股骨颈骨折内固定术后并发股骨头坏死的风险预测

Risk Prediction of Femoral Head Necrosis After Internal Fixation of Neck of Femur Fractures

目的构建股骨颈骨折内固定术后并发股骨头坏死的风险预测模型,并对模型进行验证。方法回顾性分析2014年1月至2021年6月开封市中心医院收治的312例接受内固定术的股骨颈骨折患者的临床资料,将所有患者按照2∶1比例随机分为建模组(208例)和验证组(104例),统计患者术后股骨头坏死并发情况。采用多因素logistic回归分析筛选出并发股骨头坏死的危险因素,并构建列线图风险预测模型,采用受试者工作特征(ROC)曲线、校准曲线、决策曲线验证模型。结果312例患者术后共有56例并发股骨头坏死,并发率为17.95%;建模组和验证组临床资料差异无统计学意义(P>0.05);建模组中并发组与未并发组骨折原因、Garden分型、骨折线位置、骨折至手术时间、术前牵引、Garden对线指数、内固定物取出差异有统计学意义(P<0.05);多因素logistic回归分析结果显示,Garden分型Ⅲ~Ⅳ型、骨折至手术时间>48 h、术前牵引、Garden对线指数Ⅲ~Ⅳ级、内固定物取出均是建模组患者股骨颈骨折内固定术后并发股骨头坏死的危险因素(P<0.05)。依据危险因素构建列线图风险预测模型,ROC曲线显示,建模组和验证组预测的曲线下面积分别为0.814(0.745~0.872)、0.789(0.724~0.850);建模组和验证组一致性指数分别为0.862、0.847,两组校准曲线均与预测曲线走向一致并且贴近;决策曲线显示列线图模型在建模组、验证组中均具有良好的临床应用效果。结论基于骨折原因、Garden分型、骨折线位置、骨折至手术时间、术前牵引、Garden对线指数、内固定物取出构建了股骨颈骨折内固定术后并发股骨头坏死的风险预测列线图模型,该模型具有良好的区分度、校准度和临床应用效果。

Objective To construct a risk prediction model of femoral head necrosis after internal fixation of neck of femur fracture,and to verify the model.Methods The clinical data of 312 patients with neck of femur fracture treated by internal fixation in Kaifeng Central Hospital from January 2014 to June 2021 were retrospectively analyzed.All patients were randomly divided into the modeling group(208 cases)and the validation group(104 cases)according to a 2∶1 ratio,and the complications of postoperative femoral head necrosis were counted.Multiple logistic regression analysis was used to screen out the risk factors for concurrent femoral head necrosis,and a nomogram risk prediction model was constructed.The model was validated using the receiver operating characteristic(ROC)curve,calibration curve,and decision curve.Results A total of 56 out of 312 patients developed femoral head necrosis after surgery,with a complication rate of 17.95%.There was no statistically difference in clinical data between the modeling group and the validation group(P>0.05).There were statistically differences in the causes of fractures,Garden classification,fracture line position,fracture to surgery time,preoperative traction,Garden alignment index and removal of internal fixation between the concurrent group and non-concurrent group in the modeling group of patients(P<0.05).Multivariate logistic regression analysis showed that Garden classificationⅢ-Ⅳ,time from fracture to operation>48 hours,preoperative traction,Garden alignment indexⅢ-Ⅳand removal of internal fixator were risk factors for femoral head necrosis after internal fixation of neck of femur fracture in the modeling group(P<0.05).A nomogram risk prediction model was constructed based on risk factors.The ROC curve showed that the predicted areas under the curve for the modeling group and validation group were 0.814(0.745-0.872)and 0.789(0.724-0.850),respectively.The consistency indices of the modeling group and validation group were 0.862 and 0.847,respectively.The calibration curves of both groups were consistent and close to the predicted curves.The decision curve showed that the column chart model has good clinical application effects in both the modeling group and validation group.Conclusion A nomogram model for predicting the risk of femoral head necrosis after internal fixation of femoral neck fractures was constructed based on the causes of fractures,Garden classification,fracture line location,fracture to surgery time,preoperative traction,Garden alignment index and removal of internal fixators.The model has good discrimination,calibration,and clinical application effects.