老年髋部骨折患者术后2年内再发对侧髋部骨折风险预测模型的构建及验证
Construction and validation of risk prediction model for recurrence of contralateral hip fracture in elderly patients within 2 years after operation
文涛 1赵捷 1王艳云 1阴璇 1樊文 1郝耀1
作者信息
- 1. 山西医科大学第一医院骨科,太原 030000
- 折叠
摘要
目的 探讨老年髋部骨折患者术后2年内再发对侧髋部骨折的风险因素,构建列线图预测模型并进行模型验证.方法 采用便利抽样法,选取2018年6月一2020年6月在山西医科大学第一医院骨科进行手术治疗的601例老年髋部骨折患者为研究对象,分为建模集(n=421)和验证集(n=180).根据随访患者2年内再发对侧髋骨骨折的发生情况,将建模集分为骨折再发组和正常组,比较两组患者的临床资料.采用Logistic回归分析老年髋部骨折患者术后2年内再发对侧髋部骨折的危险因素,使用R 3.6软件构建再发对侧髋部骨折风险因素列线图模型,采用受试者工作特征(ROC)曲线及校准曲线评价该模型的区分度和一致性.结果601例老年髋部骨折患者术后2年内再发对侧髋部骨折发生率为8.49％(51/601),其中建模集发生率为8.31％(35/421),验证集发生率为8.89％(16/180).建模集中,骨折再发组患者的年龄、女性比例、骨质疏松比例、合并内科疾病比例及营养不良比例均高于正常组(P＜0.05);Logistic回归分析结果显示,性别、年龄、骨质疏松、合并内科疾病是老年髋部骨折患者术后2年内再发对侧髋部骨折的影响因素(P＜0.05);构建列线图预测模型方程为:Logit(P)=-8.521+0.335 ×年龄+0.116 ×女性+0.341 ×骨质疏松+0.280 ×合并内科疾病.建模集根据列线图模型预测再发对侧髋部骨折的概率,绘制ROC曲线,灵敏度为0.826,特异度为0.804,ROC曲线下面积(AUC)为0.876;验证集的ROC曲线灵敏度为0.788,特异度为0.781,AUC为0.830.经Bootstrap法进行内部验证,建模集与验证集预测模型区分度均良好,预测概率和实际发生率具有良好的一致性(Hosmer-Lemeshow x2＝0.462,P=0.674).结论 高龄、女性、骨质疏松、合并内科疾病是老年髋部骨折患者术后2年内再发对侧髋部骨折的独立危险因素,据此构建的列线图模型对再发对侧髋部骨折有较高的预测效能,可用于评估再发骨折风险,改善患者预后.
Abstract
Objective To explore the risk factors of recurrent contralateral hip fracture within 2 years after operation in elderly patients with hip fracture,construct a nomogram prediction model and validate the model.Methods A total of 601 elderly patients with hip fracture who underwent surgical treatment in Department of Orthopedics in First Hospital of Shanxi Medical University from June 2018 to June 2020 were selected as research objects by the convenient sampling method.They were divided into the modeling set(n=421)and the verification set(n=180).According to the incidence of recurrent contralateral hip fracture within 2 years of follow-up,the modeling set was divided into the recurrent fracture group and the normal group,and the clinical data of the two groups were compared.Logistic regression was used to analyze the risk factors for recurrent contralateral hip fracture in elderly patients within 2 years after surgery.R 3.6 software was used to build a risk factor nomogram model for recurrent contralateral hip fracture.Receiver operating characteristic(ROC)curve and calibration curve were used to evaluate the differentiation and consistency of the model.Results In 601 elderly patients with hip fracture,the incidence of recurrent contralateral hip fracture within 2 years after surgery was 8.49％(51/601),among which the incidence of modeling set was 8.31％(35/421)and the incidence of verification set was 8.89％(16/180).In the modeling set,the age,female proportion,osteoporosis proportion,combined internal medical disease proportion and malnutrition proportion of patients in the recurrent fracture group were higher than those in the normal group(P＜0.05).Logistic regression analysis showed that gender,age,osteoporosis and combined internal medical diseases were the factors affecting the recurrence of contralateral hip fracture within 2 years after operation in elderly patients with hip fracture(P＜0.05).The equation for constructing a nomogram prediction model was Logit(P)=-8.521+0.335 × age+0.116×female+0.341× osteoporosis+0.280×combined internal medical diseases.The modeling set predicted the probability of recurrent contralaterial hip fracture according to the nomogram model,and plotted the ROC curve with sensitivity of 0.826,specificity of 0.804,and area under ROC curve(AUC)of 0.876.The sensitivity of ROC curve of the validation set was 0.788,the specificity was0.781,and the AUC was 0.830.After internal verification by Bootstrap method,the prediction model of the modeling set and the verification set were well distinguished,and the prediction probability and the actual incidence were well consistent(Hosmer-Lemeshow x2=0.462,P=0.674).Conclusions Advanced age,female,osteoporosis and combined internal medical diseases are independent risk factors for recurrent contralateral hip fractures in elderly patients with hip fractures within 2 years after surgery.The nomogram model constructed based on this has high predictive efficacy for recurrent hip fractures,which can be used to assess the risk of recurrent fractures and improve the prognosis of patients.
关键词
老年人/髋部骨折/再发对侧髋部骨折/风险因素/列线图Key words
Aged/Hip fracture/Recurrent contralateral hip fracture/Risk factors/Nomograph引用本文复制引用
基金项目
山西省回国留学人员科研资助项目(2022-189)
山西省青年科研基金项目(201901D211481)
出版年
2024
NETL
NSTL
万方数据