- 學位論文
多節性頸椎狹窄症不同椎板整形術之成本效果分析
Cost-effectiveness Analysis of Different Laminoplasty Procedures to Multi-level Cervical Stenosis
摘要
背景：因頸椎狹窄症引起脊髓神經及脊髓神經根的壓迫，若嚴重會導致病人嚴重失能。治療多節性頸椎狹窄症多以椎板整形術為主。目前研究少見對於open-door椎板整形術與midline open-book椎板整形術之醫療資源成本及手術效果之討論。 目的：本研究以保險者觀點，針對多節性頸椎狹窄症之病人，接受open-door與midline open-book椎板整形手術之成本效果比較。 方法：採回溯病歷方式，針對台北市某醫學中心於自2000年1月1日至2007年2月17日止期間。以診斷為ICD-9-CM 721.0、722.91、723-724並手術記錄術式為椎板整形術者共78例。將接受open-door椎板整形術與midline open-book椎板整形術分為兩群組，分析兩群組在手術後住院天數、手術實行時間、手術出血量、醫療費用、術前術後Nurick scale評分差異、術前術後JOA scale評分差異、JOA scale恢復比率、術前術後椎管直徑長度差異以及術前術後椎管直徑長度增加比率。利用t-test，分析兩群組在研究變項上的差異。 結果：在手術後住院天數、手術實行時間、手術出血量、術前術後Nurick scale評分差異、術前術後JOA scale評分差異及JOA scale恢復比率上兩群組沒有顯著差異。在醫療費用支出上midline open-book椎板整形術群組較高，open-door椎板整形術群組於手術後椎管直徑長度及增加比率較長且大。比較JOA scale恢復比率及手術後椎管直徑長度增加比率，open-door椎板整形術較具成本效果優勢。 結論：針對罹患多節性頸椎狹窄症之病人，於手術治療上使用open-door椎板整形術較midline open-book椎板整形術具有成本效果。一個手術的成功最終還是必須仰賴外科醫師的判斷、經驗以及病人病情地選擇。正確的選擇病人，給予正確的手術，病人將蒙受其利。
並列摘要
Background：The compression of cervical spine and nerve roots due to cervical stenosis, if patient’s condition is serious, it will cause severe disability. Laminoplasty is a practical surgical techmique for the treatment of multi-level cervical stenosis. There were few studies on terms of costs and effectiveness between open-door laminoplasty and midline open-book laminoplasty. Objective：This study is from a point of assurer. It aimed at people with multi-level cervical stenosis, analyzed and compared the outcome of costs and effectiveness of open-door laminoplasty to that of midline open-book laminoplasty. Methods：This study retrospectively analyzed on a medical center located at Taipei from January 1 2000 to February 17 2007. Patients’ diadnosed as ICD-9-CM 721.0、722.91、723-724 and treated with laminoplasty were screened to select 78 individuals. According to approach, patients were classified into two groups, namely open-door laminoplasty and midline open-book laminoplasty. Analyzing the two groups in the days after surgery, average operating period, estimated intraoperative blood loss, difference between preoperative and poatoperative Nurick scale, difference between preoperative and poatoperative JOA scale, JOA recocer rate, difference between preoperative and poatoperative canal diameter extent, difference between preoperative and poatoperative canal diameter augment ratio. The analysis was carried out with T-test to study the difference between the two groups. Results：There was no significant difference in the days after surgery, average operating period, estimated intraoperative blood loss, difference between preoperative and poatoperative Nurick scale, difference between preoperative and poatoperative JOA scale and JOA recocer rate between open-door laminoplasty group and midline open-book laminoplasty group. In the term of medical cost, midline open-book laminoplasty group was highter. In terms of post-operative canal diameter extent and augment ratio, open-door laminoplasty group was longer and higher. Compared which laminoplasty is ascendant in JOA scale recover rate and post-operative canal diameter augment ratio, open-door laminoplasty was better to demonstrate more cost-effectiveness option of the procedures in our study. Conclusions：In our study, mentioning surgical techmique for the treatment of multi-level cervical stenosis, open-door laminoplasty is more cost-effectiveness than midline open-book laminoplasty. The success of the operation ultimately deponds on the surgeon’s judgement, experience, and patient selection. Chosing the patient correctly and treating them adequately, they will get greatest treatment.