摘要
背景:股骨近端防旋髓内钉在临床上被广泛用于治疗老年股骨转子间骨折,该治疗方式损伤小且固定牢靠,但围术期的出血量仍较大,术后需要输血的患者比例仍居高不下,一直困扰着骨科医师。目的:探讨老年股骨转子间骨折髓内钉固定术后输血的相关危险因素,并建立和验证列线图预测模型,为临床上早期识别术后高风险输血患者提供指导。方法:选择2016年1月至2020年12月在江苏省苏北人民医院创伤骨科因股骨转子间骨折初次行髓内钉固定术的患者,回顾性分析围术期临床资料。根据患者术后是否输血,分为输血组和未输血组,分别进行单因素和多因素Logistic回归分析,以探讨术后输血的独立危险因素,根据多因素结果建立列线图预测模型,并绘制出ROC曲线和校正曲线评价模型的预测性能和一致性。结果与结论:(1)366例患者被纳入研究,输血组有142例,术后输血概率为38.8%;(2)单因素分析显示,年龄、骨折类型、术前血红蛋白、术前白蛋白、受伤至手术时间、麻醉类型、术中出血量与术后输血有关(P<0.05);(3)多因素Logistic回归分析显示,骨折类型、术前白蛋白、术前血红蛋白、术中失血量是输血的独立危险因素(P均<0.05);(4)ROC曲线显示该模型预测患者术后有输血风险的曲线下面积为0.95;校准曲线的斜率接近1,表示该模型的区分度和准确度较好;(5)根据多因素Logistic分析结果构建的老年股骨转子间骨折术后输血预测模型,可为临床骨科医师提供科学指导,进一步保障这类患者围术期的安全。
BACKGROUND:Proximal femoral nail anti-rotation is widely used in the treatment of elderly patients with femoral intertrochanteric fracture.Its surgical injury is small and the fixation is reliable,but the perioperative blood loss is still large.The proportion of patients who need blood transfusion after operation is still high,which has been bothering orthopedic surgeons.OBJECTIVE:To explore the related risk factors of blood transfusion after proximal femoral nail anti-rotation fixation of femoral intertrochanteric fracture in the elderly,and to establish and verify a nomogram prediction model to provide guidance for early identification of postoperative high-risk blood transfusion patients.METHODS:The perioperative clinical data of patients with femoral intertrochanteric fracture treated with proximal femoral nail anti-rotation in the Department of Traumatic Orthopedics of Subei People’s Hospital of Jiangsu Province from January 2016 to December 2020 were analyzed retrospectively.According to whether the patients received blood transfusion or not,the patients were divided into transfusion group and non-transfusion group.Univariate and multivariate Logistic regression analyses were performed to explore the independent risk factors for postoperative blood transfusion.According to the results of multiple factors,a nomogram prediction model was established,and the ROC curve and calibration curve were drawn to evaluate the prediction performance and consistency.RESULTS AND CONCLUSION:(1)Totally 366 patients were included in the study,with 142 patients in the transfusion group,and the probability of postoperative blood transfusion was 38.8%.(2)Univariate analysis showed that age,type of fracture,preoperative hemoglobin,preoperative albumin,time from injury to operation,type of anesthesia and intraoperative blood loss were related to postoperative blood transfusion(P<0.05).(3)Multivariate Logistic regression analysis showed that fracture type,preoperative albumin,preoperative hemoglobin and intraoperative blood loss
作者
何世平
贾大洲
李小磊
王强
He Shiping;Jia Dazhou;Li Xiaolei;Wang Qiang(Department of Orthopedics,Clinical Medical College of Yangzhou University,Northern Jiangsu People’s Hospital,Yangzhou 225001,Jiangsu Province,China)
出处
《中国组织工程研究》
CAS
北大核心
2022年第6期929-933,共5页
Chinese Journal of Tissue Engineering Research
基金
江苏省医学创新团队课题(CXTDB2017004),项目负责人:李小磊。
关键词
股骨转子间骨折
股骨近端防旋髓内钉
输血
列线图
危险因素
femoral intertrochanteric fracture
proximal femoral nail anti-rotation
blood transfusion
nomogram
risk factors
