摘要
目的:探讨膝骨关节炎患者经过人工全膝关节置换术后深静脉血栓形成(DVT)的影响因素并构建Nomogram预测模型。方法:选取2020年12月至2022年12月来我院就诊并接受人工全膝关节置换术的120例膝骨关节炎患者为研究对象。根据术后是否有DVT发生将患者分为DVT组(n=20)及非DVT组(n=100)。采用受试者工作特征(ROC)曲线分析各影响因素对膝骨关节炎患者经人工全膝关节置换术后DVT发生的预测价值;采用多因素Logistic回归分析膝骨关节炎患者经过人工全膝关节置换术后DVT发生的影响因素;采用R语言软件4.0“rms”包构建膝骨关节炎患者经过人工全膝关节置换术后DVT发生的Nomogram预测模型,校正及决策曲线对列线图预测模型进行内部验证及临床预测效能评估。结果:DVT组与非DVT组在年龄、体重指数、合并糖尿病、合并高血脂、血浆D-二聚体水平、手术时间、术中出血量、术后卧床时间、麻醉方式方面比较差异均有统计学意义(P<0.05);ROC曲线结果显示,年龄、体重指数、血浆D-二聚体、手术时间、术中出血量、术后卧床时间的AUC为0.663、0.678、0.985、0.856、0.925、0.925;多因素Logistic回归分析显示,年龄≥71岁、体重指数≥25.47 kg/m2、合并糖尿病、合并高血脂、血浆D-二聚体水平≥0.69 mg/L、全麻为膝骨关节炎患者全膝关节置换术后DVT发生的独立危险因素(P<0.05)。列线图预测模型的校正曲线与原始曲线及理想曲线接近,C-index为0.813 (0.721~0.905),模型拟合度较高;列线图预测模型的阈值>0.17,可提供临床净收益,且临床净收益均高于年龄、体重指数、合并糖尿病、合并高血脂、血浆D-二聚体、麻醉方式。结论:膝骨关节炎患者经过人工全膝关节置换术后DVT发生的影响因素为年龄、体重指数、合并糖尿病、合并高血脂、血浆D-二聚体水平、手术时间、术中出血量、术后卧床时间、麻醉方式,以其作为预测因子构建的个性化列线图预测模型有助于膝骨关节炎患者在经过全膝关节置换术后是否发生DVT的预测评估,以期尽早干预,降低发生率,改善预后。
Objective:To investigate the factors influencing the occurrence of deep vein thrombosis(DVT)in patients with knee osteoarthritis after artificial total knee arthroplasty(TKA)and to construct a nomogram prediction model.Methods:A total of 120 patients with knee osteoarthritis underwent TKA from Dec 2020 to Dec 2022 were selected.The patients were divided into DVT group(n=20)and non-DVT group(n=100)according to whether DVT occurred after surgery.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of each influencing factor to the occurrence of DVT.Multivariable logistic regression was used to analyze the factors affecting the occurrence of DVT.The nomogram prediction model of DVT was constructed by the R software 4.0"rms"package.The calibration and decision curves were used to internally validate and clinically assess the predictive efficacy of the nomogram prediction model.Results:There were significant differences between DVT group and non-DVT group in age,body mass index(BMI),diabetes mellitus,hyperlipidaemia,plasma D-dimer level,operative time,intraoperative haemorrhage,post-operative bedrest,and anaesthesia modality(P<0.05).ROC curve showed that the AUC for age,BMI,plasma D-dimer,operative time,intraoperative haemorrhage,and postoperative bedrest were 0.663,0.678,0.985,0.856,0.925 and 0.925,respectively.Multivariable logistic regression analysis showed that age≥71 years old,BMI≥25.47 kg/m2,diabetes mellitus,hyperlipidaemia,plasma D-dimer level≥0.69 mg/L,and general anaesthesia were independent risk factors for postoperative DVT(P<0.05).The calibration curve of the nomogram prediction model was close to the original and ideal curves,with a C-index of 0.813(0.721-0.905),indicating a high degree of fit.The threshold value of the nomogram prediction model was>0.17,which could provide a net clinical benefit.And its net clinical benefit was higher than age,BMI,diabetes mellitus,hyperlipidemia,plasma D-dimer,and anaesthesia mode.Conclusions:The factors affecting the occurrence of DVT in patients with knee osteoarthritis after TKA are age,BMI,diabetes mellitus,hyperlipidaemia,plasma D-dimer level,operative time,intraoperative haemorrhage,postoperative bedtrest,and anaesthesia mode.The personalized neomorph prediction model constructed by these predictive factors can help to predict and evaluate whether DVT will be occurred in patients with knee osteoarthritis after TKA,so as to intervene early,reduce the incidence and improve the prognosis.
作者
刘鹏
王小鹏
胡林峰
LIU Peng;WANG Xiaopeng;HU Linfeng(Department of Orthopedics,Xinyu People's Hospital,Xinyu 338000,China)
出处
《沈阳医学院学报》
2025年第1期55-60,共6页
Journal of Shenyang Medical College
基金
新余市科技计划项目(No.20233090846)。
关键词
膝骨关节炎
人工全膝关节置换术
深静脉血栓形成
影响因素
knee osteoarthritis
artificial total knee arthroplasty
deep vein thrombosis
influencing factors
