摘要
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:χ^(2)=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(gradeⅢ~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:χ^(2)=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.
作者
唐小花
孙建霞
王君
王美青
Tang Xiaohua;Sun Jianxia;Wang Jun;Wang Meiqing(Department of Outpatient Department,Danyang People′s Hospital,Jiangsu Province,Danyang 212300,China)
出处
《中华关节外科杂志（电子版）》
CAS
CSCD
2022年第6期677-682,共6页
Chinese Journal of Joint Surgery(Electronic Edition)
基金
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)
关键词
股骨骨折
骨折固定术
内
手术后并发症
危险因素
列线图
Femoral fractures
Fracture fixation,internal
Postoperative complications
Risk factors
Nomogram
