恒前牙外伤冠折露髓患儿术后预后不良的危险因素分析及模型构建

Analysis of risk factors and model construction of poor prognosis in children with permanent anterior tooth trauma with crown fracture

目的探究断冠再接术联合活髓切断术治疗儿童恒前牙外伤冠折露髓不良预后的危险因素,同时基于筛选出的危险因素构建风险列线图模型,并对构建的模型进行验证。方法选取98例儿童恒前牙外伤冠折露髓患儿为研究对象,均为2020年1月至2023年12月间在本院行断冠在接术联合活髓切断术治疗者。将受试者根据预后结果分为预后良好组和预后不良组,收集两组患儿临床资料,筛选患儿术后预后不良的危险因素。基于危险因素构建预后不良风险列线图模型,并对构建的模型进行验证。结果98例患儿中有18例发生预后不良,预后不良率为18.37%(18/98)。预后不良组牙髓暴露时间>24 h、牙龈炎、露髓孔直径>1 mm、口腔溃疡、牙周炎、牙根发育程度(根尖接近形成)占比高于预后良好组(P<0.05)。牙髓暴露时间>24 h、牙龈炎、牙周炎、牙根发育程度(根尖接近形成)均是影响恒前牙外伤冠折露髓患儿术后预后不良的危险因素(P<0.05)。列线图风险模型预测恒前牙外伤冠折露髓患儿术后预后不良受试者工作特征(ROC)曲线下面积(AUC)、95%CI、灵敏度、特异度分别为0.868、0.633~0.992、95.10%、79.30%(P<0.001)。列线图预测模型C指数为0.842(95%CI:0.789~0.994),预测值与实际预测值均在理想曲线附近,且Hosmer-Lemeshow拟合优度曲线检验χ^(2)=2.743,P=0.671。结论本研究综合牙髓暴露时间、牙龈炎、牙周炎、牙根发育程度等4个危险因素构建的风险列线图模型对患儿预后不良具有较高的预测价值。

Objective To explore the risk factors for poor prognosis of crown fracture and pulp exposure in children with permanent anterior tooth trauma treated by crown regrafting combined with living pulp amputation,and to establish a risk curve model based on the screened risk factors,and to verify the constructed model.Methods A total of 98 children with permanent anterior tooth injury with crown fracture and pulp exposure were selected as study subjects.All of the patients were treated in the hospital during the period from January 2020 to December 2023 with crown fracture combined with live pulp amputation.The subjects were divided into good prognosis group and poor prognosis group according to prognosis results.Clinical data of the children in the 2 groups were collected and the risk factors of poor prognosis were screened.A risk nomogram model for poor prognosis was constructed based on risk factors,and the constructed model was validated.Results Among the 98 cases,18 cases had poor prognosis,and the poor prognosis rate was 18.37%(18/98).The proportion of pulp exposure time>24 h,gingivitis,diameter of exposed pulp hole>1 mm,oral ulcer,periodontitis,and root development degree(near apical formation)in poor prognosis group was higher than that in good prognosis group(P<0.05).Pulp exposure time>24 h,gingivitis,periodontitis,root development degree(apical close formation)were all risk factors for poor prognosis in children with permanent anterior tooth trauma(P<0.05).The area under receiver operating characteristic(ROC)curve(AUC),95%CI,sensitivity and specificity were 0.868,0.633-0.992,95.10%and 79.30%(P<0.001),respectively.The C index of the nomogram prediction model was 0.842(95%CI:0.789~0.994),and both the predicted and actual predicted values were near the ideal curve,and the Hosmer-Lemeshow goodness of fit curve testχ^(2)=2.743,P=0.671.Conclusion In this study,the risk nomographic model constructed by integrating 4 risk factors,such as pulp exposure time,gingivitis,periodontitis and root development degree,it has a high predictive value for poor prognosis of children.