中国组织工程研究

中国组织工程研究 ›› 2024, Vol. 28 ›› Issue (21): 3380-3384.doi: 10.12307/2024.069

• 骨科植入物 orthopedic implant • 上一篇    下一篇

股骨转子间骨折行髓内钉治疗后营养风险预测模型的建立

张  强1，李大伟1，刘凝昊1，李倩茹1，郑颖洁1，张志峰2   

  1. 1包头医学院第二附属医院，内蒙古自治区包头市   014000；2内蒙古医科大学第二附属医院，内蒙古自治区呼和浩特市   010110
  • 收稿日期:2023-03-02 接受日期:2023-05-15 出版日期:2024-07-28 发布日期:2023-09-28
  • 通讯作者: 郑颖洁，在读博士，副主任医师，包头医学院第二附属医院，内蒙古自治区包头市 014000 张志峰，硕士，副主任医师，副教授，硕士生导师，内蒙古医科大学第二附属医院，内蒙古自治区呼和浩特市 010110
  • 作者简介:张强，男，1996年生，汉族，2021年西北民族大学毕业，硕士，医师，主要从事脊柱、关节方向的研究。 李大伟，男，1983年生，蒙古族，天津医科大学在读博士，副主任医师，主要从事脊柱微创方面的研究。
  • 基金资助:
    内蒙古自治区自然科学基金(2020MSO8144)，项目负责人：张志峰

Establishment of a nutritional risk prediction model for femoral intertrochanteric fractures treated with intramedullary nails

Zhang Qiang1, Li Dawei1, Liu Ninghao1, Li Qianru1, Zheng Yingjie1, Zhang Zhifeng2   

  1. 1Second Affiliated Hospital, Baotou Medical College, Baotou 014000, Inner Mongolia Autonomous Region, China; 2Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot 010110, Inner Mongolia Autonomous Region, China
  • Received:2023-03-02 Accepted:2023-05-15 Online:2024-07-28 Published:2023-09-28
  • Contact: Zheng Yingjie, Doctoral candidate, Associate chief physician, Second Affiliated Hospital, Baotou Medical College, Baotou 014000, Inner Mongolia Autonomous Region, China Zhang Zhifeng, Master, Associate chief physician, Associate professor, Master’s supervisor, Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot 010110, Inner Mongolia Autonomous Region, China
  • About author:Zhang Qiang, Master, Physician, Second Affiliated Hospital, Baotou Medical College, Baotou 014000, Inner Mongolia Autonomous Region, China Li Dawei, Doctoral candidate, Associate chief physician, Second Affiliated Hospital, Baotou Medical College, Baotou 014000, Inner Mongolia Autonomous Region, China
  • Supported by:
    Natural Science Foundation of Inner Mongolia Autonomous Region, No. 2020MSO8144 (to ZZF)

PDF

32

摘要：


文题释义：

股骨转子间骨折：好发于中老年骨质疏松症患者，多由间接暴力引起。临床表现为创伤史，转子区肿痛瘀斑，患肢短缩外展外旋90°畸形，局部压痛、叩击痛，下肢不能活动。非手术治疗卧床时间较长，并发症多，死亡率高，近几年多主张早期手术治疗。
营养风险：是指营养因素导致不良临床结局的风险，而营养风险只是指发生营养不良的风险，不涉及临床结局。营养风险概念的发展所基于的假设是营养支持不仅适用于已有营养不良的患者，而且也适用于由于疾病、手术或创伤导致的应激代谢状态，营养需要量增加的患者。


背景：股骨转子间骨折患者行近端防旋髓内钉内固定手术期间可能存在营养风险，根据营养评估工具建立临床预测模型。

目的：建立股骨转子间骨折行股骨近端防旋髓内钉内固定术后患者营养风险预测模型的列线图，并评价模型的准确性。
方法：回顾性选择2018年12月至2022年7月于包头医学院第二附属医院骨一科行股骨近端防旋髓内钉内固定治疗且符合标准的股骨转子间骨折患者为研究对象。运用营养风险筛查2002量表评估患者的营养风险状况。采用Logistic回归法建立模型，模型的区分度、校准度和临床适用度分别使用受试者工作特征曲线、Calibration plot校准曲线、Hosmer-Lemeshow拟合优度检验进行评价。使用Nomogram图将模型可视化。

结果与结论：①根据纳入标准共纳入76例患者，经营养风险筛查2002量表评估后营养风险的发生率为80%；②Logistic回归分析结果显示，年龄≥77岁、体质量指数< 22.80 kg/m2、上臂围< 25.01 cm、血红蛋白< 98.51 g/L、白蛋白< 31.61 g/L、前白蛋白< 138.56 g/L是术后患者营养风险发生的独立危险因素(P < 0.05)；③该模型中的受试者工作特征曲线面积为0.919(95%CI：0.843-0.994)；④拟合优度检验结果显示营养风险预测价值较高；⑤提示所构建的营养风险评估模型具有较好的区分度和校准度，具备一定的预测能力，可作为股骨转子间骨折患者行股骨近端防旋髓内钉内固定术后营养风险评估的参考工具。

https://orcid.org/0000-0001-6094-3762 (张强)

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, 股骨近端防旋髓内钉, 内固定, 营养风险, 风险评估

Abstract: BACKGROUND: Patients with femoral intertrochanteric fracture may have nutritional risks during proximal femoral nail anti-rotation surgery, and a clinical predictive model is established based on nutritional assessment tools.
OBJECTIVE: To establish the nomogram of the nutritional risk prediction model for patients with intertrochanteric fracture after proximal femoral nail anti-rotation fixation and evaluate the accuracy of the model.  
METHODS: From December 2018 to July 2022, patients with femoral intertrochanteric fractures who underwent proximal femoral nail anti-rotation fixation in First Department of Orthopedics, Second Affiliated Hospital of Baotou Medical College were selected as the study subjects. The nutritional risk status of patients was assessed using nutritional risk screening 2002. Logistic regression was used to build the model. The receiver operating characteristic curve, Calibration plot calibration curve, and Hosmer-Lemeshow goodness-of-fit test were used to evaluate the discrimination, calibration and clinical applicability of the prediction model. The model was visualized using Nomogram diagrams. 
RESULTS AND CONCLUSION: (1) Seventy-six patients were included according to the inclusion criteria. The incidence of nutritional risk was 80% after being assessed using nutritional risk screening 2002. (2) The results of Logistic regression analysis demonstrated that age ≥ 77 years old, body mass index < 22.80 kg/m2, upper arm circumference < 25.01 cm, hemoglobin < 98.51 g/L, albumin < 31.61 g/L, and prealbumin < 138.56 g/L were all independent risk factors for nutritional risk (P < 0.05). (3) The area under the receiver operating characteristic curve was 0.919 (95%CI: 0.843-0.994). (4) The results of the Hosmer-Lemeshow goodness-of-fit test displayed that nutritional risk prediction value was high. (5) It is concluded that the nutritional risk assessment model constructed in this study has a good degree of discrimination and calibration, and has a certain predictive ability, which can be used as a reference tool for nutritional risk assessment of patients after proximal femoral nail anti-rotation fixation.

Key words: femoral intertrochanteric fracture, proximal femoral nail anti-rotation, internal fixation, nutritional risk, risk assessment

中图分类号: