目的 分析老年全髋关节置换术(total hip arthroplasty,THA)后早期髋部功能障碍影响因素并构建列线图模型.方法 选取我院在 2018 年 1 月至 2021 年 5 月行 THA 治疗的 236 例老年髋部骨折患者,按1∶1 比例随机分为训练组(n=118)与验证组(n=118).使用改良爱荷华辅助量表(the modified Iowa level of assistance scale,mILAS)评估患者术后髋部功能状态.采用多因素 Logistic 回归模型分析训练组患者术后早期髋部功能障碍的危险因素并构建列线图模型.在训练组与验证组中,通过接收者操作特征(receiver operating characteristic,ROC)曲线评估列线图模型预测准确性.结果 训练组患者手术时间及术中出血量低于验证组患者(P<0.05),血红蛋白(hemoglobin,Hb)及白蛋白(albumin,ALB)高于验证组患者(P<0.05).训练组中,36 例(30.5%)患者早期髋部功能障碍.术后髋部功能障碍患者年龄、体质量指数(body mass index,BMI)、吸烟、简易精神状态检查表(mini-mental state examination,MMSE)评分、美国麻醉医师协会(American Society of Anesthesiologists,ASA)分级、微型营养评定简法(mini nutritional assessment short form,MNA-SF)评分、手术时机、Hb、ALB、C-反应蛋白(C-reactive protein,CRP)与术后髋部功能良好患者比较差异有统计学意义(P<0.05).年龄(≥75 岁)、BMI(<18.5,≥25)、ASA 分级(Ⅲ 级、Ⅳ 级)、MNA-SF 评分(营养不良)及 ALB(≤35 g/L)是术后髋部功能障碍的独立危险因素(P<0.05).列线图模型在训练组和验证组中的曲线下面积(area under the curve,AUC)值分别为 0.822(0.772～0.756)和 0.751(0.706～0.771).结论 年龄、BMI、ASA 分级、MNA-SF 评分及 ALB 与老年 THA 患者术后早期髋部功能障碍风险相关,开发的列线图模型可以有效预测其风险.
A nomogram model to predict the risk of early hip dysfunction after total hip arthroplasty in older adults
Objective To analyze the factors that affect hip dysfunction in the early postoperative period after total hip arthroplasty in the elderly and construct a nomogram model.Methods Two hundred and thirty-six elderly hip fracture patients treated with total hip arthroplasty(THA)between January 2018 and May 2021 in our hospital were selected.They were randomly divided into training group(n=118)and validation group(n=118)in a 1:1 ratio.Postoperative hip functional status was assessed in elderly hip fracture patients using the modified Iowa level of assistance scale(mILAS).A multivariate Logistic regression model was used to analyse the risk factors for early postoperative hip dysfunction of patients in the training group and to construct a nomogram model.In the training and validation groups,the predictive accuracy of the nomogram model was assessed by calibration curves.Results The operation time and intraoperative bleeding of patients in the training group were lower than that of patients in the validation group(P<0.05);haemoglobin(Hb)and albumin(ALB)were higher than that of patients in the validation group(P<0.05).In the training group,36 patients(30.5%)had early hip dysfunction.Age,body mass index(BMI),smoking,mini-mental state examination(MMSE)score,American Society of Anesthesiologists(ASA)grade,mini nutritional assessment short form(MNA-SF)score,timing of surgery,Hb,ALB,and C-reactive protein(CRP)were statistically different in patients with postoperative hip dysfunction compared with patients with good postoperative hip function(P<0.05).Age(≥75 years),BMI(<18.5,≥25),ASA grade(Ⅲ grade,Ⅳ grade),MNA-SF score(malnutrition),and ALB(≤35 g/L)were independent risk factors for postoperative hip dysfunction(P<0.05).The area under the curve(AUC)values of the nomogram model in the training and validation groups were 0.822(0.772-0.756)and 0.751(0.706-0.771),respectively.Conclusions Age,BMI,ASA classification,MNA-SF score and ALB are associated with the risk of early postoperative hip dysfunction in the elderly THA patients,and the developed nomogram model can effectively predict the risk.
万方数据
维普
