本文選題：骨質(zhì)疏松性脊柱壓縮骨折 + 經(jīng)皮椎體成形術(shù)�。� 參考：《新疆醫(yī)科大學(xué)》2015年碩士論文

【摘要】：目的:通過對骨質(zhì)疏松性脊柱壓縮骨折患者不同治療方案進(jìn)行成本-效果評價,為臨床醫(yī)師制定符合最佳成本—效價的骨質(zhì)疏松性脊柱壓縮骨折的醫(yī)療衛(wèi)生決策提供理論依據(jù)并指導(dǎo)實施。方法:收集并回顧性分析225例骨質(zhì)疏松性脊柱壓縮骨折患者的三種不同治療方案,其中74例患者行單純PVP微創(chuàng)手術(shù)治療,82例患者行PVP微創(chuàng)手術(shù)并結(jié)合唑來膦酸注射液治療,69例患者行常規(guī)藥物保守治療。比較三組患者以下臨床療效指標(biāo)及經(jīng)濟學(xué)指標(biāo),包括治療前后不同時期的壓縮椎體高度丟失率、骨密度值、疼痛視覺模擬評分(visual analogue scale,VAS)、鎮(zhèn)痛藥物使用評分及脊柱活動能力評分,以及住院天數(shù)、住院總費用、住院期間康復(fù)費用、出院后康復(fù)期費用;將三組患者住院天數(shù)、住院總費用及康復(fù)期費用與治療前后脊椎功能活動評分差值及脊椎壓縮骨折的X線影像分級之間進(jìn)行相關(guān)性分析。結(jié)果:PVP微創(chuàng)組患者住院天數(shù)最短,藥物保守組住院天數(shù)最長(F=329.608,P0.05);治療后3個月及12個月,三組患者的骨密度值、VAS評分及壓縮椎體高度丟失率之間兩兩比較均具有統(tǒng)計學(xué)差異(P0.05),其中保守組的骨密度值最低,VAS評分及椎體高度丟失率最高;治療后3個月,三組患者鎮(zhèn)痛藥物使用評分均減低(F=146.580、186.324、135.110,P0.05),其中PVP微創(chuàng)+藥物組的評分最低;三組患者脊柱活動能力均有所改善(F=282.872、173.446、313.856,P0.05),其中PVP微創(chuàng)+藥物組的脊柱活動能力要優(yōu)于其余兩組。經(jīng)濟學(xué)指標(biāo)分析顯示:保守組的住院費用最低,住院期間康復(fù)費及出院后康復(fù)期費用較高(F=630.869、796.695、123.306,P=0.000)。保守組的住院天數(shù)、住院總費用及康復(fù)期費用分別與治療前后脊柱活動能力評分差值及X線影像分級之間具有正相關(guān)性,其余兩組僅住院總費用與X線影像分級呈正相關(guān)性(P0.05)。結(jié)論:經(jīng)成本-效果分析,PVP微創(chuàng)并結(jié)合唑來膦酸藥物治療骨質(zhì)疏松性脊柱壓縮骨折是療效最好的方法,但是經(jīng)濟成本最高,適用于脊柱壓縮骨折程度較重和經(jīng)濟條件較好的患者;單純PVP微創(chuàng)手術(shù)治療的成本-效價較好,適用于任何程度的脊柱壓縮骨折,可在臨床中推廣應(yīng)用;藥物保守治療雖然成本低,但是療效一般,僅適合于壓縮程度較輕的患者,或者無法耐受微創(chuàng)手術(shù)和經(jīng)濟條件一般的患者。
[Abstract]:Objective: to evaluate the cost-effectiveness of different treatments in patients with osteoporotic spinal compression fracture. To provide a theoretical basis for clinicians to make the best cost-titer of osteoporotic spinal compression fracture medical and health decisions and guide the implementation. Methods: two hundred and twenty-five patients with osteoporotic spinal compression fracture were collected and analyzed retrospectively. Among them, 74 patients were treated with PVP minimally invasive surgery and 82 patients were treated with PVP minimally invasive operation and 69 patients with zoledronic acid injection were treated with routine drug conservative therapy. The following clinical and economic indexes were compared among the three groups, including the loss rate of compressed vertebral body height, bone mineral density, visual analogue scale, analgesic drug use score and spinal activity score before and after treatment. And the days of hospitalization, the total cost of hospitalization, the cost of rehabilitation during hospitalization, the cost of recovery after discharge; the days of hospitalization of the three groups of patients, The correlation analysis was made between the total cost of hospitalization and the cost of convalescence and the difference in the score of spinal functional activity before and after treatment and the X-ray image classification of vertebral compression fracture. Results the minimal invasive group had the shortest hospitalization days, while the drug conservative group had the longest stay in hospital, 3 months and 12 months after the treatment, and the patients in the drug conservative group had the longest hospitalization days of 329.608, 3 and 12 months after treatment. The BMD and VAS scores of the three groups were significantly different from those of the compression vertebral height loss rate (P 0.05), and the conservative group had the lowest VAS score and the highest vertebral height loss rate, 3 months after treatment. The scores of analgesic drug use in the three groups were all decreased, among which the PVP minimally invasive drug group had the lowest score, and the spinal mobility of the three groups was improved by 282.872173.446A313.856U P0.05, among which the PVP minimally invasive drug group was superior to the other two groups. The economic index analysis showed that the cost of hospitalization in conservative group was the lowest, the cost of rehabilitation during hospitalization and the cost of recovery period after discharge were higher than that of FY630.869796.695A123.306m. There was a positive correlation between the days of hospitalization, the total cost of hospitalization and the cost of convalescence before and after treatment, respectively, and the difference between the score of spinal mobility and X-ray image grading before and after treatment. The other two groups only had a positive correlation with the total cost of hospitalization and the grade of X-ray image. Conclusion: minimally invasive PVP combined with zoledronic acid is the best method for the treatment of osteoporotic spinal compression fracture, but the economic cost is the highest. It is suitable for the patients with severe spinal compression fracture and better economic condition, the cost and titer of PVP minimally invasive surgery is better, it is suitable for any degree of spinal compression fracture, and can be popularized and applied in clinic. Conservative drug therapy, although low in cost, is generally effective and is only suitable for patients with less compression, or can not tolerate minimally invasive surgery and economic conditions.
【學(xué)位授予單位】：新疆醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R687.3

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