[1]王晓伟 杨红梅 孙天胜 刘智 刘川 高杰.髓内钉治疗老年股骨转子间骨折术后内固定相关并发症预测模型建立与验证[J].中华老年骨科与康复电子杂志,2026,(01):38-46.[doi:10.3877/cma.j.issn.2096-0263.2026.01.006]
　Wang Xiaowei,Yang Hongmei,Sun Tiansheng,et al.Establish a predictive model for postoperative complications of intramedullary nailing in the treatment of elderly intertrochanteric fractures and validate its effectiveness[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2026,(01):38-46.[doi:10.3877/cma.j.issn.2096-0263.2026.01.006]
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髓内钉治疗老年股骨转子间骨折术后内固定相关并发症预测模型建立与验证()
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中华老年骨科与康复电子杂志[ISSN:1674-3911/CN:11-9292/R]

卷:
期数:
2026年01期
页码:
38-46
栏目:
髋部骨折
出版日期:
2026-02-05

文章信息/Info

Title:
Establish a predictive model for postoperative complications of intramedullary nailing in the treatment of elderly intertrochanteric fractures and validate its effectiveness
作者:
王晓伟 杨红梅 孙天胜 刘智 刘川 高杰
100700 北京，中国人民解放军总医院第七医学中心骨科
Author(s):
Wang Xiaowei;  Yang Hongmei;  Sun Tiansheng;  Liu Zhi;  Liu Chuan;  Gao Jie.
Department of orthopedics, the seventh medical center, General Hospital of the Chinese people’s Liberation Army, Beijing 100700, China
关键词:
老年人;  股骨转子间骨折;  内固定并发症
Keywords:
Aged;  Intertrochanteric fracture;  Complications of internal fixation
DOI:
10.3877/cma.j.issn.2096-0263.2026.01.006
文献标志码:
A
摘要:
目的 建立髓内钉治疗老年股骨转子间骨折术后内固定并发症预测模型并验证其效能。方法 回顾性分析2015年1月至2022年12月期间我院骨科采用髓内钉治疗的451例股骨转子间骨折患者资料，平均年龄（81.97±7.91）岁，其中男性129例，女性322例，A1型135例，A2型225例，A3型91例，按照3：1的比例将患者随机分配至建模组（338例）和验证组（113例），利用建模组数据，采用Logistic回归分析筛选术后内固定并发症的独立危险因素，并构建预测模型；利用验证组数据，使用受试者工作曲线分析其预测效能，利用Hosmer-Lemeshow拟合优度检验评价其拟合程度。结果 平均随访时间（19.08±9.50）月，随访期间共有72例（15.9%）内固定并发症，其中头钉切出16例（INTERTAN 11例，PFNA 5例），切穿股骨头5例（INTERTAN 1例，PFNA 4例），断钉2例（INTERTAN 1例，PFNA 1例），骨不连合17例（INTERTAN 13例，PFNA 4例），过度退出32例（INTERTAN 9例，PFNA 24例），多因素Logistic结果显示：不稳定骨折、复位质量差、重度骨质疏松、PFNA和开始负重时间＞4周是术后内固定并发症的独立危险因素（P＜0.05）。基于以上指标构建预测模型，建模组ROC曲线下面积为0.864，灵敏度和特异度分别为0.882和0.700，模型拟合度良好（c2=5.094，P=0.747）。验证组ROC曲线下面积为0.858灵敏度和特异度分别为0.810和0.804，Youden指数为0.614，且该模型拟合程度良好（c2=8.110，P=0.423）。结论 不稳定骨折、复位质量差、重度骨质疏松、PFNA和开始负重时间＞4周是髓内钉治疗老年股骨转子间骨折术后内固定并发症的独立危险因素，基于以上指标建立的预测模型具有良好的预测效能。
Abstract:
Objective To establish a prediction model for postoperative complications of intramedullary nail treatment for elderly intertrochanteric fractures and verify its effectiveness. Methods A retrospective analysis was conducted on the data of 451 patients with intertrochanteric fractures treated with intramedullary nails in our orthopedic department from January 2015 to December 2022. The average age was 81.97±7.91 years, including 129 males and 322 females, 135 patients with A1 type, 225 patients with A2 type, and 91 patients with A3 type. The patients were randomly assigned to a modeling group (338 cases) and a validation group (113 cases) in a 3:1 ratio. Using the modeling group data, logistic regression analysis was used to screen for independent risk factors for postoperative internal fixation complications, and a prediction model was constructed; Using validation group data, we analyzed its predictive performance using the subject work curve, and evaluate its fitting degree using Hosmer Lemeshow fitting toxicity test. Results There were a total of 72 cases (15.9%) after surgery, including 16 cases (11 cases of INTERTAN, 5 cases of PFNA), 5 cases (1 case of INTERTAN, 4 cases of PFNA), 2 cases (1 case of INTERTAN, 1 case of PFNA), 17 cases (13 cases of INTERTAN, 4 cases of PFNA), and 32 cases (9 cases of INTERTAN, 24 cases of PFNA) of excessive withdrawal. Multivariate logistic analysis showed that unstable fractures, poor reduction quality, severe osteoporosis, PFNA, and weight-bearing time>4 weeks were independent risk factors for postoperative internal fixation complications (P<0.05). Based on the above indicators, a prediction model was constructed with a modeling group ROC curve area of 0.864, sensitivity and specificity of 0.882 and 0.7, respectively. The model fit was good (c2=5.094, P=0.747). The area under the ROC curve of the validation group is 0.858, with sensitivity and specificity of 0.810 and 0.804, respectively. The Youden index is 0.614, and the model fits well (c2=8.110, P=0.423). Conclusions Unstable fractures, poor reduction quality, severe osteoporosis, PFNA, and weight-bearing time>4 weeks are independent risk factors for postoperative internal fixation complications in the treatment of elderly intertrochanteric fractures with intramedullary nails. The predictive model established based on these indicators has good predictive performance.

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备注/Memo

备注/Memo:
基金项目：国家自然科学基金面上项目（82172389）；北京科技新星计划（Z181100006218031）
更新日期/Last Update: 2026-05-18