【摘要】 目的对人工全膝关节置换术(tatolkneereplacement,TKR)医疗费用中的各项组成进行分析,为提高TKR的治疗效果,减少并发症,普及人工全膝关节置换术提供帮助。方法对1992、1995、1998和2001年行初次单侧人工全膝关节置换术、无术后并发症及住院期间无其他手术史者的医疗费用进行分析和比较,应用SPSS10.0统计软件对数据进行处理。结果1992～2001年医疗费用中上涨幅度最大的是康复费和假体费,即使扣除物价上涨因素,其幅度仍达到1998年的318.0%、214.2%和2001年的291.4%、219.8%。下降幅度最大的是床位费和输血费。四个年度的各项费用中所占比例最大的是假体费,分别为54.7%、56.1%、56.0%及63.3%。医疗费用增加的主要因素:(1)为保证患者术后的功能,使用进口假体比例的增加;(2)由于感染细菌谱的改变,尤其是抗生素的滥用导致细菌普遍的高耐药性,大量采用进口抗生素;(3)为降低TKR术后较高的血栓发生率,术后普遍使用抗凝药物;(4)对术后康复的重视。降低的因素为:(1)抗生素应用转为以预防感染为目的,采用国产化和短期化;(2)术前准备和手术技术的完善使床位周转率加快导致床位费大幅下降;(3)普遍采用术前预存血及术后自体引流血回输技术使输血费下降。结论经过对近十年TKR医疗费用组成的分析,假体费所占比例最大,假体更多还原

【Abstract】 Objective To analyze the composition of hospital cost for total knee replacement (TKR)in recent years in order to improve the effectiveness of TKR,reduce its complications and extend the TKR more widely in China.Methods The data was obtained for primary unilateral TKA performed in2001,1998,1995compared with that performed in1992in Peking University People’s Hospital.There were no postoperative complications and other surgical treatments during the hospitalization period.Results From1992through2001,prosthetic and physical therapy cost were predominantly increased214.2%and318.0%respectively in1998;219.8%and291.4%respectively in2001.The least cost was hospital room and blood transfusion fee.Among all the hospital costs in these four individual years,the most expensive was at-tributed to prosthesis cost,reached as54.7%,56.1%,56.0%and63.3%of total costs respectively.The influ-enced factors of the increasing hospital costs for TKR were as following:1)The using of imported knee im-plants increased in achieving better post-operative function of knee;2)The expensive imported antibiotic was widely used because of high drug-resistance due to the abuse of antibiotics;3)The anti-coagulative drugs on account of reducing the incidence of post-operative DVT was widely accepted;4)The emphasis on physical therapy was more considered.The possible factors of the decreasing hospital costs for TKR were using less expensive home-made antibiotics in short time just to prevent infections,reducing the length of hospital stay by enough preparation before operation,improving surgical technique and adopting preoperative blood salvage and re-transfusion to reduce the blood transfusion cost.Conclusion Through the analysis of total hospi tal cost of TKR in recent ten years,the prosthesis cost accounted for the most proportion,and the in crease of the hospital cost was attributed to prosthesis,anti-coagulative drugs,antibiotics and physical ther-apy.At same time,the average postoperative ROM of knee increased from93.6°to112.3°,and the in ci-dence of compli cations decreased from10.3%to5.3%.The better result of TKR,satisfactory knee function and the life quality of patient were obtained.更多还原