胫骨平台骨折内固定术后骨不愈合的风险预测列线图模型构建研究

Establishment of nomogram model for predicting the risk of nonunion after internal fixation of tibial plateau fractures

目的探讨胫骨平台骨折内固定术后骨不愈合的因素,并构建风险预测列线图模型。方法回顾性分析禹州市人民医院2015年1月至2021年12月收治的342例胫骨平台骨折内固定术治疗患者的资料,将其分为建模集(n=228)和验证集(n=114)。采用Logistic回归分析研究患者术后骨不愈合的危险因素,建立风险预测列线图模型,并采用验证集数据对模型的区分度进行验证。结果骨不愈合发生率为11.99%,建模集和验证集中骨不愈合发生率分别为12.28%、11.40%;年龄、体重指数(BMI)、合并骨质疏松症、合并糖尿病、开放性骨折、粉碎性骨折、切开复位、术后骨折解剖情况差均是骨不愈合的危险因素(O^R=5.223、5.942、6.726、6.322、6.404、6.560、6.706、7.501,P<0.05),术后负重时间是其保护因素(O^R=0.578,P<0.05);基于以上结果建立骨不愈合的风险预测列线图模型,验证显示C-index值为0.852,且校正曲线与标准曲线拟合度良好;列线图模型预测骨不愈合的曲线下面积(AUC)为0.892,灵敏度为78.22%,特异度为100.00%。结论胫骨平台骨折内固定术后有骨不愈合风险,年龄、BMI、合并骨质疏松症、合并糖尿病、开放性骨折、粉碎性骨折、切开复位、术后骨折解剖情况差和术后负重时间均是其影响因素,基于此建立列线图模型的效能良好。

【Objective】To explore the factors of nonunion of tibial plateau fractures after internal fixation,and to construct a risk prediction nomograph model.【Methods】The data of 342 patients with tibial plateau fractures treated by internal fixation from January 2015 to December 2021 in the hospital were analyzed retrospectively,which were divided into modeling set(n=228)and verification set(n=114).Logistic regression analysis was used to study the risk factors of postoperative bone nonunion,and a risk prediction nomograph model was established.The model differentiation was verified by validation set data.【Results】The incidence of bone nonunion was 11.99%,12.28%in the modeling set and 11.40%in the verification set.Age,BMI,osteoporosis,diabetes,open fracture,comminuted fracture,open reduction,poor postoperative fracture anatomy were all risk factors for bone nonunion(O^R=5.223,5.942,6.726,6.322,6.404,6.560,6.706,7.501,P<0.05).Postoperative weight bearing time was the protective factor(O^R=0.578,P<0.05).Based on the above results,a nomograph model for predicting the risk of bone nonunion was established.The validation showed that the C-index value was 0.852,and the calibration curve was well fitted with the standard curve.The area under curve(AUC)of nomogram model for predicting bone nonunion was 0.892,the sensitivity was 78.22%,and the specificity was 100.00%.【Conclusion】There is a risk of bone nonunion after internal fixation of tibial plateau fractures.Age,BMI,osteoporosis,diabetes,open fractures,comminuted fractures,open reduction,poor fracture anatomy after surgery,and weight bearing time after surgery are all influencing factors.Based on this,the nomogram model is effective.