游离股前外侧皮瓣坏死的危险因素分析及预测模型的建立  

Analysis of Risk Factors for Free Anterolateral Thigh Flap Necrosis and Establishment of Prediction Model

作　　者：吴育煜 胡朝波 陈绵川 陈华佑 WU Yuyu;HU Chaobo;CHEN Mianchuan;CHEN Huayou(Department of Hand and Foot Microsurgery,the Second Affi liated Hospital of Hainan Medical College,Haikou 570311,Hainan,China)

机构地区：[1]海南医学院第二附属医院手足显微外科,海南海口570311

出　　处：《中国美容医学》2023年第5期63-67,共5页Chinese Journal of Aesthetic Medicine

基　　金：海南省重点研发计划项目(编号:ZDYF2020128)。

摘　　要：目的:分析影响游离股前外侧皮瓣坏死的危险因素并建立预测模型。方法:收集2009年12月-2021年12月笔者医院接受游离股前外侧皮瓣修复术的540例患者资料进行回顾性分析,将纳入患者按照7:3分为建模组(378例)及验证组(162例)。对建模组患者资料行单因素及多因素Logistic回归分析,并根据游离股前外侧皮瓣坏死的影响因素分析结果建立预测模型,绘制校准曲线及ROC曲线评估模型的有效性及区分度。结果:单因素分析结果显示,血管危象、年龄、皮瓣血肿及皮瓣感染为影响游离前外侧皮瓣坏死的因素(P<0.05);性别、吸烟史、饮酒史、合并高血压、合并糖尿病、受伤机制、术前创面感染、手术时间、术中补液量、麻醉时间、静脉吻合血管数及皮瓣面积为影响游离前外侧皮瓣坏死的无关因素(P>0.05)。行多因素Logistic回归分析显示,血管危象、皮瓣感染、皮瓣血肿为影响游离股前外侧皮瓣坏死的危险因素(P<0.05);对所建立的预测模型通过绘制校准曲线评估模型的预测有效性,结果显示,建模组χ^(2)=7.235,P=0.246;验证组χ^(2)=6.401,P=0.213。绘制ROC曲线评估模型的区分度,结果显示,建模组ROC曲线下面积为0.871[95%CI(0.833~0.903)],敏感性为78.12%,特异性为84.97%;验证组ROC曲线下面积为0.791[95%CI(0.747~0.831)],敏感性为68.75%,特异性为78.32%。结论:血管危象、皮瓣感染、皮瓣血肿为影响游离股前外侧皮瓣坏死的危险因素,建立的预测模型区分度及有效性较好,能够作为早期筛选游离股前外侧皮瓣坏死发生的工具。Objective To analyze the risk factors of free anterolateral thigh flap necrosis,and to establish a prediction model.Methods The data of 540 patients who underwent free anterolateral thigh flap repair in the author's hospital from December 2009 to December 2021 were collected for retrospective analysis.The included patients were separated into a modeling group(378 cases)and a validation group(162 cases)according to 7:3.Univariate and multivariate Logistic regression analysis was performed on the patient data of the modeling group,a prediction model was established according to the analysis results of the influencing factors of free anterolateral thigh flap necrosis.Calibration curve and ROC curve were drawn to evaluate the validity and discrimination of the model.Results Univariate analysis,showed that vascular crisis,age,flap hematoma and flap infection were the factors affecting the necrosis of free anterolateral flap(P<0.05),Gender,smoking history,drinking history,hypertension,diabetes mellitus,injury mechanism,preoperative wound infection,operation time,intraoperative fluid volume,anesthesia time,venous anastomosis number and flap area were independent factors affecting the necrosis of free anterolateral flap(P>0.05).Multivariate Logistic regression analysis showed that vascular crisis,flap infection and flap hematoma were the risk factors for free anterolateral thigh flap necrosis(P<0.05);the prediction validity of the established prediction model was evaluated by drawing a calibration curve,and the results showed that the modeling groupχ^(2)=7.235,P=0.246;the validation groupχ^(2)=6.401,P=0.213.The ROC curve was drawn to evaluate the discrimination of the model,the results showed that the area under the ROC curve of the modeling group was 0.871[95%CI(0.833-0.903)],the sensitivity was 78.12%,and the specificity was 84.97%;the area under the ROC curve of the validation group was 0.791[95%CI(0.747-0.831)],the sensitivity was 68.75%,and the specificity was 78.32%.Conclusion Vascular crisis,flap infection and f

关 键 词：游离股前外侧皮瓣坏死 危险因素 预测模型 列线图 

分 类 号：R622[医药卫生—整形外科]