影响股骨颈骨折患者术后出现股骨头坏死的相关因素分析及列线图预测模型的构建

Analysis of factors affecting the postoperative development of femoral head necrosis in patients with femoral neck fracture and construction of a nomogram predictive model

目的分析影响股骨颈骨折患者术后出现股骨头坏死的相关因素,并构建列线图预测模型。方法采用回顾性研究的方法,选取2019年6月至2021年10月海南省中医院收治的180例股骨颈骨折患者为研究对象,根据患者是否发生股骨头坏死分为发生组75例和未发生组105例。采用受试者工作特征(ROC)曲线分析预测价值;采用Logistic回归分析影响患者术后出现股骨头坏死的危险因素;采用内部数据验证列线图模型临床效能。结果两组年龄、性别构成、体质量指数等一般资料比较差异无统计学意义(P>0.05);与未发生组比较,发生组患者Garden骨折分型大多为Ⅲ或Ⅳ型,术前牵引、骨折移位、复位质量不满意者较多,创伤至手术时间较长(P>0.05);创伤至手术时间的曲线下面积为0.766(95%CI 0.697~0.826),最佳截断值为42 h;Garden骨折分型(Ⅲ或Ⅳ型)、术前牵引(是)、骨折移位(是)、复位质量(不满意)、创伤至手术时间(>42 h)是影响股骨颈骨折患者术后出现股骨头坏死的危险因素(P<0.05);列线图模型预测患者术后出现股骨头坏死的风险C-index为0.802(95%CI 0.692~0.873);模型预测患者术后出现股骨头坏死的风险阈值>0.09,列线图模型提供临床净收益。结论Garden骨折分型(Ⅲ或Ⅳ型)、术前牵引(是)、骨折移位(是)、复位质量(不满意)、创伤至手术时间(>42 h)是影响股骨颈骨折患者术后出现股骨头坏死的危险因素,且基于变量构建的列线图模型有较好的预测能力。

Objective To analyze the related factors that affect the occurrence of femoral head necrosis in patients with femoral neck fracture after surgery,and to build a nomogram predictive model.Methods Using a retrospective study method,180 patients with femoral neck fracture who were admitted to Hainan Provincial Hospital of Traditional Chinese Medicine from June 2019 to October 2021 were selected as the study objects.According to whether the patients had femoral head necrosis,they were divided into the occurrence group(75 cases)and the non occurrence group(105 cases).The receiver operating characteristic(ROC)curve was used to analyze the predictive value;Logistic regression was used to analyze the risk factors of postoperative femoral head necrosis;internal data were used to verify the clinical efficacy of nomogram model.Results There was no significant difference in age,sex,body mass index and other general data between the two groups(P>0.05);compared with the non occurrence group,Garden fracture in the occurrence group was mostly classified as typeⅢorⅣ,and more patients with preoperative traction,fracture displacement and unsatisfactory reduction quality,and the time from trauma to surgery was longer(P>0.05).The area under curve of the time from trauma to surgery was 0.766(95%CI 0.697 to 0.826),and the optimal cutoff value was 42 h;Garden fracture classification(typeⅢorⅣ),preoperative traction(yes),fracture displacement(yes),reduction quality(unsatisfactory)and time from trauma to surgery(>42 h)were the risk factors affecting the postoperative femoral head necrosis in patients with femoral neck fracture(P<0.05).The risk of femoral head necrosis predicted by nomogram model was 0.802(95%CI 0.692 to 0.873).The risk threshold of femoral head necrosis predicted by the model was>0.09,and nomogram model provides clinical net income.ConclusionsGarden fracture classification(typeⅢorⅣ),preoperative traction(yes),fracture displacement(yes),reduction quality(unsatisfactory)and time from trauma to surgery(>42 h)are the risk factors affecting the postoperative femoral head necrosis in patients with femoral neck fracture,and the nomogram model based on variables has a better predictive ability.