列线图预测股骨转子间骨折患者下肢深静脉血栓形成的研究

Nomogram for predicting deep vein thrombosis in the lower extremity of intertrochanteric femoral fractures

目的 调查股骨转子间骨折术后下肢深静脉血栓 (deep venous thromboses,DVT) 形成的独立危险因素,据此建立列线图预测模型。方法 收集 2018 年 1 月至 2022 年 12 月,三甲医院经治的股骨转子间骨折患者的数据,采用单因素和多因素 Logistic 回归分析,确定股骨转子间骨折术后下肢 DVT 形成的独立危险因素,并建立对应的列线图。绘制接收机工作特性 (ROC) 曲线并计算曲线下面积,并且绘制校正曲线和决策曲线评估模型性能。结果 646 例股骨转子间骨折患者纳入研究,有 161 例术后发生血栓,发生率为 24.77%。经过单因素和多因素 Logistic 回归分析,共有 5 个变量确定为股骨转子间骨折术后下肢 DVT 形成独立危险因素,分别为年龄 > 75 岁 (OR,1.978;95% CI,1.060~3.691),体质量指数 (body mass index,BMI) >24 (OR,2.637;95% CI,1.133~6.139),术前患有糖尿病 (OR,2.286;95% CI,1.143~4.569),受伤方式为高能量损伤 (OR,2.647;95% CI,1.414~4.953),骨折至手术时间 > 48 h (OR,6.258;95% CI,2.218~17.658)。结论 本次研究构建的股骨转子间骨折术后下肢 DVT 形成的列线图具有良好的预测精度,有助于骨科医师对股骨转子间骨折术后发生下肢 DVT 高危患者提前干预。

Objective To investigate the independent risk factors for lower limb deep vein thrombosis after intertrochanteric femoral fracture and to establish a nomogram prediction model accordingly.Methods Data from patients with intertrochanteric femoral fractures in the Affiliated Hospital of Xinjiang Medical University from January 2018 to December 2022 were collected,and one-way and multi-way logistic regression analyses were used to determine the independent risk factors for DVT formation in the lower limbs after intertrochanteric femoral fracture surgery,and to establish the corresponding nomogram.Receiver operating characteristic curves were plotted,the area under the curve was calculated,and the calibration and decision curves were plotted to evaluate the model performance.Results A total of 646 patients with intertrochanteric femoral fractures were included in the study,and 161 patients developed postoperative thrombosis,with an incidence of 24.77%.After univariate and multifactorial logistic regression analysis,a total of 5 variables were identified as independent risk factors for DVT formation in the lower extremity after intertrochanteric femoral fracture,including namely age > 75 years (OR,1.978;95% CI,1.060-3.691),body mass index (BMI) > 24 (OR,2.637;95% CI,1.133-6.139),preoperative diabetes mellitus (OR,2.286;95% CI,1.143-4.569),injury mode of high-energy injury (OR,2.647;95% CI,1.414-4.953),and fracture-to-operation time > 48 h (OR,6.258;95% CI,2.218-17.658).Conclusions The nomogram for lower extremity deep vein thrombosis after intertrochanteric femoral fracture constructed in this study has good predictive accuracy which will help orthopedic surgeons to intervene earlier for patients at high risk of lower extremity deep vein thrombosis after intertrochanteric femoral fracture surgery.