基于LEARNS模式的康复训练在老年股骨颈骨折术后的康复效果及预测模型  

Rehabilitation outcomes and predictive model based on LEARNS model for elderly patients after femoral neck fracture surgery

作　　者：吴治才 魏长宝 潘婕 Wu Zhi-cai;Wei Chang-bao;Pan Jie(Rehabilitation Treatment Center,Wuxi Ninth People's Hospital,Wuxi,Jiangsu 214062,China;Department of Joint Surgery,Wuxi Ninth People's Hospital,Wuxi,Jiangsu 214062,China)

机构地区：[1]无锡市第九人民医院康复治疗中心,江苏无锡214062 [2]无锡市第九人民医院关节外科,江苏无锡214062

出　　处：《中国现代医学杂志》2024年第17期14-21,共8页China Journal of Modern Medicine

基　　金：江苏省自然科学基金面上项目(No:BK20211088)。

摘　　要：目的构建并验证基于LEARNS模式的康复训练的老年股骨颈骨折术后康复效果的预测模型。方法前瞻性选取2019年1月—2023年4月无锡市第九人民医院收治的109例基于LEARNS模式康复训练的老年股骨颈骨折患者为研究组,另选取与研究组性别年龄匹配的109例接受常规康复训练的老年股骨颈骨折患者为对照组。统计两组术后3个月髋关节功能康复效果。分析影响老年股骨颈骨折术后康复效果的因素;构建基于LEARNS模式的康复训练的老年股骨颈骨折术后康复效果预测的列线图模型,并进行预测模型的验证及效能评估。结果髋关节功能达优良的患者89例。多因素逐步Logistic回归分析结果显示骨质疏松[OR=3.892(95%CI:1.602,9.460)]、术后康复训练介入时间[OR=5.023(95%CI:2.067,12.207)]、手术外侧入路[OR=4.076(95%CI:1.677,9.905)]、下肢深静脉血栓[OR=4.047(95%CI:1.665,9.836)]是影响老年股骨颈骨折术后康复效果的危险因素(P<0.05)。建立列线图预测模型,各因素总分范围为84~357分,对应风险率范围为0.05~0.80。列线图模型验证结果显示C-index指数为0.802(95%CI:0.761,0.837),预测老年股骨颈骨折术后康复效果的校正曲线趋近于理想曲线(P>0.05)。受试者工作特征曲线结果显示:列线图模型预测老年股骨颈骨折术后康复效果的敏感性85.00%(95%CI:0.611,0.960),特异性为82.02%(95%CI:0.722,0.891),曲线下面积为0.872(95%CI:0.795,0.949)。结论基于LEARNS模式的康复训练的老年股骨颈骨折术后康复效果预测的列线图模型预测术后康复效果效能良好。Objective To develop and validate a predictive model for postoperative rehabilitation outcomes in elderly patients with femoral neck fractures using rehabilitation training based on the LEARNS model.Methods A prospective study was conducted on 109 elderly patients with femoral neck fractures who received rehabilitation training based on the LEARNS model between January 2019 and April 2023 at The Ninth People's Hospital of Wuxi(study group).Another 109 age-and gender-matched elderly patients who received conventional rehabilitation training were selected as the control group.The hip joint functional recovery outcomes were evaluated 3 months post-surgery.Factors influencing postoperative rehabilitation outcomes in elderly patients were analyzed.A nomogram prediction model was constructed for rehabilitation outcomes based on the LEARNS model,and the model's predictive performance and validation were assessed.Results A total of 89 patients achieved good to excellent hip joint function recovery.Multivariate stepwise logistic regression analysis identified osteoporosis[OR=3.892(95%CI:1.602,9.460)],the timing of rehabilitation intervention post-surgery[OR=5.023(95%CI:2.067,12.207)],lateral surgical approach[OR=4.076(95%CI:1.677,9.905)],and lower limb deep vein thrombosis[OR=4.047(95%CI:1.665,9.836)]as significant risk factors affecting rehabilitation outcomes(P<0.05).The constructed nomogram prediction model had a total score range of 84-357,corresponding to a risk rate range of 0.05-0.80.Model validation showed a C-index of 0.802(95%CI:0.761,0.837),with the calibration curve closely aligning with the ideal curve(P>0.05).The receiver operating characteristic(ROC)curve analysis indicated a sensitivity of 85.00%(95%CI:0.611,0.960)and specificity of 82.02%(95%CI:0.722,0.891),with an area under the curve(AUC)of 0.872(95%CI:0.795,0.949).Conclusion The nomogram prediction model based on LEARNS model rehabilitation training demonstrates good predictive performance for postoperative rehabilitation outcomes in elderly patients w

关 键 词：股骨颈骨折 LEARNS模式 康复训练 康复效果 列线图 

分 类 号：R614[医药卫生—麻醉学]