使用外固定延长然后髓内钉固定与使用内置磁性延长钉进行胫骨牵张成骨的成本比较
Cost Comparison of Tibial Distraction Osteogenesis Using External Lengthening and Then Nailing vs Internal Magnetic Lengthening Nails.
作者信息
Dvorzhinskiy Aleksey, Zhang David T, Fragomen Austin T, Rozbruch S Robert
机构信息
Department of Limb Lengthening and Complex Reconstruction, Hospital for Special Surgery, New York, United States.
出版信息
Strategies Trauma Limb Reconstr. 2021 Jan-Apr;16(1):14-19. doi: 10.5005/jp-journals-10080-1513.
AIM AND OBJECTIVE
Tibial lengthening can be performed by distraction osteogenesis via lengthening and then nailing (LATN) or by using a magnetic lengthening nail (MLN). MLN avoids the complications of external fixation while providing accurate and easily controlled lengthening. Concerns exist still regarding the high upfront cost of the magnetic nail, which serves to limit its use in resource-poor areas and decrease adoption among cost-conscious surgeons. The purpose of this study was to compare the hospital, surgeon, and total cost between LATN and MLN when used for tibial lengthening.
MATERIALS AND METHODS
A retrospective review was performed comparing consecutive tibial lengthening using either LATN (n = 17) or MLN (n = 15). The number of surgical procedures and time to union were compared. Surgeon and hospital payments were used to perform cost analysis after adjusting for inflation using the consumer price index (CPI).
RESULTS
Patients treated with MLN underwent fewer surgeries (3.6 vs 2.8; p < 0.001) but had a longer time to union as compared with patients treated with LATN (19.79 vs 27.84 weeks; p = 0.006). Total costs were similar ($50,345 vs $46,162; p = 0.249) although surgeon fees were lower for MLN as compared with LATN ($6,426 vs $4,428; p < 0.001).
CONCLUSION
LATN and MLN had similar overall costs in patients undergoing tibial lengthening. MLN was associated with fewer procedures but a longer time to union as compared with LATN.
CLINICAL SIGNIFICANCE
Despite an increased upfront cost in MLN, there was no difference in total cost between LATN and MLN when used for tibial lengthening. Thus, in cases where either method is feasible, cost may not be a deciding factor when selecting the appropriate treatment.
HOW TO CITE THIS ARTICLE
Dvorzhinskiy A, Zhang DT, Fragomen AT, Cost Comparison of Tibial Distraction Osteogenesis Using External Lengthening and Then Nailing vs Internal Magnetic Lengthening Nails. Strategies Trauma Limb Reconstr 2021;16(1):14-19.
目的
胫骨延长可通过先延长再钉内固定（LATN）的牵张成骨术或使用磁性延长钉（MLN）来进行。MLN避免了外固定的并发症，同时提供精确且易于控制的延长。然而，磁性钉高昂的前期成本仍然令人担忧，这限制了其在资源匮乏地区的使用，并降低了注重成本的外科医生的采用率。本研究的目的是比较LATN和MLN用于胫骨延长时的医院成本、医生成本和总成本。
材料与方法
进行了一项回顾性研究，比较连续使用LATN（n = 17）或MLN（n = 15）进行胫骨延长的情况。比较了手术次数和骨愈合时间。使用消费者价格指数（CPI）对通货膨胀进行调整后，利用医生和医院的收费进行成本分析。
结果
与接受LATN治疗的患者相比，接受MLN治疗的患者手术次数更少（3.6次对2.8次；p < 0.001），但骨愈合时间更长（19.79周对27.84周；p = 0.006）。尽管MLN的医生费用低于LATN（6426美元对4428美元；p < 0.001），但总成本相似（50345美元对46162美元；p = 0.249）。
结论
在接受胫骨延长的患者中，LATN和MLN的总体成本相似。与LATN相比，MLN的手术次数较少，但骨愈合时间较长。
临床意义
尽管MLN的前期成本较高，但在用于胫骨延长时，LATN和MLN的总成本并无差异。因此，在两种方法均可行的情况下，成本可能不是选择合适治疗方法时的决定性因素。
如何引用本文
Dvorzhinskiy A, Zhang DT, Fragomen AT, 胫骨牵张成骨术使用外固定延长再钉内固定与内磁性延长钉的成本比较。创伤肢体重建策略2021；16(1):14 - 19。
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