分析影响老年髋部骨折患者术后便秘的影响因素，并据此构建老年髋部骨折患者术后便秘的列线图模型，为个性化防治老年髋部骨折患者术后便秘提供帮助。

按纳入排除标准选取2020年2月至2022年2月期间淮安市第二人民医院手术治疗的髋部骨折患者131例。纳入标准：年龄≥60岁，骨折前可行走，等于或低于身体高度摔倒，伤后24 h内入院。排除标准：全身多处骨折或病理性骨折，濒危患者，合并多脏器损伤。根据术后是否便秘分为便秘组与非便秘组，比较两组间一般资料[性别、年龄、身体质量指数(BMI)]；既往病史(高血压、心脏病、糖尿病、脑血管疾病)；手术方式(骨钉修复、全髋关节置换、部分髋关节置换)；术中情况(麻醉方式、手术方式、手术时长、术中出血量)；术后卧床时间、是否使用益生菌等资料。根据logistic回归分析影响老年髋部骨折患者术后便秘的影响因素，采用R语言根据logistic筛选的影响因素构建评估髋部骨折患者术后便秘风险的列线图模型，并评估模型区分度与准确度。

131例患者发生便秘者为67例，便秘发生率为51.2%；便秘组与非便秘组性别、BMI、吸烟、饮酒、高血压、心脏病、糖尿病、脑血管疾病、手术方式、麻醉方式、手术时长、术中出血量比较差异无统计学意义(均为P>0.05)；与非便秘组相比，便秘组年龄、术前便秘比例、术后卧床时间升高、使用益生菌比例降低(t＝6.816、χ²＝35.503、t＝15.956、χ²＝40.663，均为P<0.05)；年龄增加、有术前便秘、术后卧床时间延长、未使用益生菌是影响髋部骨折患者术后便秘发生的危险因素[优势比(OR)＝1.251、22.365、10.220、0.030，均为P<0.05)]；以年龄、术后卧床时间、使用益生菌、术前便秘4项影响因素构建预测的列线图模型的区分度与准确度较高。

基于髋部骨折患者年龄、术后卧床时间、是否使用益生菌、术前是否便秘因素构建的列线图模型对髋部骨折患者术后是否发生便秘具有较高的预测价值，可为临床髋部骨折患者术后便秘的筛查提供帮助。

To analyze the influencing factors of postoperative constipation in elderly patients with hip fracture, and construct a nomograph model of postoperative constipation in elderly patients with hip fracture, so as to provide help for personalized prevention and treatment of postoperative constipation in elderly patients with hip fracture.

A total of 131 patients with hip fracture admitted to The Second People's Hospital of Huai'an Hospital from February 2020 to February 2022 were selected by inclusion and exclusion criteria. Inclusion criteria: age≥60 years, ambulatory before bone fractures, falling height ≤body height, admission is within 24h. Exclusion criteria: multiple fractures or pathologic fractures, patients in critical condition, multiple organ injuries. The enrolled patients were grouped into constipation group and non constipation group according to whether they were constipation after operation. The general data [gender, age, body mass index (BMI)], past medical history (hypertension, heart disease, diabetes, cerebrovascular disease), operation methods (bone nail repair, total hip replacement, partial hip replacement), intraoperative conditions (anesthesia mode, operation methods, operation duration, intraoperative blood loss), time in bed after operation, use of probiotics and other data were compared between the two groups. According to the logistic regression analysis, the influencing factors of postoperative constipation in elderly hip fracture patients were analyzed, the R language was applied to construct an nomograph model to evaluate the risk of postoperative constipation in patients with hip fracture according to the influencing factors screened by the statistics, and the model discrimination and accuracy were evaluated.

Sixty-seven of 131 patients had constipation, and the incidence of constipation was 51.2%; there was no obvious difference between constipation group and non constipation group in gender, BMI, smoking, drinking, hypertension, heart disease, diabetes, cerebrovascular disease, operation mode, anesthesia mode, operation duration and intraoperative blood loss (all P>0.05). Compared with the non-constipation group, age, proportion of constipation before surgery, and time in bed after surgery increased, and the proportion of probiotics usage decreased in the constipation group (t=6.816, χ²=35.503, t=15.956, χ²=40.663, all P<0.05). Advanced age, constipation before surgery, prolonged bed rest after surgery, and no probiotics were risk factors for postoperative constipation in patients with hip fracture [odds ratio(OR)=1.251, 22.365, 10.220, 0.030, all P <0.05]. The nomogram model based on age, bed time after operation, probiotics use, and preoperative constipation had a high discrimination and accuracy.

The nomograph model which is based on the age of patients with hip fracture, time in bed after operation, use of probiotics and constipation before operation, has a high predictive value for whether constipation will occure after hip fracture. The nomograph model can provide help for the screening of postoperative constipation in patients with hip fracture.