中国组织工程研究

中国组织工程研究 ›› 2023, Vol. 27 ›› Issue (29): 4690-4695.doi: 10.12307/2023.650

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

膝骨关节炎患者跌倒恐惧影响因素分析及列线图模型构建

马  威1，2，庞  坚1，2，张洁帆1，2，许  坤1，2，王用玉1，2，张  旻1，2，陈  博1，2，石  瑛1，2，詹红生1，2   

  1. 1上海中医药大学附属曙光医院石氏伤科医学中心，上海市   201203；2上海市中医药研究院骨伤科研究所，上海市   201203
  • 收稿日期:2022-06-30 接受日期:2022-08-05 出版日期:2023-10-18 发布日期:2022-12-02
  • 通讯作者: 庞坚，主任医师，上海中医药大学附属曙光医院石氏伤科医学中心，上海市 201203；上海市中医药研究院骨伤科研究所，上海市 201203
  • 作者简介:马威，男，1994年生，甘肃省平凉市人，回族，上海中医药大学中医骨伤科学在读硕士，医师，主要从事骨与关节退行性疾病的研究。
  • 基金资助:
    国家自然科学基金项目(81674003)，项目负责人：庞坚；国家自然科学基金项目(81774340)，项目负责人：陈博；国家自然科学基金项目(81973875)，项目负责人：张旻；上海市慢性筋骨病临床医学研究中心项目(20MC1920600)，项目负责人：詹红生；上海市临床重点专科“中医骨伤科”项目(shslczdzk03901)，项目负责人：詹红生；全国中医学术流派传承工作室第二轮建设项目“石氏伤科”(SHDC2020CR1051B)，项目负责人：石瑛；上海申康医院发展中心临床三年行动计划项目(SHDC2020CR3090B)，项目负责人：詹红生

Analysis of influencing factors of fear of falling in patients with knee osteoarthritis and construction of nomogram model

Ma Wei1, 2, Pang Jian1, 2, Zhang Jiefan1, 2, Xu Kun1, 2, Wang Yongyu1, 2, Zhang Min1, 2, Chen Bo1, 2, Shi Ying1, 2, Zhan Hongsheng1, 2   

  1. 1Shi's Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China; 2Institute of Traumatology & Orthopedics, Shanghai Academy of Traditional Chinese Medicine, Shanghai 201203, China
  • Received:2022-06-30 Accepted:2022-08-05 Online:2023-10-18 Published:2022-12-02
  • Contact: Pang Jian, Chief physician, Shi's Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China; Institute of Traumatology & Orthopedics, Shanghai Academy of Traditional Chinese Medicine, Shanghai 201203, China
  • About author:Ma Wei, Master candidate, Physician, Shi's Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China; Institute of Traumatology & Orthopedics, Shanghai Academy of Traditional Chinese Medicine, Shanghai 201203, China
  • Supported by:
    the National Natural Science Foundation of China, No. 81674003 (to PJ); National Natural Science Foundation of China, No. 81774340 (to CB); National Natural Science Foundation of China, No. 81973875 (to ZM); a Project of Shanghai Clinical Research Center for Chronic Musculoskeletal Diseases, No. 20MC1920600 (to ZHS); Shanghai Key Clinical Specialty “Traditional Chinese Medicine Orthopedics” Project, No. shslczdzk03901 (to ZHS); The Second Round of Construction Project of “Shi’s Traumatology” National Traditional Chinese Medicine School Inheritance Studio, No. SHDC2020CR1051B (to SY); Clinical Three-Year Action Plan Project of Development Center of Shanghai Shenkang Hospital, No. SHDC2020CR3090B (to ZHS)

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摘要：


文题释义：

跌倒恐惧：是指进行某些活动时为了避免跌倒而出现的自我效能或信心降低，跌倒恐惧是老年人群中重要的健康问题，跌倒恐惧对老年人身体功能和生活质量有很大的影响。 
受试者工作特征曲线：又称ROC曲线，最初运用在军事上，现在更多应用在医学领域用来推断某个阳性事件诊断标准值的重要方法，ROC曲线下面积显示僵硬有显著的诊断价值，其面积的大小代表了此预测因素的临床准确性概率大小。

背景：跌倒恐惧会加重膝骨关节炎患者的膝关节不稳定性，导致患者减少活动而身体整体功能衰退，因此，对膝骨关节炎患者跌倒恐惧影响因素进行筛选及构建列线图模型，能够减少跌倒恐惧产生的伤害并为个体化诊疗方案制定提供借鉴。
目的：探讨膝骨关节炎患者跌倒恐惧的影响因素及状况，并尝试建立膝骨关节炎患者跌倒恐惧列线图预测模型。
方法：应用横断面研究方法，纳入2019年9月至2021年2月于上海中医药大学附属曙光医院就诊的膝骨关节炎患者560例，其中跌倒恐惧组469例，无跌倒恐惧组91例。分析比较两组患者一般资料、膝骨关节炎指数评分量表及医院焦虑抑郁量表评分后得出膝骨关节炎患者跌倒恐惧的影响因素，将影响因素绘制受试者工作特征曲线，得到具有跌倒恐惧诊断价值的约登指数，各因素约登指数最大值为膝骨关节炎跌倒恐惧的最佳诊断值(截断值)，绘制列线图，建立膝骨关节炎患者跌倒恐惧预测模型。
结果与结论：①Logistic回归分析表明，身高、男性为膝骨关节炎患者跌倒恐惧的保护因素，年龄、失业、膝骨关节炎指数僵硬量表评分、焦虑量表评分为膝骨关节炎患者跌倒恐惧的危险因素；②受试者工作特征曲线结果表明，膝骨关节炎指数僵硬量表评分对膝骨关节炎患者有显著的诊断价值(约登指数=0.733)，其次为年龄、焦虑、性别有一定诊断价值；③列线图结果表明，膝骨关节炎指数僵硬量表的最大评分(8分)可占膝骨关节炎跌倒恐惧预测因素的41.6%；④结果显示，膝骨关节炎患者具有较高的跌倒恐惧发生率，关节僵硬、女性可能是跌倒恐惧的风险因子，低身高可能是跌倒恐惧的保护因素，在临床治疗干预中有必要关注跌倒恐惧及相关因素的处理。
https://orcid.org/0000-0003-4065-0924(庞坚) 
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: 膝骨关节炎, 跌倒恐惧, 影响因素, 调查, 列线图模型

Abstract: BACKGROUND: Fear of falling will aggravate the instability of the knee joint in patients with knee osteoarthritis, leading to the reduction of activities and the decline of the overall body function. Therefore, screening the factors affecting the fear of falling in patients with knee osteoarthritis and constructing a nomogram model can reduce the injury caused by the fear of falling and provide a reference for the formulation of individualized diagnosis and treatment plans. 
OBJECTIVE: To explore the influencing factors and conditions of fear of falling in patients with knee osteoarthritis, and to establish a predictive model for the risk of fear of falling in patients with knee osteoarthritis. 
METHODS: A cross-sectional study method was used to enroll 560 patients with knee osteoarthritis who visited Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from September 2019 to February 2021. Among them, 469 were in the falling fear group and 91 were in the non-falling fear group. The general information of patients, the Western Ontario and McMaster Universities Arthritis Index, and the Hospital Anxiety and Depression Scale scores were analyzed and compared between the two groups to determine the influencing factors of the fear of falling in knee osteoarthritis patients. Receiver operating characteristic curves of the influencing factors were drawn to obtain the Youden’s index with diagnostic value for the fear of falling. The maximum value of the Youden index of each factor was the best diagnostic value (cutoff value) of the knee osteoarthritis fear of falling. A nomogram was drawn to establish the knee predictive model for the fear of falling in patients with knee osteoarthritis. 
RESULTS AND CONCLUSION: (1) Logistic regression analysis showed that height and male were the protective factors for the fear of falling in patients with knee osteoarthritis, and age, unemployment, Western Ontario and McMaster Universities Arthritis Index stiffness scale score, and anxiety scale score were the risk factors for the fear of falling in patients with knee osteoarthritis. (2) Receiver operating characteristic curve results showed that Western Ontario and McMaster Universities Arthritis Index had a significant diagnostic value for knee osteoarthritis patients (Youden’s index=0.733), followed by age, anxiety, and gender. (3) The results of the nomogram showed that the maximum score of the Western Ontario and McMaster Universities Arthritis Index stiffness scale (8 points) could account for 41.6% of the predictors of knee osteoarthritis fear of falling. (4) It is concluded that there is a high incidence of fear of falling among patients with knee osteoarthritis, and joint stiffness and female gender may be risk factors for fear of falling, while low height may be a protective factor for fear of falling, and there is a need to focus on fear of falling and the management of related factors in clinical treatment interventions. 

Key words: knee osteoarthritis, fear of falling, influencing factor, investigation, nomogram model

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