个体化预测股骨转子间骨折患者围手术期隐匿性失血风险的列线图模型构建  

Construction of a Nomograph Model for Individualized Prediction of the Risk of Occult Blood Loss During Perioperative Period in Patients with Intertrochanteric Fracture of the Femur

作　　者：李建辉 裴宏[2] 黄光勇 黄昊飞[1] Li Jianhui;Pei Hong;Huang Guangyong(Department of Orthopedics and Fraumatology,Pengzhou Hospital of Traditional Chinese Medicine,Chengdu,Sichuan 611930;Department of Traditional Chinese Medicine,the Fifth People′s Hospital of Sichuan Province,Chengdu,Sichuan 610031,China)

机构地区：[1]彭州市中医医院骨伤科,四川成都611930 [2]四川省第五人民医院中医科,四川成都610031

出　　处：《四川医学》2024年第7期760-765,共6页Sichuan Medical Journal

摘　　要：目的构建股骨转子间骨折患者围手术期出现隐匿性失血风险的列线图预测模型。方法回顾性收集我院2020年6月至2022年6月收治的96例股骨转子间骨折患者的临床资料。根据平均失血量分为大量失血组(n=42)和非大量失血组(n=54)。对失血的影响因素进行单因素分析和多因素分析,R3.6.3软件及rms程序包构建预测隐匿性失血风险的列线图模型,并评估模型的区分度和一致性。结果96例患者发生大量隐匿性失血的有42例,占比43.75%。单因素分析显示,大量失血组和非大量失血组患者年龄、手术类型、入院白蛋白、DD之间差异有统计学意义(χ^(2)=8.979、8.368、15.453,t=5.855,P<0.05);多因素Logistic回归分析显示,年龄>70岁、手术类型为InterTAN、入院白蛋白<30 g/L、DD是影响股骨转子间骨折患者围手术期隐匿性失血的独立危险因素(P<0.05);列线图模型显示,年龄>70岁、InterTAN、入院白蛋白<30 g/L、DD每增加0.5 mg/L分别增加14.2分、14.8分、26.8分、11.1分的权重;检验发现模型一致性、区分度均较好。结论年龄>70岁、手术类型InterTAN、入院白蛋白<30 g/L、DD均是股骨转子间骨折患者围术期隐匿性失血的影响因素,本研究构建的列线图模型在用于个体化预测股骨转子间骨折患者围术期隐匿性失血具有一定临床意义。Objective To construct a nomogram prediction model for the risk of occult blood loss in perioperative patients with intertrochanteric fracture of femur.Methods From June 2020 to June 2022,clinical data of 96 patients with intertrochanteric fracture of femur admitted to our hospital were retrospectively collected.According to the average amount of blood loss,they were divided into a large amount of blood loss group(n=42)and a non large amount of blood loss group(n=54).Univariate and multivariate analysis were conducted on the influencing factors of blood loss.The R3.6.3 software and rms package was applied to build a nomogram model to predict the risk of occult blood loss,and the differentiation and consistency of the model were evaluated.Results Among 96 patients,42(43.75%)had massive occult blood loss.Univariate analysis showed that there were statistically significant difference in age,surgical type,admission albumin,and DD(χ^(2)=8.979,8.368,15.453,t=5.855,P<0.05).Multivariate Logistic regression analysis showed that age>70 years old,surgical type InterTAN,admission albumin<30 g/L,and DD were independent risk factors for perioperative occult blood loss in patients with intertrochanteric fractures of the femur(P<0.05).The column chart model showed that age>70 years old,InterTAN,admission albumin<30 g/L,and DD increase by 14.2,14.8,26.8,and 11.1 points for every 0.5 mg/L increase,respectively.The model had good consistency and discrimination.Conclusion Age>70 years old,surgical type InterTAN,admission albumin<30 g/L and DD would be all influencing factors for perioperative occult blood loss in patients with intertrochanteric fracture.The column-graph model would have certain clinical significance for individual prediction of perioperative occult blood loss in patients with intertrochanteric fracture.

关 键 词：股骨转子间骨折 围手术期 隐匿性失血 列线图模型 

分 类 号：R683[医药卫生—骨科学]