摘要
目的探讨胫骨平台伴髁间棘骨折病人术后关节功能恢复的影响因素及其预测效能。方法2020年5月~2022年7月收治的胫骨平台伴髁间棘骨折病人58例,均经手术治疗。术后随访12个月,末次随访时依据美国特种外科医院(HSS)评分将入组病人分为关节功能恢复不良组、恢复良好组,比较两组病人临床资料。采用R软件基于影响病人术后关节功能预后不良的危险因素构建列线图预测模型,拟合优度检验、受试者工作特征(ROC)曲线评估风险列线图模型的预测效能。结果58例病人术后均获得12个月随访,末次随访时HSS评分为40~95分,其中<59分19例。单因素分析结果显示,BMI、骨质疏松、术前ASA分级、皮肤软组织损伤、髁间棘骨折块游离、术后功能训练可能与病人术后关节功能恢复不良具有相关性(P<0.05)。多因素logistic回归分析结果显示,BMI≥23 kg/m^(2)、骨质疏松、术前ASA分级Ⅲ~Ⅳ级、皮肤软组织损伤、髁间棘骨折块游离、术后功能训练不依从是影响病人术后关节功能恢复不良的独立危险因素(P<0.05),且各危险因素呈单独作用模式,不存在交互作用(偏差度=1.02,Pearsonχ^(2)=0.98,R~2=0.34,P>0.05)。基于BMI、骨质疏松、术前ASA分级、皮肤软组织损伤、髁间棘骨折块游离、术后功能训练构建列线图模型,Calibration验证结果显示,实测值与预测值结果基本一致。Bootstrap内部验证法结果显示,该列线图模型预测胫骨平台伴髁间棘骨折病人术后关节功能恢复不良的敏感度、特异度、ROC曲线下面积分别为86.50%、72.40%、0.885。结论BMI≥23 kg/m^(2)、骨质疏松、术前ASA分级Ⅲ~Ⅳ级、皮肤软组织损伤、髁间棘骨折块游离、术后功能训练不依从是影响胫骨平台伴髁间棘骨折病人术后关节功能恢复不良的危险因素,据此构建的列线图模型具有良好的准确度、区分度。
Objective To investigate the influencing factors and predictive efficacy of joint function recovery in patients with tibial plateau fracture with intercondylar spine.Methods Fifty-eight patients with tibial plateau fracture with intercondylar spine admitted to the hospital from May 2020 to July 2022 were selected,all of whom were treated by surgery.The patients were followed up for 12 months after surgery,at the last follow-up,the patients were divided into two groups:poor prognosis group and good prognosis group according to Hospital for Special Surgery(HSS)score,and the clinical data of the two groups were compared.R software was used to build a nomogram prediction model based on the risk factors affecting the poor prognosis of postoperative joint function.Goodness of fit test,receiver operating characteristic(ROC)curve to assess risk nomogram model calibration and differentiation.Results All 58 patients were followed up for 12 months after operation.The HSS score at the last follow-up was 40-95 points,of which 19 were<59 points.The results of univariate analysis showed that BMI,osteoporosis,preoperative ASA grade,skin and soft tissue injury,intercondylar spine fracture block free,and postoperative functional training may be correlated with poor prognosis of postoperative joint function(P<0.05).Multivariate logistic regression analysis showed that BMI≥23 kg/m^(2),osteoporosis,preoperative ASA gradeⅢtoⅣ,skin and soft tissue injury,intercondylar spine fracture mass free and non-adherence to postoperative functional training were independent risk factors for poor prognosis of postoperative joint function(P<0.05),there was no interaction among the risk factors(deviation=1.02,Pearsonχ^(2)=0.98,R^(2)=0.34,P>0.05).A nomogram model was constructed based on BMI,osteoporosis,preoperative ASA grading,skin and soft tissue injury,intercondylar spine fracture block free,and postoperative functional training.Calibration results showed that the measured values were basically consistent with the predicted values.The results of the Bootstrap internal validation method showed that the sensitivity,specificity,and area under the ROC curve of this nomogram model for predicting poor postoperative joint function recovery in patients with tibial plateau fractures with intercondylar spinous fractures were 86.50%,72.40%,and 0.885,respectively.Conclusion BMI≥23 kg/m^(2),osteoporosis,preoperative ASA grade,skin and soft tissue injury,intercondylar spine fracture fragment free,and non-adherence to postoperative functional training are risk factors for poor prognosis of postoperative joint function in patients with tibial plateau fracture with intercondylar spine fracture.The nomogram model constructed based on this has good accuracy and discrimination.
作者
孙磊
杨玉亭
李朝辉
SUN Lei;YANG Yuting;LI Chaohui(Department of Trauma Surgery,Shandong Wendeng Osteopath Hospital,Weihai 264400,China)
出处
《临床外科杂志》
2025年第9期992-996,共5页
Journal of Clinical Surgery
关键词
胫骨平台伴髁间棘骨折
外科手术
预后
列线图模型
tibial plateau with intercondylar spine fracture
surgery
prognosis
nomogram model
