骨质疏松性老年股骨转子间骨折患者股骨近端防旋髓内钉内固定术后再骨折的危险因素分析及预测模型建立

Analysis of risk factors for refracture after proximal femoral nail antirotation internal fixation in elderly patients with osteoporotic intertrochanteric femur fractures and establishment of a prediction model

目的:探讨骨质疏松性老年股骨转子间骨折患者股骨近端防旋髓内钉(PFNA)内固定术后再骨折的危险因素,建立列线图预测模型。方法:回顾性分析2018年1月至2022年2月于蚌埠医科大学附属泰兴市人民医院行PFNA内固定术治疗的123例患者的临床资料。根据术后患者患侧是否发生内固定物周围再骨折分为再骨折组(18例)和未再骨折组(105例)。收集并记录患者性别、年龄、身高、体重、体重指数(BMI)、是否合并内科慢性疾病、Singh指数、骨折分型、骨折复位情况、开始负重时间、尖顶距(TAD)、是否进行抗骨质疏松治疗、外侧壁厚度及内侧壁复位状态。采用单因素分析和多因素logistic回归分析确定术后再骨折的独立危险因素,建立预测模型并验证。结果:单因素分析结果提示,年龄、合并内科慢性疾病、Singh指数、TAD、抗骨质疏松治疗、外侧壁厚度均为影响PFNA内固定术后患者再骨折的相关因素(P均<0.05)。多因素logistic回归分析结果显示,合并内科慢性疾病、Singh指数Ⅰ~Ⅲ级、TAD≥25 mm、不进行抗骨质疏松治疗、外侧壁厚度≤21 mm是骨质疏松性老年股骨转子间骨折患者PFNA内固定术后再骨折的独立危险因素(P均<0.05)。基于多因素logistic回归分析的结果,建立列线图,并进行内部验证。受试者操作特征(ROC)曲线分析显示曲线下面积(AUC)为0.965(95%CI:0.927~1.000),显示出良好的区分度。校准曲线显示模型具有良好的预测能力。结论:合并内科慢性疾病、Singh指数Ⅰ~Ⅲ级、TAD≥25mm、不进行抗骨质疏松治疗、外侧壁厚度≤21mm是骨质疏松性老年股骨转子间骨折患者PFNA内固定术后再骨折的独立危险因素。基于这些关键危险因素建立的预测模型能够精确评估PFNA内固定术后再骨折的发生风险,临床应用价值显著,值得推广。

Objectives:To identify the risk factors for refracture after proximal femoral nail antirotation(PFNA)internal fixation in elderly patients with osteoporotic intertrochanteric femur fractures,and to develop a predictive nomogram model.Methods:A retrospective analysis was conducted on clinical data of 123 patients who underwent PFNA internal fixation at Taixing People's Hospital Affiliated to Bengbu Medical University.Patients were divided into refracture(18 cases)and non-refracture(105 cases)groups based on postoperative peri-implant refracture.Demographic and clinical data were collected,including sex,age,height,weight,body mass index(BMI),the presence of chronic internal disease,Singh index,fracture classification,fracture reduction status,time to weightbearing,tip-apex distance(TAD),anti-osteoporosis treatment,thickness of the lateral wall and medial wall reduction status.Univariate and multivariate logistic regression analysis was conducted to identify the independent risk factors for refracture,and to establish and validate a predictive model.Results:Univariate logistic regression analysis identified that age,the presence of chronic internal disease,Singh index,TAD,anti-osteoporosis treatment and lateral wall thickness were related factors affecting refracture after PFNA internal fixation(all P<0.05).These factors were subsequently included in the multivariate logistic regression analysis.The results confirmed that the presence of chronic internal disease,Singh index,TAD,anti-osteoporosis treatment,and lateral wall thickness were independent risk factors for refracture(all P<0.05).A nomogram was established based on the results of the multivariate logistic regression and internally validated.The ROC analysis revealed that the AUC of the nomogram was 0.965(95%CI:0.927-1.000),indicating excellent discrimination.The calibration curve showed good predictive ability of the model.Conclusions:The presence of chronic internal diseases,Singh index,TAD,anti-osteoporosis treatment,and lateral wall thickness are independent risk factors for refracture after PFNA internal fixation in elderly patients with osteoporotic intertrochanteric fractures.The predictive model based on these key risk factors can accurately assess the risk of refracture,and holds significant clinical value with potential for widespread application.