Clinical Efficacy And Health Economics Evaluation Of Kirschner Wire Tension Band Versus Patellar Ring For Patellar Fractures

Objective:To compare the cost-effectiveness of Kirschner wire tension band(KTB)versus patella ring(PR)for treatment of patellar fracture,and to provide a basis for selecting an economical and effective surgical method.Methods:According to the inclusion and exclusion criteria,a retrospective study was conducted on 99 patients who underwent surgical treatment for patellar fracture patients from January 2015 to August 2016 at our department.In term of surgical procedure performed,53 patients received open reduction and internal fixation(ORIF)with KTB,while the remaining 46 patients had ORIF with PR.The fracture healing time,postoperative complications,Bostman score postoperative of 1 and 2 years,visual analogue scale(VAS)for knee pain postoperative of 1 and 2 years and medical expenses were recorded and compared between the two groups.In addition,the cost minimization analysis(CMA)and cost-effectiveness analysis(CEA)were calculated and compared.The postoperative efficacy with different fracture types was compared between the two groups.Results:Although the KTB group had significantly higher postoperative complication rate,and significantly lower Bostman score at 1 year postoperatively than the PR group(P<0.05),no statistically significant differences regarding to the Bostman and VAS scores at 2 years were proved between the two groups(P>0.05).In patients with transverse fractures,there was no statistically significant difference in efficacy between the two groups(P>0.05).In comminuted fractures,the VAS score and Bostman score of postoperative of 1 years in the PR group were significantly better than KTB group(P<0.05),and there was no statistically significant difference between postoperative of 2 years(P>0.05).In term of medical expense,the KTB group consumed significantly less money in the primary hospitalization and the total medical services than the PR group(P<0.05),nevertheless the former paid significantly more fee for complication treatment than the latter(P<0.05).In term of CER,one point increment in Bostman score required to pay 431.93 Yuan in the KTB group,whereas 631.04 Yuan in the PR group.Conclusion:Both Kirschner wire tension band and patellar ring do achieve satisfactory long-term outcomes for patella fracture,by contrast,the Kirschner wire tension band might be a more cost-effective selection.