老年股骨颈骨折患者行髋关节置换术后静脉血栓栓塞症预测模型的构建

Construction of Predictive Model for Venous Thromboembolism after Hip Replacement in Elderly Patients with Femoral Neck Fracture

目的分析老年股骨颈骨折患者行全髋(HTA)或半髋关节置换术(HA)后新发静脉血栓栓塞症(VTE)的危险因素,建立老年股骨颈骨折行髋关节置换后VTE风险的预测模型,并分析其预测效能.方法选取老年股骨颈骨折后行髋关节置换术患者101例为研究对象,其中,术后新发VTE的25例患者为VTE组,76例术后无VTE的患者为对照组.首先通过单因素分析髋关节置换术后发生VTE的相关因素,并将具有统计学意义(P<0.05)的指标纳入多因素Logistic回归模型分析,筛选出影响患者髋关节置换术后发生VTE的危险因素,建立风险预测模型.然后通过应用受试者工作特征(Receiver Operating Characteristic,ROC)曲线分析其预测效能,最后应用Hosmer-Lemeshow评价其预测效能.结果纳入分析的101例患者中,25例(24.8%)患者为新发VTE病例,回归分析结果显示:糖尿病、应用骨水泥、Caprini评分是老年患者髋关节置换术后新发VTE的独立危险因素(P<0.05),行主、被动功能锻炼是老年患者髋关节置换术后新发VTE的保护因素(P<0.05),基于以上4个指标构建的预测模型曲线下面积(Area Under Curve,AUC)为0.970,约登指数最大值为0.868,此时该模型灵敏度为96.0%,特异度为90.8%,截断值为-0.8635.Hosmer-Lemeshow检验结果显示:模型的预测效能为91.09%,模型拟合良好.结论建立的风险预测模型对VT E风险预测效果良好,有助于骨科医师预测老年股骨颈骨折患者行髋关节置换术后新发VTE的高风险人群.

Objective To analyze the risk factors of new venous thromboembolism(VTE)after total or hemihip arthroplasty in elderly patients with femoral neck fracture,establish a prediction model for the risk of VTE after hip arthroplasty in elderly patients with femoral neck fracture,and analyze its predictive efficacy.MethodA total of 101 elderly patients undergoing hip replacement after femoral neck fracture were selected as the study subjects.Among them,25 patients with new postoperative VTE were included in the VTE group,and 76 patients without postoperative VTE were included in the control group.First,the related factors of VTE after hip arthroplasty were analyzed by univariate analysis,and the indicators with statistical significance(P<0.05)were included in the multivariate Logistic regression model for screening out the risk factors affecting the occurrence of VTE after hip arthroplasty,and the risk prediction model was established.Then,the receiver operating characteristic(ROC)curve was applied to analyze the predictive performance,and Hosmer-Lemeshow was used to evaluate the predictive performance.Results101 patients included in the analysis,25 cases(24.8%)had recurrence.The regression analysis showed that diabetes,bone cement use and Caprini score were independent risk factors for new VTE after hip replacement in elderly patients(P<0.05),active and passive functional exercise was a protective factor for new VTE after hip replacement in elderly patients(P<0.05),the area under curve(AUC)of the prediction model based on the above four indexes was 0.970,and the maximum value of Youden index was 0.868.At this time,the sensitivity,specificity and cutoff value of the model were 96.0%,90.8%and-0.8635.Hosmer-Lemeshow test results showed that the prediction efficiency of the model was 91.09%,and the model fit well.ConclusionThe risk prediction model has good effect on VTE risk prediction,can help orthopedic surgeons predict line in elderly patients with femoral neck fracture after hip replacement new VTE high-risk population.