老年股骨颈骨折半髋关节置换术后输血预测模型的建立  

Establishment of nomogram for predicting blood transfusion following hemiarthroplasty of femoral neck fractures in elderly patients

作　　者：贾大洲 孙钰[1] 何世平 张亚鑫 戴纪杭 林群 李小磊[1] 王强[1] Jia Dazhou;Sun Yu;He Shiping;Zhang Yaxin;Dai Jihang;Lin Qun;Li Xiaolei;Wang Qiang(Department of Bone and Joint,Clinical Medical College of Yangzhou University,Northern Jiangsu People’s Hospital,Yangzhou 225001,China)

机构地区：[1]扬州大学临床医学院(江苏省苏北人民医院),225001

出　　处：《中华关节外科杂志（电子版）》2022年第1期1-7,共7页Chinese Journal of Joint Surgery(Electronic Edition)

基　　金：江苏省医学创新团队课题(CXTDB2017004)。

摘　　要：目的分析老年股骨颈骨折患者半髋关节置换术后输血的危险因素,建立老年股骨颈骨折患者半髋关节置换术后输血的列线图预测模型。方法回顾性分析2016年1月至2020年6月江苏省苏北人民医院股骨颈骨折行半髋关节置换术的235例患者。纳入标准:年龄≥60岁,新发、单侧股骨颈骨折;手术方式为半髋关节置换术。排除标准:合并全身其他骨折;术前输血;合并凝血功能障碍或者其他血液系统疾病;身体状况较差无法耐受手术者;病历资料不完整者。根据术后是否输血,分为输血组和未输血组。收集其临床资料,包括性别、年龄、身体质量指数(BMI)、高血压、糖尿病、冠心病、脑卒中、吸烟、饮酒、术前血红蛋白(Hb)、术前血小板(PLT)、术前白蛋白、术前凝血功能、术前抗凝药使用、骨折Garden分型、受伤至手术时间、假体类型、术后是否引流、术后血钙浓度、美国麻醉师协会(ASA)分级、麻醉方式、手术时间、术中出血量等。应用单因素和多因素logistic回归模型筛选术后输血的独立危险因素;通过R软件构建列线图预测模型,并绘制出受试者工作特征(ROC)曲线及校准曲线来评价模型的区分度和准确度。结果本研究共纳入235例研究对象,输血组60例,输血率为25.5%。两组患者在术前Hb(χ^(2)=62.831)、麻醉方式(χ^(2)=6.539)、手术时间(χ^(2)=79.392)、术中出血量(χ^(2)=74.515)、假体类型(χ^(2)=5.631)方面的组间差异有统计学意义(均为P<0.05)。多因素logistic回归模型分析显示:术前Hb水平(Hb<100 g/L)、手术时间延长(时间≥60 min)、术中出血量增多(出血量≥200 ml)是老年股骨颈骨折患者半髋关节置换术后输血的独立危险因素(均为P<0.05)。列线图预测模型曲线下面积AUC为0.95,校准曲线的斜率接近1,提示该预测模型具有良好的区分度和准确度。结论基于术前血红蛋白、手术时间、术中出血量这3项�Objective To analyze the risk factors of blood transfusion after hemiarthroplasty in elderly patients with femoral neck fracture,and to establish a nomogram prediction model of blood transfusion after hemiarthroplasty in elderly patients with femoral neck fracture.Methods A total of 235 patients who underwent hemiarthroplasty for femoral neck fractures in the Northern Jiangsu People’s Hospital from January 2016 to June 2020 were analyzed retrospectively.Inclusion criteria:age≥60 years,new onset,unilateral femoral neck fracture;surgical method is hemiarthroplasty.Exclusion criteria:other fractures;preoperative blood transfusion;coagulation disorders or other hematological diseases;poor physical condition;incomplete medical records.According to whether blood transfusion was performed or not,the patients were divided into transfusion group and non-transfusion group.The clinical data were collected,including sex,age,body mass index(BMI),hypertension,diabetes,coronary heart disease,stroke,smoking,drinking,preoperative hemoglobin(Hb),preoperative platelet(PLT),preoperative albumin,preoperative use of anti-coagulants,Garden classification of femoral neck fracture,time of injury to operation,the type of prosthesis,postoperative drainage,postoperative serum calcium concentration,American Association of anesthesiologists(ASA)grade,mode of anesthesia,operation time,intraoperative blood loss and so on.Single-factor and multi-factor logistic regression models were used to screen the independent risk factors of postoperative blood transfusion,and the nomogram prediction model was constructed by R software,and the receiver operating characteristic(ROC)curve and calibration curve were drawn to evaluate the differentiation and accuracy degree of the model.Results A total of 235 subjects were included in this study,including 60 cases in the blood transfusion group,with a blood transfusion rate of 25.5%.There were significant differences between the two groups in preoperative Hb(χ^(2)=62.831),mode of anesthesia(χ^(2)=6.539),o

关 键 词：股骨颈骨折 关节成形术 置换 髋 输血 危险因素 列线图 

分 类 号：R687.4[医药卫生—骨科学]