老年股骨颈骨折手术病人1年死亡率调查及其预测模型的构建

doi:10.3969/j.issn.1003-9198.2023.02.011

摘要/Abstract

摘要： 目的调查老年股骨颈骨折手术病人1年死亡率,并构建其预测模型。方法选择2019年2月至2020年5月在我院接受手术治疗的老年股骨颈骨折病人208例进行回顾性分析。收集可能影响病人1年内死亡的相关临床资料。根据病人1年内生存情况将其分为生存组与死亡组,比较2组病人临床资料,并采用Logistic回归分析老年股骨颈骨折病人术后1年死亡的影响因素,以多因素分析结果构建列线图预测模型。结果生存组和死亡组年龄、入院前合并症、骨折前Harris髋关节评分、美国卒中协会(ASA)分级、骨折类型、WBC、Hb、白蛋白、活化部分凝血活酶时间差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示:入院前合并症≥2种、ASA分级Ⅲ~Ⅳ级、囊内骨折为老年股骨颈骨折病人术后1年死亡的危险因素,Hb和骨折前Harris髋关节评分为保护因素(P<0.05)。以各因素β值构建老年股骨颈骨折病人术后1年内死亡预测模型:Prob=1/(1+e^-Y),Y=0.389×入院前合并症-0.385×骨折前Harris髋关节评分+0.371×ASA分级+0.415×骨折类型-0.386×Hb,以此构建列线图模型。绘制ROC曲线显示,预测模型的AUC为0.964(95%CI:0.936~0.992),Bootstrap法内部验证结果显示:平均绝对误差为0.016,模型表现与理想模型基本拟合。结论老年股骨颈骨折病人术后1年死亡率主要受合并症、ASA分级、骨折类型、Hb和髋关节功能等因素的影响,以上述因素构建的列线图模型可有效预测老年股骨颈骨折病人术后1年死亡风险,模型具有较高的区分度与准确度。

关键词: 老年人, 股骨颈骨折, 预后, 列线图, 预测模型

Abstract: Objective To investigate the 1-year mortality of the elderly patients with femoral neck fracture receiving surgery, and to construct a predictive model. Methods A total of 208 elderly patients with femoral neck fractures who were treated with surgery in our hospital from February 2019 to May 2020 were enrolled in this study. The clinical data were collected for retrospective analysis. According to the survival of the patients, they were divided into the survival group and the death group. The clinical data of the two groups were compared, and Logistic regression analysis was used to evaluate the influencing factors of 1-year survival. A nomogram prediction model was constructed based on the results of the multivariate analysis. Results There were significant difference in age, comorbidities before admission, pre-fracture Harris hip score, American stroke association (ASA) grade, fracture type, the levels of white blood cell(WBC), hemoglobin (Hb),albumin and activated partial thromboplastin time between the survival group and the death group(P<0.05). Multivariate Logistic regression analysis showed that ≥2 kinds of comorbidities before admission, ASA grade Ⅲ-Ⅳ, and intracapsular fracture were the risk factors for 1-year death in the elderly patients with femoral neck fracture. Increased hemoglobin and pre-fracture Harris hip score were the protective factors (P<0.05). The β value of each factor was used to construct a one-year mortality prediction model for the elderly patients with femoral neck fracture: Prob=1/(1+e^-Y), Y=0.389×pre-hospital comorbidities -0.385×pre-fracture Harris hip score+0.371×ASA grade+0.415×fracture type-0.386×Hb. Nomogram model was constructed based on this formula. The receiver operating characteristic(ROC)curve of the model was drawn, and the area under the ROC curve was 0.964(95% CI: 0.936-0.992). The internal verification results of the Bootstrap method showed that the mean absolute error was 0.016, and the model performance fitted the ideal model. Conclusions The 1-year mortality of the elderly patients with femoral neck fracture is mainly affected by the comorbidities, ASA classification, fracture type, Hb and pre-fracture Harris hip score. The nomogram model constructed with the above factors can effectively predict the 1-year mortality risk of the elderly patients with femoral neck fracture receiving surgery with high discrimination and accuracy.

Key words: aged, femoral neck fracture, prognosis, nomogram, predictive model

中图分类号:

R 683.42

卢俊松, 吕国荣, 田龙, 何涛, 严纯, 陈路, 杨志强. 老年股骨颈骨折手术病人1年死亡率调查及其预测模型的构建[J]. 实用老年医学, 2023, 37(2): 151-155.

LU Jun-song, LYU Guo-rong, TIAN Long, HE Tao, YAN Chun, CHEN Lu, YANG Zhi-Qiang. One-year mortality of elderly patients with femoral neck fracture receiving surgery and the construction of its prediction model[J]. Practical Geriatrics, 2023, 37(2): 151-155.

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