Construction and Validation of Visual Prediction Model for Bone Nonunion After Internal Fixation of Osteoporotic Femoral Neck Fractures
Objective To explore the risk factors of bone nonunion after internal fixation in patients with osteoporotic femoral neck fracture(OFNF)and construct a predictive nomogram model.Methods The clinical data of 226 OFNF patients treated with internal fixation in Nanyang Zhang Zhongjing Hospital from January 2014 to July 2021 were retrospectively analyzed,and they were divided into healing group(174 cases)and non-healing group(52 cases)according to whether the fracture healed or not after operation.Logistic regression analysis was used to screen the independent risk factors of bone nonunion after internal fixation in OFNF patients,and a nomogram model for predicting the risk was constructed.The receiver operating characteristic(ROC)curve was drawn to evaluate the discrimination of the above model,and Bootstrap self-sampling method and consistency index(CI)were used to internally verify the above model.Results The incidence rate of bone nonunion in patients with OFNF after internal fixation was 23.01％(52/226).The proportions of patients with fracture Garden type of Ⅲ/Ⅳ,Singh index ofⅠ-Ⅲ,time from fracture occurrence to operation＞2 days,comminuted fracture,non-anatomical reduction and time of non-weight bearing activities after operation＜3 months in non-healing group were higher than those in healing group(P＜0.05).Logistic regression analysis showed that fracture Garden type of Ⅲ/Ⅳ,Singh index of Ⅰ-Ⅲ,time from fracture occurrence to operation＞2 days,comminuted fracture and non-anatomical reduction were all independent risk factors for bone nonunion after internal fixation in OFNF patients(OR=2.184,2.065,2.565,2.452,2.361,P＜0.05).The area under the curve(AUC)of evaluating nomogram model was 0.815,and the nomogram had good discrimination.Bootstrap self sampling method and CI were used to verify the nomogram model,and the result showed that CI was 0.868,and the calibration curve and the ideal curve fitted well.Conclusion The Garden type of fracture,the degree of osteoporosis,the time from fracture occurrence to operation,comminuted fracture and the reduction quality are all independent risk factors for bone nonunion after internal fixation in patients with OFNF.The nomogram model established based on above factors has good prediction effect on the risk of bone nonunion after internal fixation in patients with OFNF,and it can effectively screen out high-risk OFNF patients with bone nonunion after internal fixation and provide clinical guidance for prevention and treatment.
osteoporotic femoral neck fractureinternal fixationnonunioninfluencing factorsnomograph model
万方数据
维普
