摘要
目的探讨膝关节周围骨折(fracture around the knee,FAK)患者术前发生下肢深静脉血栓(deep vein thrombosis,DVT)的危险因素并构建相应风险预测模型。方法回顾性分析2020年1月至2023年12月收治239例FAK患者的临床资料。根据术前下肢深静脉彩色多普勒超声结果分为DVT组(n=64)和非DVT组(n=175)。通过单因素分析和多因素logistic回归分析确定术前发生DVT的独立危险因素,根据独立危险因素建立列线图预测模型,绘制受试者工作特征(receiver operator characteristic,ROC)曲线评价该模型对发生术前DVT的风险预测效能,绘制校准曲线和临床决策曲线分析(decision curve analysis,DCA)曲线验证该模型的一致性和有效性。结果纳入研究的239例患者中,有64例术前检出DVT,术前DVT发生率26.77%;单因素分析结果显示,2组患者年龄、损伤程度、骨折部位、术前制动时间、术前血红蛋白(hemoglobin,Hb)、术前红细胞比容(hematocrit,HCT)和术前D-二聚体差异有统计学意义(P<0.05);多因素logistic回归分析结果显示,年龄、损伤程度、术前制动时间、术前D-二聚体水平是FAK患者术前发生DVT的独立危险因素;ROC曲线显示,根据独立危险因素构建的列线图模型预测价值良好,ROC曲线下面积(area under curve,AUC)为0.863,95%的置信区间为0.805~0.920,敏感度为64.0%,特异度为97.1%。校准曲线显示该模型具有较好的一致性。DCA曲线显示在阈值范围0.1~0.8中该模型临床净收益均较高。结论年龄、损伤程度、术前制动时间、术前D-二聚体水平与FAK患者术前发生DVT关系密切,据此构建的列线图预测模型预测效能良好,值得临床推广。
Objective To explore the risk factors for preoperative deep vein thrombosis(DVT)in patients with fractures around the knee(FAK)and to construct a predictive risk model.MethodssA retrospective analysis of the clinical data of 239 FAK patients admitted to our hospital from January 2020 to December 2023.According to preoperative lower limb Doppler ultrasound results,patients were divided into two groups:the DVT group(n=64)and the non-DVT group(n=175).Univariate and multivariate logistic regression analyses were performed to identify the independent risk factors for preoperative DVT.Based on these independent factors,a nomogram prediction model was constructed.The model's predictive performance for preoperative DVT was evaluated by the receiver operating characteristic(ROC)curve,and its consistency and effectiveness were validated using calibration and decision curve analysis(DCA)curves.Results Among the 239 patients included in the study,64 had preoperative DVT,with an incidence rate of 26.77%.Univariate analysis showed significant differences between the two groups in terms of age,injury severity,fracture site,preoperative immobilization time,preoperative hemoglobin(Hb),preoperative hematocrit(HCT),and preoperative D-dimer levels(P<0.05).Multivariate logistic regression analysis identified age,injury severity,preoperative immobilization time,and preoperative D-dimer levels as independent risk factors for preoperative DVT in FAK patients.The ROC curve indicated that the nomogram model based on these independent risk factors had good predictive value,with an area under the curve(AUC)of 0.863(95%CI:0.805-0.920),sensitivity of 64.0%,and specificity of 97.1%.The calibration curve showed good consistency of the model.The DCA curve indicated high clinical net benefit across threshold probabilities ranging from 0.1 to O.8.Conclusion Age,injury severity,preoperative immobilization time,and preoperative D-dimer levels are closely related to the occurrence of preoperative DVT in FAK patients.The nomogram prediction model based on these factors demonstrates good predictive performance and is worthy of clinical application.
作者
唐茁栋
李亭燕
王明友
王川
刘绍江
TANG Zhuo-dong;LI Ting-yan;WANG Ming-you;WANG Chun;LlU Shao-jiang(Department of Orthopedics,Panzhihua Central Hospital,Panzhihua 617000,Sichuan,China;不详)
出处
《广东医学》
2025年第5期707-713,共7页
Guangdong Medical Journal
基金
四川省临床重点专科建设项目经费资助
攀枝花市指导性科技计划项目(2022ZD-S-16)
攀枝花市中心医院院内科研项目(202403)。
关键词
膝关节
骨折
深静脉血栓
危险因素
预测模型
列线图
knee joint
fracture
deep vein thrombosis
risk factors
prediction model
nomogram
