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中华关节外科杂志(电子版) ›› 2022, Vol. 16 ›› Issue (06) : 677 -682. doi: 10.3877/cma.j.issn.1674-134X.2022.06.005

临床论著

预测老年股骨粗隆间骨折术后并发症的列线图模型构建
唐小花1,(), 孙建霞1, 王君1, 王美青1   
  1. 1. 212300 江苏省丹阳市人民医院
  • 收稿日期:2021-11-05 出版日期:2022-12-01
  • 通信作者: 唐小花
  • 基金资助:
    江苏省医院协会2017年度医院管理创新研究立项课题(JSYGY-3-2017-17)

Construction of nomogram model for risk prediction of postoperative complications of intertrochanteric femoral fracture in elderly

Xiaohua Tang1,(), Jianxia Sun1, Jun Wang1, Meiqing Wang1   

  1. 1. Department of Outpatient Department, Danyang People′s Hospital, Jiangsu Province, Danyang 212300, China
  • Received:2021-11-05 Published:2022-12-01
  • Corresponding author: Xiaohua Tang
引用本文:

唐小花, 孙建霞, 王君, 王美青. 预测老年股骨粗隆间骨折术后并发症的列线图模型构建[J/OL]. 中华关节外科杂志(电子版), 2022, 16(06): 677-682.

Xiaohua Tang, Jianxia Sun, Jun Wang, Meiqing Wang. Construction of nomogram model for risk prediction of postoperative complications of intertrochanteric femoral fracture in elderly[J/OL]. Chinese Journal of Joint Surgery(Electronic Edition), 2022, 16(06): 677-682.

目的

构建影响老年股骨粗隆间骨折术后并发症的列线图模型,并评估模型的区分度和一致性。

方法

回顾性分析2016年3月至2021年3月丹阳市人民医院因股骨粗隆间骨折入院506例患者,符合股骨粗隆间骨折特征,低能量骨折损伤,8 h内接受手术治疗;排除肝、肾功能异常及恶性肿瘤患者,存在髋关节炎、股骨头坏死、骨发育障碍。患者均行Gamma髓内钉闭合复位内固定术治疗,并根据术后1个月内是否出现并发症分为并发症组(76例)和无并发症组(430例)。收集临床资料,采用单因素及多因素logistic回归法筛选影响老年股骨粗隆间骨折患者术后并发症的危险因素;采用R软件构建预测术后并发症的列线图模型,并使用受试者工作特征(ROC)曲线及校准曲线验证列线图模型的区分度和一致性。

结果

老年股骨粗隆间骨折患者术后并发症发生率为15%(76/506)。多因素logistic回归分析结果显示,糖尿病[优势比(OR)=1.823,95%置信区间(CI)=(1.083,3.069)]、术中出血量≥118 ml[OR=3.348,95%CI=(1.828,6.134)]、麻醉时间≥154 min [OR=1.951,95%CI=(1.122,3.392)]、伤前身体状况(Ⅲ~Ⅵ级)[OR=1.740,95%CI=(1.017,2.977)]是影响患者术后并发症的危险因素(均为P<0.05)。构建的列线图预测模型具有较好的区分度[ROC曲线下面积(AUC)= 0.725,95%CI=(0.663,0.786)]和一致性(Hosmer-Lemeshow拟合优度检验:χ2=7.119,P=0.524)。

结论

本研究构建的预测老年股骨粗隆间骨折患者术后并发症的列线图模型,具有较好的区分度和一致性。

Objective

To construct a nomogram model that affects postoperative complications of intertrochanteric femoral fracture in the elderly, and to evaluate the distinction and consistency of the model.

Methods

A total of 506 patients with intertrochanteric femoral fracture who were treated in Danyang People′s Hospital from March 2016 to March 2021 were included in the study for retrospective analysis. These patients were all low energy fracture injuries and received surgical treatment by closed reduction and Gamma intramedullary nail fixation within eight hours. The patients with hepatic or renal dysfunction, malignant tumor, hip arthritis, femoral head necrosis, and bone development disorder were excluded. According to whether complications occurred within one month after surgery, the patients were divided into the complication group (76 cases) and the non-complication group (430 cases). Univariate and multivariate logistic regression were used to analyze clinical data and screen the risk factors of postoperative complications in the elderly patients with intertrochanteric femoral fracture. Soft R was applied to structure a nomograph model to predict the postoperative complications of elderly patients with intertrochanteric femoral fracture, and the receiver operating characteristic (ROC) curve and calibration curve of subjects were used to verify the discrimination and consistency of the model.

Results

The postoperative complication rate of elderly patients with intertrochanteric femoral fracture was 15% (76/506). Multivariate logistic regression analysis showed that diabetes [odds ratio (OR)=1.823, 95% confidence interval (CI)=(1.083, 3.069)], intraoperative blood loss≥118 ml [ OR=3.348, 95%CI=(1.828, 6.134)], anesthesia time≥154 min [OR=1.951, 95%CI=(1.122, 3.392)], and pre-injury physical condition (grade Ⅲ~Ⅵ) [OR=1.740, 95%CI=(1.017, 2.977)] were the risk factors for postoperative complications in the elderly patients with intertrochanteric femoral fracture (all P<0.05). The constructed nomogram prediction model had good discrimination [the area under the ROC curve(AUC)= 0.725, 95%CI=(0.663, 0.786)] and consistency (Hosmer-Lemeshow goodness of fit test: χ2=7.119, P=0.524).

Conclusion

The nomogram model constructed in this study to predict postoperative complications of elderly patients with intertrochanteric femoral fracture has good discrimination and consistency.

表1 老年股骨粗隆间骨折患者术后并发症的单因素分析
因素 总人数 并发症组 无并发症组 χ2 P
例数 506 76 430
TNF-α [μg/L,(±s)] 27.73±7.18 26.47±6.55 t=1.523 >0.05
IL-6 [ng/L,(±s)] 46.63±9.67 45.72±10.28 t=0.718 >0.05
IL-10 [ng/L,(±s)] 8.73±2.36 9.18±2.52 t=-1.448 >0.05
髋骨骨密度[g/cm2,(±s)] 0.77±0.11 0.79±0.13 t=-1.263 >0.05
年龄[例(%)]
<67岁 169 14(8.28) 155(91.72) χ2=9.020 0.003
≥67岁 337 62(18.40) 275(81.60)
性别[例(%)]
262 43(16.41) 219(83.59)
244 33(13.52) 211(86.48) χ2=0.825 >0.05
BMI [例(%)]
<28.0 kg/m2 268 46(17.16) 222(82.84) χ2=2.053 >0.05
≥28.0 kg/m2 238 30(12.61) 208(87.39)
高血压[例(%)]
226 40(17.70) 186(82.30) χ2=2.297 >0.05
280 36(12.86) 244(87.14)
糖尿病[例(%)]
162 42(25.93) 120(74.07) χ2=22.206 <0.001
344 34(9.88) 310(90.12)
慢性阻塞性肺疾病[例(%)]
25 6(24.00) 19(76.00) χ2=1.662 >0.05
481 70(14.55) 411(85.45)
骨量减少或骨质疏松[例(%)]
261 46(17.62) 215(82.38)
245 30(12.24) 215(87.76) χ2=2.865 >0.05
骨折分型[例(%)]
144 15(10.42) 129(89.58)
164 22(13.41) 142(86.59)
74 16(21.62) 58(58.38) χ2=6.534 >0.05
73 13(17.81) 60(82.19)
51 10(19.61) 41(80.39)
不稳定型骨折[例(%)]
304 54(17.76) 250(82.24) χ2=4.490 0.034
202 22(10.89) 180(89.11)
术中出血量[例(%)]
<118 ml 238 26(10.92) 212(89.08)
≥118 ml 268 50(18.66) 218(81.34) χ2=5.905 0.015
手术时间[例(%)]
<86 min 230 23(10.00) 207(90.00)
≥86 min 276 53(19.20) 223(80.80) χ2=8.324 0.004
麻醉时间[例(%)]
<154 min 237 22(9.28) 215(90.72)
≥154 min 269 54(20.07) 215(79.93) χ2=11.496 0.001
伤前身体状况[例(%)]
Ⅰ~Ⅱ级 244 28(11.48) 216(88.52)
Ⅲ~Ⅵ 262 48(18.32) 214(81.68) χ2=4.638 0.031
表2 老年股骨粗隆间骨折患者术后并发症的多因素分析
图1 预测老年股骨粗隆间骨折术后并发症的列线图模型建立
图2 列线图模型预测术后并发症的ROC(受试者工作特征曲线)
图3 列线图模型预测术后并发症的校准曲线注:actual probablility-实际概率;predicted Pr-预测概率
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