人工股骨头置换治疗老年股骨颈骨折:髋关节功能不良风险预测模型的验证  

Artificial femoral head replacement for femoral neck fracture in the elderly:validation of a risk prediction model for hip dysfunction

作　　者：阿布都艾尼江·阿不力米提 阿里木·马木提 李斯密 Abuduainijiang·Abulimiti;Alimu·Mamuti;Li Simi(Department of Sports Medicine,First People’s Hospital of Kashi Prefecture,Kashi 844000,Xinjiang Uygur Autonomous Region,China)

机构地区：[1]喀什地区第一人民医院运动医学科,新疆维吾尔自治区喀什市844000

出　　处：《中国组织工程研究》2025年第33期7143-7149,共7页Chinese Journal of Tissue Engineering Research

摘　　要：背景:人工股骨头置换是老年人股骨颈骨折最主要的手术方式之一,然而术后髋关节功能不良是一个常见且棘手的问题。目的:建立老年股骨颈骨折患者行人工股骨头置换后早期髋关节功能改善情况的列线图预测模型并进行验证。方法:回顾性选择2022年1月至2023年10月在喀什地区第一人民医院因股骨颈骨折行人工股骨头置换的230例患者,收集可能影响术后早期髋关节功能的相关因素,在术后6个月时采用Harris髋关节评分量表评估髋关节功能改善情况。根据术后髋关节功能改善情况是否理想将患者分为功能正常组和功能不良组,比较两组患者术前、术中及术后因素,以LASSO回归筛选潜在因素后行多因素Logistic回归,以R4.1.3软件建立列线图预测模型并进行内部验证。结果与结论:①最终纳入221例患者,术后6个月患者平均Harris评分为82.07±8.28;②LASSO回归筛选出4个潜在影响因素,以此行多因素logistic回归分析结果显示,年龄、体质量指数、受伤至手术天数及术后负重时间为术后早期髋关节功能不良的独立影响因素(P<0.05);③根据多因素结果建立列线图模型,校准曲线结果显示,预测曲线与标准曲线基本拟合;受试者操作特征曲线分析结果显示,列线图模型预测术后早期髋关节功能不良的曲线下面积为0.870[95%CI(0.819,0.921)];④术后早期髋关节功能改善情况受年龄、体质量指数、受伤至手术天数及术后负重时间等因素的影响,此次研究建立的列线图模型用于预测人工股骨头置换后早期髋关节功能不良具有较高的区分度与准确度。BACKGROUND:Artificial femoral head replacement is one of the primary surgical methods for femoral neck fractures in the elderly patients.However,postoperative hip dysfunction remains a common and challenging issue.OBJECTIVE:To establish and validate a nomogram prediction model for early improvement of hip joint function in elderly patients undergoing artificial femoral head replacement for femoral neck fractures.METHODS:230 patients who underwent hip hemiarthroplasty for femoral neck fractures at The First People’s Hospital of Kashi Prefecture from January 2022 to October 2023 were retrospectively selected.Relevant factors that could influence early postoperative hip function were collected,and hip function improvement was assessed at 6 months postoperatively using the Harris Hip Score.Patients were divided into two groups based on whether their postoperative hip function improvement was satisfactory.Preoperative,intraoperative,and postoperative factors were compared between the two groups.Potential factors were screened using LASSO regression,followed by multivariate logistic regression to establish a nomogram prediction model using R4.1.3 software,which was then internally validated.RESULTS AND CONCLUSION:(1)A total of 221 patients were included in the study,with an average Harris Hip Score of(82.07±8.28)at 6 months postoperatively.(2)LASSO regression identified four potential influencing factors.Multivariate logistic regression analysis revealed that age,body mass index,time from injury to surgery,and time postoperative weight-bearing were independent factors affecting early postoperative hip function(P<0.05).(3)Based on the multivariate results,a nomogram model was established.The calibration curve indicated good agreement between the predicted and observed outcomes.Receiver operating characteristic curve analysis results showed that the area under the curve for predicting early postoperative hip dysfunction using the nomogram model was 0.870[95%CI(0.819,0.921)].(4)Early postoperative hip function improvem

关 键 词：股骨颈骨折 半髋关节置换 人工股骨头置换 多因素分析 预测模型 列线图 骨科植入物 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学] R683.42