骨质疏松症患者髋关节置换预后相关因素分析及Nomogram预测模型的构建  

Analysis of factors associated with prognosis of osteoporosis patients after hip arthroplasty and construction of Nomogram prediction model

作　　者：王荣强[1] 杨柳 吴向坤[1] 尚立林[1] Wang Rongqiang;Yang Liu;Wu Xiangkun;Shang Lilin(Nanyang Second People’s Hospital,Nanyang 473000,Henan Province,China)

机构地区：[1]南阳市第二人民医院,河南省南阳市473000

出　　处：《中国组织工程研究》2025年第33期7137-7142,共6页Chinese Journal of Tissue Engineering Research

摘　　要：背景:骨质疏松症患者髋关节置换预后不良严重影响患者的生活质量。准确预测骨质疏松症患者髋关节置换预后不良的危险因素仍然是骨科医生面临的重大挑战。目的:探讨骨质疏松症患者髋关节置换预后不良的危险因素并构建Nomogram预测模型。方法:选择2020年7月至2022年6月于南阳市第二人民医院行髋关节置换的192例骨质疏松症患者为研究对象,术后6个月行髋关节Harris评分,将Harris评分≥80分的患者纳入预后良好组(n=142),Harris评分<80分的患者纳入预后不良组(n=50)。收集两组患者临床资料并进行单因素分析;受试者工作特征曲线分析计量指标对骨质疏松症患者髋关节置换预后不良的预测价值;二分类logistic回归分析影响骨质疏松症患者髋关节置换预后不良的危险因素;构建骨质疏松症患者髋关节置换预后不良的Nomogram预测模型,采用校正曲线行内部验证并计算一致性指数,决策曲线行临床预测效能评估。结果与结论:①两组患者在年龄、体质量指数、手术时间、术中出血量、血清白蛋白、外周血淋巴细胞计数、预后营养指数、并发症方面的差异有显著意义(P<0.05);②年龄、体质量指数、手术时间、术中出血量、血清白蛋白、外周血淋巴细胞计数、预后营养指数的曲线下面积为0.813,0.780,0.787,0.764,0.777,0.785,0.818;③年龄、体质量指数、术中出血量、并发症是影响骨质疏松症患者髋关节置换预后不良的危险因素;④Nomogram预测模型的校正、原始曲线与理想曲线接近,一致性指数为0.851(0.815-0.886),模型拟合度较高,Nomogram预测模型的阈值>0.12,可提供临床净收益,且临床净收益均高于独立预测因子;⑤提示年龄、体质量指数、术中出血量、并发症是影响骨质疏松症患者髋关节置换预后不良的危险因素,基于此构建的Nomogram预测模型可帮助临床医生对骨质疏松症患者髋关节�BACKGROUND:Poor prognosis of hip arthroplasty in patients with osteoporosis seriously affects the patients’quality of life.Accurately predicting the risk factors for poor prognosis of hip arthroplasty in patients with osteoporosis remains a major challenge for orthopedic surgeons.OBJECTIVE:To explore risk factors for poor prognosis after hip arthroplasty in patients with osteoporosis and construct a Nomogram prediction model.METHODS:A total of 192 patients with osteoporosis who underwent hip arthroplasty in Nanyang Second People’s Hospital from July 2020 to June 2022 were selected as study subjects.Harris hip function scale was performed 6 months after operation.Patients with Harris score≥80 were included in the good prognosis group(n=142),while patients with Harris score<80 were included in the poor prognosis group(n=50).Clinical data of the two groups were collected and subjected to univariate analysis.Receiver operating characteristic curves were used to analyze the predictive value of the measures for poor prognosis after hip arthroplasty in patients with osteoporosis.Binary logistic regression was used to analyze the risk factors affecting poor prognosis after hip arthroplasty in patients with osteoporosis.The Nomogram prediction model for poor prognosis after hip arthroplasty in patients with osteoporosis was constructed.The calibration curve was internally validated and the concordance index was calculated,and the decision curve was evaluated for clinical predictive efficacy.RESULTS AND CONCLUSION:(1)The differences between the two groups were statistically significant in terms of age,body mass index,operative time,intraoperative bleeding,serum albumin,peripheral blood lymphocyte count,prognostic nutritional index,and complications(P<0.05).(2)Area under the curve for age,body mass index,operative time,intraoperative bleeding,serum albumin,peripheral blood lymphocyte count,and prognostic nutritional index were 0.813,0.780,0.787,0.764,0.777,0.785,and 0.818.(3)Age,body mass index,intraoperative bleeding

关 键 词：骨质疏松症 髋关节置换 预后 Nomogram预测模型 并发症 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学] R687.4