«上一篇/Previous Article|本期目录/Table of Contents|下一篇/Next Article»

中华老年骨科与康复电子杂志[ISSN:1674-3911/CN:11-9292/R]

卷:

期数:

2023年04期

页码:

226-232

栏目:

膝关节

出版日期:

2023-08-05

文章信息/Info

Title:

Analysis of risk factors and construction of predictive nomogram for deep vein thrombosis in the lower extremity after open wedge high tibial osteotomy

作者:

宋碧萱1; 郭海川2; 韩子钰3; 周瑞娟4; 李承思2; 姬晨妮2

999077 香港中文大学医学院1；050051石家庄，河北医科大学第三医院骨科2；050011 石家庄，河北医科大学基础医学院3；050010 石家庄，河北师范大学教育学院4

Author(s):

ong Bixuan1;  Guo Haichuan2;  Han Ziyu3;  Zhou Ruijuan4;  Li Chengsi2;  Ji Chenni2.

1School of Medicine, Chinese University of Hong Kong, Hong Kong 999077, China; 2Department of Orthopedics, the Third Hospital of Hebei Medical University, Shijiazhuang 050051, China; 3School of Basic Medicine, Hebei Medical University, Shijiazhuang 050051, China; 4School of Education, Hebei Normal University, Shijiazhuang 050010, China

关键词:

开放式楔形胫骨高位截骨术;  下肢深静脉血栓形成;  危险因素;  列线图

Keywords:

Open wedge high tibial osteotomy;  Deep venous thrombosis;  Risk factors;  Nomogram

DOI:

10.3877/cma.j.issn.2096-0263.2023.04.005

文献标志码:

A

摘要:

目的 利用患者医疗数据探索开放式楔形胫骨高位截骨术（OWHTO）后发生下肢深静脉血栓形成（DVT）的危险因素，并构建预测列线图模型。方法 回顾性地收集2021年9月至2023年5月期间于河北医科大学第三医院骨科接受OWHTO治疗内侧间室膝骨关节炎伴内翻畸形的患者的临床数据。以术后是否存在DVT的发生将人群分为DVT组与非DVT组。通过单因素及多因素逻辑回归分析，确定与OWHTO术后发生DVT独立相关的危险因素，并根据结果构建预测列线图。采用受试者操作曲线下面积AUC，Brier评分，C指数，Bootstrap500次重复抽样验证，以及校准曲线和决策曲线分析进一步评估和验证模型的预测效能。结果 744例患者被纳入该研究。多因素逻辑回归表明撑开高度≥13 mm、高水平的空腹血糖、低水平的ALB，以及D-二聚体＞1.07 mg/L被确认为与OWHTO术后DVT发生的高风险独立相关。根据多因素分析结果构建的预测列线图表现良好，AUC为0.775，波尔分数为0.031，C指数为0.775，经Bootstrap500次重复抽样验证，校正后的Brier评分和C指数分别为0.033和0.747，此外校准曲线显示模型的预测概率和DVT发生的实际概率之间具有良好的一致性。决策曲线分析表明该列线图模型可以很好地指导临床实践。结论 撑开高度≥13mm、高水平的空腹血糖、低水平的ALB，以及D-二聚体＞1.07 mg/L是OWHTO术后DVT的独立危险因素，并且据此构建的列线图模型具有良好的预测性能。

Abstract:

Objective To explore the risk factors for developing lower extremity deep vein thrombosis (DVT) after open wedge high tibial osteotomy (OWHTO) using patient medical data and construct a predictive line graph model. Methods Clinical data were retrospectively collected from patients who underwent OWHTO for medial compartment knee osteoarthritis with inversion deformity at the Department of Orthopedics, 3rd Hospital of Hebei Medical University between May 2022 and May 2023. The population was divided into a DVT group and a non-DVT group by the presence or absence of DVT after surgery. Risk factors independently associated with the occurrence of DVT after OWHTO were identified by univariate and multifactorial logistic regression analysis, and predictive nomogram were constructed based on the results. The predictive efficacy of the model was further evaluated and validated using the area under the subject operating curve AUC, Poe’s score, C index, Bootstrap 500 replicate sampling validation, and calibration curve and decision curve analysis. Results 372 patients were included in the study. Multifactorial logistic regression showed that a propped height ≥13 mm, high levels of fasting glucose, low levels of ALB, and D-dimer >1.07 mg/L were identified as independently associated with a high risk of developing DVT after OWHTO. The predictive nomogram constructed from the results of the multifactorial analysis performed well with an AUC of 0.775, a Brier score of 0.031, and a C-index of 0.775, which were validated by Bootstrap 500 replicate sampling with a corrected Brier score and C-index of 0.747 and 0.033, respectively, in addition to calibration curves showing that the model’s predicted probability and the actual probability of DVT occurrence between with good agreement. The decision curve analysis showed that the nomogram model could guide clinical practice well. Conclusion The propped height ≥13 mm, high fasting glucose levels, low ALB levels, and D-dimer >1.07 mg/L were independent risk factors for postoperative DVT after OWHTO, and the nomogram model constructed accordingly had a good predictive performance.

备注/Memo

备注/Memo:

基金项目：河北省科技厅高水平人才团队建设专项（No. 225A7703D）

常用功能

更新日期/Last Update: 2023-09-01