摘要
目的探讨股骨转子下骨折髓内钉术后骨折不愈合影响因素并构建风险评估模型。方法回顾性分析2006年2月至2018年1月于我院收治的251例股骨转子下骨折手术复位固定患者,根据收治时间不同,将纳入本研究的251例患者分为:①2006年2月至2014年2月纳入的为建模组,用于风险评估模型的构建;②2014年3月至2018年1月纳入的为验证组,用于风险评估模型效能的评价。建模组统计术后骨折不愈合率,患者的一般资料、骨折相关、手术复位相关、机械因素及生物学因素,采用单因素分析筛选骨折不愈合的影响因素。单因素分析存在统计学差异的指标,采用Logistics回归模型进行多因素分析,构建风险评估模型。通过验证组对影响因素再次评估,并对该模型的区分度和校准度进行评价。结果建模组149例患者中有34例发生骨折不愈合。在分析的13个潜在影响因素中通过单因素分析及logistic回归分析均显示术后髋内翻、髓内钉固定失效、完全切开复位为骨折不愈合危险因素,术后复位内侧皮质为骨折不愈合保护因素,并建立回归方程。以Logistic回归模型为基础,绘制列线图(又称诺莫,Nomogram图)。验证组102例中24例发生骨折不愈合,区分度检验:ROC曲线下面积为AUC=0.883>0.7,表明其有中等区分度评估术后骨折不愈合的发生。拟合优度检验:H-L检验(χ2=2.921,P=0.71>0.5)表明该模型具有较好的校准度。结论转子下骨折髓内钉术后髋内翻、髓内钉固定失效、完全切开复位为骨折不愈合的危险因素,术后复位内侧皮质为其保护因素。该风险评估模型有中等区分度以及较好的校准度,可为转子下骨折术后发生骨折不愈合的风险评估提供参考。
Objective To study the influencing factors of fracture nonunion after intramedullary nailing for subtrochanteric fracture and construct a risk assessment model.Methods A retrospective analysis was performed on 251 patients with intramedullary nail fractures of the femoral subtrochanteric fracture from February 2006 to January 2018.According to the different treatment time,the 251 patients included in this study were divided into the modeling group and the verification group.In the modeling group,postoperative fracture nonunion rate,general data,fracture related factors,surgical reduction related factors,mechanical and biological factors were calculated,and the influencing factors of fracture nonunion were screened by univariate analysis.Indicators with statistical differences in univariate analysis were analyzed using Logistic regression model for multivariate analysis to build the risk assessment model.The influencing factors were re-evaluated through the verification group,and the differentiation and calibration of the model were evaluated.Results Fracture nonunion occurred in 34 of 149 patients in the modeling group.Among the 13 potential influencing factors,univariate analysis and logistic regression analysis showed that postoperative hip varus,intramedullary nail fixation failure and complete open reduction were the risk factors of fracture nonunion.Postoperative reduction of medial cortex was a protective factor for fracture nonunion,and a regression equation was established.Based on the logistic regression model,the Nomogram diagram was drawn.In the verification group,fracture nonunion occurred in 24 of 149 patients.The area under the ROC curve was AUC=0.883>0.7,indicating that there was a moderate differentiation to evaluate the occurrence of fracture nonunion after operation.The goodness of fit test:the H-L test(χ2=2.921,P=0.712)showed that the model had a good calibration.Conclusion The risk factors of fracture nonunion were hip varus,failure of intramedullary nail fixation and complete open reduction after intramedullary nailing of subtrochanteric fracture,and postoperative reduction of medial cortex was the protective factor.The risk assessment model has moderate differentiation and good calibration,which can provide reference for the risk assessment of fracture nonunion after subtrochanteric fracture operation.
作者
王郑浩
李开南
郑江
陈尔东
陈明灿
Wang Zhenghao;Li Kainan;Zheng Jiang;Chen Erdong;Chen Mingcan(Department of Orthopaedics,Affiliated Hospital of Chengdu University,Chengdu 610081,China)
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2020年第2期88-96,共9页
Chinese Journal of Orthopaedics
基金
国家重点研发项目(2016YFC0105806)。
关键词
股骨骨折
骨折
不愈合
预测
校准
Femoral fracture
Fracture,ununited
Forecasting
Calibration
