GardenⅢ、Ⅳ型股骨颈骨折术后股骨头坏死的影响因素及预测分析
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闫雪松
,张永先,李家威,范志鹏,吴卓航
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1.中国人民解放军联勤保障部队第九六〇医院骨科，山东济南，250031；2.山东第一医科大学临床医学院，山东潍坊，250117；3.山东第二医科大学临床医学院，山东潍坊，261000
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摘要：目的? 探讨GardenⅢ、Ⅳ型股骨颈骨折闭合复位内固定术后发生股骨头坏死的影响因素，并构建Nomogram模型评估其预测价值。方法? 采用回顾性病例对照研究，纳入我院 2008年 1月至 2020年12月收治的 374例 GardenⅢ、Ⅳ型股骨颈骨折患者（坏死组 108例，非坏死组 266例），均行闭合复位CCS或DHS内固定术。收集患者术前至术后的多项基线资料。通过随访（>3年）及影像学检查确诊股骨头坏死。采用二元 logistic回归分析股骨头坏死的影响因素，并基于此构建预测股骨头坏死风险的Nomogram模型，最后通过 ROC曲线、校准曲线及DCA评估模型的预测效能。结果? 本研究纳入 374例GardenⅢ、Ⅳ型股骨颈骨折患者，股骨头坏死发生率为 28.9%（108/374）。多因素 Logistic回归进一步确定吸烟、Garden指数、解剖分型、受伤至手术时间、Pauwels角、BMI及手术时长为股骨头坏死的独立危险因素（P<0.05）。基于上述独立危险因素构建的Nomogram预测模型表现出良好性能：AUC为 0.874，区分度良好；校准曲线斜率近 1，拟合度佳；DCA显示该模型在较广阈值范围内具有更高的临床净获益。结论? 本研究明确了GardenⅢ、Ⅳ型股骨颈骨折术后股骨头坏死的独立危险因素。基于此构建的列线图模型能为临床提供个体化预测，通过早期干预可控因素，对降低股骨头坏死风险、改善患者预后具有重要价值。
关健词：股骨颈骨折；内固定；股骨头坏死；预测模型 |
Risk Factors and Predictive Analysis of Femoral Head Necrosis After Surgery for Garden Type Ⅲ and Ⅳ Femoral Neck Fractures
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Xuesong Yan, Yongxian Zhang, Jiawei Li, Zhipeng Fan, Zhuohang Wu
1.Department of Orthopaedics, The 960th Hospital of the PLA Joint Logistics Support Force,
Jinan Shandong 250031, China; 2.Medical School of Clinical Medicine of Shandong First Medical University, Jinan Shandong 250117, China; 3.Medical School of Clinical Medicine of Shandong Second Medical University, Weifang Shandong261000, China
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Abstract：objective To investigate the risk factors of femoral head necrosis following closed reduction and internal fixation for Garden type Ⅲ and Ⅳ femoral neck fractures, and to establish a nomogram model for evaluating its predictive value.Methods A retrospective case-control study was performed, including 374 patients with Garden type Ⅲ and Ⅳ femoral neck fractures treated in our hospital from January 2008 to December 2020 (108 in the necrosis group and 266 in the non-necrosis group). All patients underwent closed reduction and internal fixation with CCS or DHS. Baseline data were collected preoperatively and postoperatively. Femoral head necrosis was diagnosed by follow-up (>3 years) and imaging examinations. Binary logistic regression was used to analyze the influencing factors of femoral head necrosis, based on which a predictive nomogram was established. The predictive performance of the model was evaluated by ROC curve, calibration curve and decision curve analysis (DCA).Results Among the 374 included patients, the incidence of postoperative femoral head necrosis was 28.9% (108/374). Multivariate logistic regression identified smoking, Garden index, anatomical classification, time from injury to surgery, Pauwels angle, BMI and operation duration as independent risk factors for femoral head necrosis (P<0.05). The nomogram model showed favorable predictive performance: the AUC was 0.874 with good discrimination; the calibration curve was close to the ideal line with satisfactory fitness; DCA revealed that the model achieved favorable clinical net benefit within a wide range of threshold probabilities.Conclusion This study identifies the independent risk factors for femoral head necrosis after surgery for Garden type Ⅲ and Ⅳ femoral neck fractures. The established nomogram allows individualized risk prediction in clinical practice, which is of great significance for reducing the incidence of femoral head necrosis and improving patient prognosis through early intervention of modifiable risk factors.
Keywords : Femoral neck fracture; Internal fixation; Femoral head necrosis; Prediction model
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