马蹄内翻足患者踝足四关节融合跟腱延长术后下肢深静脉血栓形成的危险因素及模型预测  

Risk factors and model prediction of lower extremity deep vein thrombosis in patients with clubfoot after ankle-foot fusion and achilles tendon lengthening

作　　者：蒋云鹏 赵媛[1] 武勇[1] 蒋鹏[2] Jiang Yunpeng;Zhao Yuan;Wu Yong;Jiang Peng(Department of Foot and Ankle Surgery,Beijing Jishuitan Hospital,Beijing 100035;Department of Vascular Surgery,Beijing Jishuitan Hospital,Beijing 100035)

机构地区：[1]北京积水潭医院足踝外科,北京100035 [2]北京积水潭医院血管外科,北京100035

出　　处：《血管与腔内血管外科杂志》2022年第6期651-655,共5页Journal of Vascular and Endovascular Surgery

基　　金：首都卫生发展科研专项项目(首发2022-2-1122)。

摘　　要：目的探讨马蹄内翻足患者踝足四关节融合跟腱延长术后下肢深静脉血栓形成的危险因素及模型预测效能。方法收集2019年3月至2021年4月北京积水潭医院收治的马蹄内翻足患者的临床资料,所有患者均行踝足四关节融合跟腱延长术治疗,根据术后下肢深静脉彩色多普勒超声检查结果将患者分为血栓组(n=24)与非血栓组(n=58)。分析马蹄内翻足患者踝足四关节融合跟腱延长术后下肢深静脉血栓形成的危险因素。构建并验证列线图预测模型,对其预测效能进行分析与验证。结果单因素分析结果显示:两组患者的年龄、麻醉方式、手术时长、术前是否存在基础疾病、总蛋白、阿司匹林用药史、纤维蛋白原水平比较,差异均有统计学意义(P<0.05)。多因素分析结果显示:麻醉方式、术前是否存在基础疾病、总蛋白水平、纤维蛋白原水平、年龄、阿司匹林用药史均是马蹄内翻足患者术后下肢深静脉血栓形成的独立危险因素(P<0.05)。列线图预测模型结果显示:麻醉方式63分、手术时长80分、术前是否存在基础疾病63分、总蛋白75分、纤维蛋白原70分。借助受试者工作特征(ROC)曲线验证列线图效能,结果显示:马蹄内翻足患者术后下肢深静脉血栓发生风险的C-index为0.782,95%CI为0.673~0.871;ROC的曲线下面积为0.816(95%CI:0.757~0.899),预测灵敏度为85.25%,特异度为81.58%。结论马蹄内翻足患者踝足四关节融合跟腱延长术后下肢深静脉血栓的发生率较高,危险因素相对较多,针对危险因素成功构建的预测模型具有良好的区分度,预测效能较高。Objective To investigate the risk factors and model prediction efficacy of lower extremity deep vein thrombosis in patients with clubfoot after four-joint fusion of ankle and foot and achilles tendon lengthening.Method The clinical data of patients with clubfoot admitted to Beijing Jishuitan Hospital from March 2019 to April 2021 were collected,all patients underwent four-joint fusion of ankle and foot and achilles tendon lengthening,and the patients were divided into thrombosis group(n=24)and non-thrombotic group(n=58)based on the result of color Doppler ultrasonography of lower extremity postoperative deep vein.The risk factors of postoperative deep vein thrombosis in the lower extremity of the patients with four-joint fusion of ankle and foot and achilles tendon lengthening were analyzed.The nomogram prediction model were constructed and validated,and its predictive performance were analyzed and validated.Result Univariate analysis showed that there were statistically significant differences in age,anesthesia method,operation time,preoperative underlying disease,total protein,aspirin medication history,and fibrinogen level between the two groups(P<0.05).Multivariate analysis showed that the anesthesia method,the existence of preoperative underlying diseases,total protein,fibrinogen level,age,and aspirin medication history were all independent risk factors for postoperative deep vein thrombosis in patients with clubfoot(P<0.05).The results of the nomogram prediction model showed 63 points for anesthesia method,80 points for operation time,63 points for the existence of preoperative underlying diseases,75 points for total protein,and 70 points for fibrinogen.Using the deep vein thrombosis(ROC)curve to verify the efficiency of the nomogram,the results showed that the C-index of the risk of postoperative deep vein thrombosis in patients with clubfoot was 0.782(95%CI:0.673-0.871);the area under the ROC curve was 0.816(95%CI:0.757-0.899),the predictive sensitivity was 85.25%,and the specificity was 81.58%.Conclusion

关 键 词：马蹄内翻足 踝足四关节融合跟腱延长术 深静脉血栓 危险因素 预测模型 

分 类 号：R543[医药卫生—心血管疾病]