目的：比较人工关节置换术与内固定术在高龄不稳定型粗隆间骨折患者中的成本-效果，并分析其中护理服务项目的成本。方法：对81例70岁以上采用人工关节置换术或内固定术治疗高龄不稳定型粗隆间骨折的患者进行直接医疗成本资料、人口学资料及临床疾病资料的收集。按照手术方式将患者分为两组，利用当面访谈法对患者进行术前、术后6个月的髋关节功能评价，根据总分得出两组患者的优良率。对使用成本-效果比的指标进行经济分析。结果：人工关节置换组和内固定组患者术后6个月的优良率分别是50.0%和36.4%，差异有统计学意义（P<0.05）。护理服务中收费项目仅占12.3%，总住院费用中护理治疗费用占3.18%，平均工时价格为59.95元/h。两组患者直接医疗成本有显著差异，患者每获得一个单位的效果，内固定术要比人工关节置换术多花费216.7元。结论：6个月的近期成本-效果分析得出，人工关节置换术明显优于内固定术。护理服务实际成本与现行收费标准不一致。%Objective:To compare the cost-effectiveness between arthroplasty and internal fixation of the patients with intertrochanteric femur fractures.And to analyze the cost of nursing services.Method:A total of 81 patients over 70 years who were treated for unstable intertrochanteric femur fractures with arthroplasty and internal fixation were enrolled in this study.Medical costs, demography data and clinical disease data were collected. The 81 patients were divide into arthroplasty group and internal fixation group according to different surgical methods.Assess the hip function of preoperative and postoperative patients with Harris Scale by face to face interviews, the excellent rate of two groups was assessed according to the total score.The economic indicators of cost-effectiveness use were analyzed.Result: The excellent rate of the arthroplasty group and the internal fixation group were 50.0% and 36.4%, the difference was statistically significant (P<0.05).Nursing services items accounted for only 12.3%,the cost of nursing care was 3.18% and the average price was 59.95 yuan per hour.There was a statistical difference in direct medical costs parts between the two groups. If patients obtain one unit effect, internal fixation expend significantly larger 216.7 yuan than the arthroplasty group.Conclusion:The recent effect of arthroplasty is better than internal fixation for elderly patients with unstable intertrochanteric femur fractures.The actual cost of nursing service is not consistent with the current charge standard.
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