì)相同,年齡(±3歲)、身體質(zhì)量指數(shù)(±2Kg/m2)、隨訪時(shí)間(12個(gè)月)相近6個(gè)條件進(jìn)行1∶1配對(duì),共配成35對(duì)。經(jīng)Excel采用雙人雙機(jī)平行錄入、專人核對(duì)的方式記錄入組患者的基線資料(年齡、身體質(zhì)量指數(shù)、隨訪時(shí)間、受傷至手術(shù)時(shí)間、性別、股骨干骨折AO分型和側(cè)別、工作性質(zhì)、致傷原因、基礎(chǔ)病、骨折的性質(zhì))、臨床指標(biāo)(切口總長(zhǎng)度、手術(shù)時(shí)間、術(shù)中出血量、術(shù)后住院時(shí)間、骨折愈合時(shí)間,術(shù)前和術(shù)后第1、7天及出院前1天血清超敏C反應(yīng)蛋白,術(shù)前和術(shù)后第1、2、3、7天及出院前1天晨起體溫,術(shù)后第1、2、3、4、5、6、7天及出院前1天止痛藥使用率,臨床療效及并發(fā)癥)、經(jīng)濟(jì)學(xué)指標(biāo)(醫(yī)療成本、最小成本、成本-效果比及其敏感度)等,用SPSS20.0分析組間及組內(nèi)資料的差異性,P0.05認(rèn)為比較存在統(tǒng)計(jì)學(xué)差異。結(jié)果:(1)兩組基線資料均衡性良好(P0.05),有可比性。截止到隨訪日,共剔除6例患者(MIPPO組3例,髓內(nèi)釘組3例),91.43%的患者完成研究,隨訪時(shí)間(12-25)個(gè)月,中位隨訪時(shí)間14.6個(gè)月。(2)臨床療效:MIPPO組中,23例優(yōu),7例良,2例差,優(yōu)良率93.75%;髓內(nèi)釘組中,21例優(yōu),8例良,3例差,優(yōu)良率90.625%。兩組臨床療效相當(dāng)(P0.05)。(3)MIPPO組手術(shù)時(shí)間、術(shù)中出血量、骨折愈合時(shí)間少于髓內(nèi)釘組(P0.05);兩組切口總長(zhǎng)度、術(shù)后住院時(shí)間相當(dāng)(P0.05)。(4)血清超敏C反應(yīng)蛋白:兩組間無(wú)統(tǒng)計(jì)學(xué)差異(P0.05),兩組術(shù)后第1天較本組術(shù)前明顯升高,至術(shù)后第7天恢復(fù)穩(wěn)定。(5)晨起體溫:組間及組內(nèi)對(duì)比未體現(xiàn)出統(tǒng)計(jì)學(xué)差異(P0.05)。(6)止痛藥使用率:MIPPO組術(shù)后第1、2、3天為81.25%、78.125%、71.875%,低于髓內(nèi)釘組的93.75%、90.625%、84.375%(P0.05);MIPPO組術(shù)后第4、5、6、7天及出院前1天為62.50%、50.00%、15.625%、3.125%、3.125%,與髓內(nèi)釘組71.875%、56.25%、21.875%、6.25%、3.125%的差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。(7)并發(fā)癥:MIPPO組中,1例淺層感染,1例單枚螺釘松動(dòng),1例下肢深靜脈血栓,發(fā)生率為9.375%;髓內(nèi)釘組中,1例淺層感染,1例下肢深靜脈血栓,1例延遲愈合,1例輕度創(chuàng)傷性關(guān)節(jié)炎,發(fā)生率為12.50%。兩組并發(fā)癥發(fā)生率相近(P0.05)。(8)經(jīng)濟(jì)學(xué)指標(biāo):兩組醫(yī)療成本構(gòu)成比分布接近(P0.05),兩組材料費(fèi)、藥品費(fèi)、檢查費(fèi)、治療費(fèi)、其它費(fèi)用等直接醫(yī)療成本接近(P0.05),MIPPO組間接醫(yī)療成本低于髓內(nèi)釘組(P0.05);MIPPO組最小成本、成本-效果比分別為(37.37±7.28)千元、422.89,低于髓內(nèi)釘組的(44.51±6.69)千元、533.35(P0.05);誤工費(fèi)和材料費(fèi)上、下浮動(dòng)10%后敏感度分析顯示,MIPPO組的最小成本分和成本-效果比均優(yōu)于髓內(nèi)釘組。結(jié)論:經(jīng)皮微創(chuàng)鋼板與交鎖髓內(nèi)釘內(nèi)固定術(shù)均能有效治療新鮮閉合成人股骨干骨折,且經(jīng)皮微創(chuàng)鋼板有出血少、術(shù)后疼痛輕、骨折愈合快、最小成本和成本-效果比低等優(yōu)勢(shì)。
[Abstract]:Objective: from the angle of economics and clinical comparison of minimally invasive percutaneous plate and interlocking intramedullary nail fixation in the treatment of adult femoral fractures, and provide theoretical basis for treatment of femoral shaft fractures. Methods: following the review, pairing, design control, were selected from January 2014 to March 2015 in Baoding city the hospital closed second fresh adult femoral shaft fracture underwent minimally invasive percutaneous plate fixation (Minimally invasive percutaneous plate osteosynthesis, MIPPO) treatment were divided into group MIPPO treated with interlocking intramedullary nail fixation treatment as the intramedullary nail group, according to gender, AO type of fracture, the nature of the work the same (+ 3 years), age, body mass index (2Kg/m2), follow-up period (12 months). 1: 1 matched 6 conditions, with a total of 35 by Excel. Using a double double machine parallel input, by way of recording in check Baseline data of patients (age, body mass index, follow-up time, time from injury to surgery, gender, femoral shaft fracture AO type and side, the nature of the work, the cause of injury, basic disease, fracture properties), clinical indicators (total length of incision, operation time, bleeding volume, operation time after operation, fracture healing time, 1,2,3,7 days 1,7 days before and after surgery and 1 days before the serum high-sensitivity C reactive protein, preoperative and postoperative discharge before and after the 1 day morning temperature, 1,2,3,4,5,6,7 days after operation and discharged 1 days before the analgesic use rate, clinical efficacy and complications) Economics, index (medical costs, minimum cost, cost effectiveness ratio and sensitivity), with SPSS20.0 analysis of differences between group and group data, P0.05 believes that there is significant difference. Results: (1) the balance of baseline data of the two groups (P0.05), has good comparability. Until the follow-up a total of 6 cases were excluded. 鎮(zhèn)ｈ，

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