Development and verification of collapse risks prediction model for ARCO stage Ⅱ nontraumatic osteonecrosis of femoral head
Objective:The risk factors for collapse in association research circulation osseous(ARCO)stage Ⅱ(non-collapse)nontraumatic osteonecrosis of the femoral head(NONFH)were analyzed,and a nomogram risk prediction model was developed to provide a simple tool and theoretical basis for identifying ARCO stage Ⅱ patients with a high collapse risk.Methods:Patients with ARCO stage Ⅱ and stage ⅢA(early collapse)NONFH diagnosed and treated from July 2017 to February 2024 were retrospectively selected as subjects.The patients were randomly divided into a training group and a verification group at a ratio of 6∶4 to screen the independent risk factors of collapse and develop a prediction model and test the model's effectiveness.The optimal characteristic values were screened using LASSO regression analysis of the indexes of the patients in the training group with R statistical software.The risk factors of collapse were screened using a multifactor Logistic regression analysis.A prediction model was developed,and thus,the prediction and differentiation performance of the model for the risk of collapse in ARCO stage Ⅱ patients were compared between the training and verification groups.The evaluation indexes included the C-index and calibration curve.The model was visually quantified by a nomogram and its clinical effectiveness was evaluated by a decision curve.Results:A total of 78 patients(95 hips)with ARCO stage Ⅱ NONFH and 80 patients(102 hips)with ARCO stageⅢ A NONFH who met the criteria were included,totaling 197 hips.Multifactor Logistic regression analysis showed a long pain time(OR=1.176,95％CI:1.090-1.313),the percentage of femoral head involvement(PFHI)＞30％(OR=25.257,95％CI:2.771-436.321),bone marrow edema(BME)grade 3(OR=1.963,95％CI:0.017-22.424),combined preserved angle(CPA)＜118.7°(OR=6.814,95％CI:1.658-37.099),high red blood cell volume distribution width(OR=1.097,95％CI:0.611-1.570)and high platelet volume distribution width(OR=1.174,95％CI:0.119-13.149)were independent risk factors for femoral head collapse(P＜0.05).The collapse risk prediction model for patients with NONFH in ARCO stage Ⅱ developed in this study showed good differentiation,and its C-indices in the training and verification groups were 0.844 and 0.878,respectively.In the training and verification groups,the calibration curve showed that the predicted results of the nomogram agreed well with the actual observational results.The results of the decision curve analysis showed that the prediction model could provide more net benefits to patients within a more extensive probability threshold range.Conclusion:Long pain duration,PFHI＞30％,BME grade 3,CPA＜118.7°,high red blood cell volume distribution width and high platelet volume distribution width can be used as predictive factors for the occurrence of femoral head collapse in ARCO stage Ⅱ,which is helpful for clinicians to detect and intervene in the occurrence and development of femoral head collapse in the early stages.
nontraumatic osteonecrosis of the femoral headregression analysis
万方数据
