胸腰椎骨折患者术后静脉血栓栓塞风险Nomogram预测模型的建立与验证  

Establishment and Verification of a Nomogram Model to Predict the Risk of Postoperative Venous Thromboembolism in Patients with Thoracolumbar Fracture

作　　者：关艳[1] 徐文硕[1] 付莹[1] 孙铭霞[1] 孙彦豹[1] GUAN Yan;XU Wenshuo;FU Ying(Chengde Central Hospital,Hebei Chengde 067000,China)

机构地区：[1]河北省承德市中心医院,河北承德067000

出　　处：《河北医学》2024年第12期2084-2091,共8页Hebei Medicine

基　　金：河北省承德市科学技术研究与发展计划项目,(编号:202102A012)。

摘　　要：目的:构建胸腰椎骨折患者术后静脉血栓栓塞(VTE)风险Nomogram预测模型,并对模型进行验证,旨在为患者术后防治VTE提供参考。方法:选取2020年6月至2023年2月我院收治252例胸腰椎骨折患者,术后14d行下肢血管超声检查,根据是否发生VTE分组,分为VTE组(n=43)、非VTE组(n=209)。统计两组患者临床资料,LASSO-Logistic回归胸腰椎骨折患者术后VTE发生的影响因素,并构建Nomogram预测模型,用校准曲线、ROC曲线评估该模型。结果:VTE组≥60岁、高脂血症、全麻、腰背部筋膜损伤、骨密度≥-2.5g/cm^(2)患者比、体重指数高于非VTE组,骨折至入院时间、骨折至手术时间、手术时间均长于非VTE组,血红蛋白(Hb)、白蛋白(ALB)低于非VTE组(P<0.05);LASSO回归筛选变量为年龄、腰背部筋膜损伤、合并骨质疏松、体重指数、骨折至入院时间、ALB、Hb、手术时间;年龄、腰背部筋膜损伤、合并骨质疏松、体重指数、骨折至入院时间、ALB、手术时间、Hb是胸腰椎骨折患者术后VTE发生的影响因素(P<0.05);根据LASSO-Logistic回归获得结果构建Nomogram预测模型,ROC曲线在训练集、验证集中该模型预测患者术后VTE具有良好预测价值,校准度结果显示在训练集、验证集中预测术后VTE发生率与实际情况之间具有良好的一致性。结论:胸腰椎骨折术后VTE发生影响因素分别为年龄、腰背部筋膜损伤、合并骨质疏松、体重指数、骨折至入院时间、ALB、Hb、手术时间,根据所获得的因素构建Nomogram预测模型,该模型在预测患者术后VTE发生具有良好一致性和预测效能。Objective:To construct and verify a Nomogram model for predicting the risk of postoperative venous thromboembolism(VTE)in patients with thoracolumbar fracture,and thus providing a reference for prevention and treatment of VTE.Methods:A total of 252 patients with thoracolumbar fracture admitted to our hospital from June 2020 to February 2023 were enrolled.Lower extremity vascular ultrasound examination was performed at 14 days postoperatively.According to the presence and absence of VTE,the patients were divided into VTE group(n=43)and non-VTE group(n=209).The clinical data of the two groups were assessed,and the influencing factors of postoperative VTE in patients with thoracolumbar fracture were analyzed by least absolute shrinkage and selection operator(LASSO)-Logistic regression.A Nomogram prediction model was constructed,and the model was evaluated by calibration curve and receiver operating characteristic(ROC)curve.Results:The ratio of patients≥60 years old,hyperlipidemia,general anesthesia,lumbar and back fascia injury,bone mineral density≥-2.5g/cm^(2)and body mass index in VTE group were significantly higher than those in non-VTE group,the time from fracture to admission,the time from fracture to operation and the operation time were significantly longer than those in non-VTE group.Hemoglobin(Hb)and albumin(ALB)in VTE group were significantly lower than those in non-VTE group(P<0.05).The regression screening variables by LASSO regression were age,lumbar and back fascia injury,pooled osteoporosis,body mass index,time from fracture to admission,ALB,Hb,and operation time.Age,lumbar and back fascia injury,pooled osteoporosis,body mass index,time from fracture to admission,ALB,operation time,and Hb were factors that influence the incidence of postoperative VTE in patients with thoracolumbar fractures(P<0.05).Based on the results obtained from LASSO-logistic regression,a Nomogram prediction model was constructed.The ROC curve showed that the model had good predictive value for predicting postoperative VTE in

关 键 词：胸腰椎骨折 静脉血栓栓塞 风险 NOMOGRAM 模型 

分 类 号：R687.3[医药卫生—骨科学]