中国组织工程研究 ›› 2023, Vol. 27 ›› Issue (18): 2915-2920.doi: 10.12307/2023.343

• 骨科植入物相关临床实践 Clinical practice of orthopedic implant • 上一篇    下一篇

老年股骨转子间骨折术后严重并发症预测模型的构建及验证

翁友林1,蔡  昱2,李祖涛2,郭  彬1,徐江波2   

  1. 1新疆医科大学研究生学院,新疆维吾尔自治区乌鲁木齐市   830000;2新疆维吾尔自治区人民医院创伤骨科,新疆维吾尔自治区乌鲁木齐市   830000
  • 收稿日期:2022-04-23 接受日期:2022-06-15 出版日期:2023-06-28 发布日期:2022-09-19
  • 通讯作者: 徐江波,硕士,主任医师,硕士生导师,新疆维吾尔自治区人民医院创伤骨科,新疆维吾尔自治区乌鲁木齐市 830000
  • 作者简介:翁友林,男,1987年生,河南省固始县人,汉族,新疆医科大学在读硕士,主治医师,主要从事创伤骨科方面的研究。

Construction and validation of a model for predicting postoperative severe complications of  intertrochanteric fracture in the elderly

Weng Youlin1, Cai Yu2, Li Zutao2, Guo Bin1, Xu Jiangbo2   

  1. 1Graduate School of Xinjiang Medical University, Urumqi 830000, Xinjiang Uygur Autonomous Region, China; 2Department of Traumatic Orthopaedics, People’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830000, Xinjiang Uygur Autonomous Region, China
  • Received:2022-04-23 Accepted:2022-06-15 Online:2023-06-28 Published:2022-09-19
  • Contact: Xu Jiangbo, Master, Chief physician, Master’s supervisor, Department of Traumatic Orthopaedics, People’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830000, Xinjiang Uygur Autonomous Region, China
  • About author:Weng Youlin, Master candidate, Attending physician, Graduate School of Xinjiang Medical University, Urumqi 830000, Xinjiang Uygur Autonomous Region, China

摘要:

文题释义:
股骨转子间骨折:发生在自髋关节囊外股骨颈基底部,沿小转子至髓腔近端区域的骨折,绝大多数转子间骨折发生在低能量损伤的老年人中,尽管防旋股骨近端髓内钉闭合复位内固定很大程度上解决了老年转子间骨折固定的生物力学问题,但术后并发症发生率仍然很高。
临床预测模型:是指利用多因素模型估算患有某病的概率或者将来某结局发生的概率。临床预测模型包括诊断模型和预后模型,此次研究主要通过诊断模型预测老年股骨转子间骨折发生术后严重并发症的概率,以便对患者进行风险分层,从而制定针对性治疗策略。

背景:准确的围术期风险预测至关重要,目前针对老年股骨转子间骨折术后发生严重并发症的预测模型较少,医生和患者的临床决策缺乏依据,此次研究旨在开发针对老年股骨转子间骨折发生术后严重并发症的列线图,指导围术期临床决策。
目的:探讨老年股骨转子间骨折发生术后严重并发症的危险因素,并构建风险预测模型。
方法:回顾性分析2019年1月至2022年4月新疆维吾尔自治区人民医院老年股骨转子间骨折患者519例的临床资料,记录纳入患者的人口特征、术前化验指标和手术变量,研究结局为术后是否发生严重并发症。采用向前逐步法及似然比检验进行最佳预测模型的筛选,通过受试者工作特征曲线、Hosmer-Lemeshow拟合优度检验、决策曲线分析对模型进行准确性和稳定性评估,并绘制诺莫图。
结果与结论:①美国麻醉医师协会分级、改良5项衰弱指数评分、C-反应蛋白与白蛋白比值、术前血红蛋白、年龄是老年股骨转子间骨折发生术后严重并发症的重要危险因素;②预测模型验证结果显示:建模组发生术后严重并发症的受试者工作特征曲线下面积为0.786,95%置信区间为0.722-0.850;验证组发生术后严重并发症的受试者工作特征曲线下面积为0.725,95%置信区间为0.640-0.808;③建模组和验证组Hosmer-Lemeshow拟合优度检验的P值分别为0.738和0.581,证明模型校准度良好;④决策曲线分析显示:当建模组和验证组的阈值概率分别为8%-58% 和 11%-54% 时,对老年股骨转子间骨折患者进行临床干预后可能受益;⑤此次研究提出了一种有效的预测模型,该模型有助于个体化预测老年股骨转子间骨折术后严重并发症的发生,帮助临床医师采取个性化治疗措施。

https://orcid.org/0000-0003-1582-307X (翁友林)

中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程

关键词: 股骨转子间骨折, 老年人, 术后严重并发症, 危险因素, 预测模型

Abstract: BACKGROUND: Accurate perioperative risk prediction is very important. At present, there are few prediction models for severe complications of intertrochanteric fracture in the elderly, and the clinical decision-making of doctors and patients lacks basis. The purpose of this study is to develop a nomogram for severe complications of intertrochanteric fracture in the elderly, and to guide the perioperative clinical decision-making.
OBJECTIVE: To explore the risk factors of severe postoperative complications of  intertrochanteric fracture in the elderly and to establish a risk prediction model. 
METHODS: A retrospective study was conducted on clinical data of 519 elderly patients with intertrochanteric fracture in the People’s Hospital of Xinjiang Uygur Autonomous Region from January 2019 to April 2022. The demographic characteristics, preoperative laboratory indicators and surgical variables of the included patients were recorded. Study outcome was the occurrence of serious complications after operation. The forward stepwise method and likelihood ratio test were used to screen the best prediction model. The accuracy and stability of the model were evaluated through the receiver operator characteristic curve, Hosmer-lemeshow goodness of fit test and decision curve analysis, and nomograms were drawn. 
RESULTS AND CONCLUSION: (1) American Society of Anesthesiologists classification, 5-factor Modified Frailty Index, ratio of C-reactive protein to albumin, preoperative hemoglobin, and age were important risk factors for serious postoperative complications of intertrochanteric fracture in the elderly. (2) The validation results of the predictive model showed that the area under the receiver operator characteristic curve of severe postoperative complications in the modeling group was 0.786, 95% confidence interval (0.722-0.850). The area under the receiver operator characteristic curve of severe postoperative complications in the validation group was 0.725, 95% confidence interval (0.640-0.808). (3) The P values of Hosmer-lemeshow goodness of fit test in modeling group and validation group were 0.738 and 0.581, respectively, which proved that the models were well calibrated. (4) Decision curve analysis showed that elderly patients with intertrochanteric fractures might benefit from clinical intervention when the threshold probabilities of the modeling group and validation group were 8%-58% and 11%-54%, respectively. (5) This study presents an effective prediction model, which is helpful to predict the occurrence of serious postoperative complications of elderly intertrochanteric fractures and help clinicians take personalized treatment measures.

Key words: Intertrochanteric fracture, aged, severe postoperative complication, risk factor, prediction model

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