目的 研究股骨颈骨折(femoral neck fracture,FNF)空心螺钉内固定(cannulated screw fixation,CSF)术后并发股骨头坏死的危险因素,构建一个个体化的股骨头坏死风险预测列线图模型.方法 回顾性分析作者医院骨科2018-09/2021-01月252例符合条件的FNF患者作为研究对象,并收集临床资料.通过单因素分析,筛选与CSF术后股骨头坏死相关因素,再将它们纳入多因素Logistic回归模型中进行危险因素分析.采用R软件建立列线图模型,并通过Bootstrap法对其进行内部验证并且绘制校准曲线;利用受试者工作特征(receiver operating characteristic,ROC)曲线及曲线下面积(area under the curve,AUC)评估预测模型的区分度,并绘制决策曲线分析(decision curve analysis,DCA)曲线,以评估预测模型的应用价值.结果 252例FNF患者CSF术后,61例并发股骨头坏死,发生率为24.21％.Logistic回归分析结果显示,年龄≥60岁、糖尿病史、头下型骨折、Garden分型Ⅲ～Ⅳ型、Pauwels分型Ⅱ型、VN分型Ⅱ～Ⅲ型为FNF患者CSF术后股骨头坏死的危险因素(P＜0.05).校准曲线预测FNF患者CSF术后股骨头坏死发生风险与实际发生风险的一致性较好,列线图模型预测FNF患者CSF术后股骨头坏死风险内部验证的ROC曲线AUC为0.968(95％CI:0.949～0.987),DCA表明当阈值概率在0～1时模型能够带来临床收益.结论 本研究成功构建了一个高精度的列线图预测模型,该模型包括年龄、糖尿病史、骨折线部位、Garden分型、Pauwels分型、VN分型等预测变量,有助于提高对FNF患者CSF术后并发股骨头坏死高危患者的早期识别和管理效率.
Establishment and Validation of A Nomogram Model of the Risk of Femoral Head Necrosis Complicated by Cannulated Screw Fixation Surgery After Femoral Neck Fracture
Objective To explore the risk factors of femoral head necrosis complicated by cannulated screw fixation(CSF)surgery after femoral neck fracture(FNF),and to construct an individualized nomogram model for predicting the risk of femoral head necrosis.Methods A retrospective analysis was performed for 252 eligible FNF patients in the orthopedics depart-ment of the author's hospital,and clinical data were collected.Univariate analysis was used to screen the factors associated with femoral head necrosis after CSF surgery,and then they were included in the multivariate Logistic regression model to analyze the risk factors.A nomogram model was established by R software,which was internally verified by the Bootstrap method and the calibration curve was drawn;the discrimination of the predictive model was evaluated by receiver operating characteristic(ROC)curve and area under the curve(AUC),the decision curve analysis(DCA)curve was drawn to evaluate the applicative value of the predictive model.Results After the 252 FNF patients with CSF surgery,61 had femoral head necrosis,with an incidence of 24.21％.The Logistic regression analysis results showed that age ≥60,history of diabetes mellitus,subcephalic fractures,Ⅲ-Ⅳ Garden classification,Ⅱ Pauwels classification and Ⅱ-Ⅲ VN classification were risk factors for femoral head necrosis after CSF surgery in FNF patients(P＜0.05).The consistency predicted good agreement between the risk of the femoral head necrosis after CSF surgery and the actual occurrence of risk in FNF patients,the AUC of ROC curve for internal validation of the nomogram model predicting the risk of femoral head necrosis after CSF surgery in FNF patients was 0.968(95％CI:0.949-0.987),the DCA showed that the model was able to bring clinical benefit when the threshold probability of the patient was between 0 and 1.Conclusion In this study,a high-precision nomogram predictive model is successfully constructed,which included predictors such as age,history of diabetes mellitus,fracture line site,Garden classification,Pauwels classification,VN classification,etc.,which is helpful to improve the early identification and management efficiency of FNF patients at high risk of femoral head necrosis after CSF surgery.
Femoral neck fractureCannulated screw fixationFemoral head necrosisRisk factorPredictive model
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