股骨干闭合性骨折髓内钉术后骨折不愈合风险模型构建

目的 探讨股骨干闭合性骨折髓内钉术后骨折不愈合的危险因素并构建风险评估模型。方法回顾性分析诊断为闭合性股骨干骨折并行髓内钉治疗的患者共261例。将所有患者以7∶3的比例随机分为两组,其中共183例患者纳入建模组,78例患者纳入验证组。建模组统计患者年龄、性别、骨质疏松、吸烟、内固定是否失效、是否存在骨折对位不良、骨折类型、骨折部位、感染。建模组采用单因素分析明确股骨闭合骨折髓内钉术后骨折不愈合的危险因素,采用logistic回归模型进行多因素分析并建立回归方程。通过R语言软件绘制nomogram图,构建风险评估模型。通过验证组评价该风险评估模型的校准度和区分度。结果建模组183例患者中共14例出现骨折不愈合。其中年龄、性别、骨质疏松、骨折部位、术后感染与骨折不愈合无相关性。吸烟、内固定失效、骨折对位不良、复杂骨折为骨折不愈合的危险因素。验证组中绘制该风险评估模型在预测股骨闭合性骨折髓内钉术后骨折不愈合发生的ROC曲线下面积为0.952>0.9,具有统计学意义（P=0.001）,提示该风险评估模型具有较高的准确度。拟合优度检验表明该模型校准度较好（2=1.757,P=0.882）。结论股骨干闭合性骨折髓内钉术后吸烟、内固定失效、复杂骨折、骨折对位不良为骨折不愈合的危险因素。该风险评估模型具有较好的区分度及校准度,可为临床预测股骨干闭合性骨折髓内钉术后骨折不愈合风险的发生提供参考。

Nomogram of fracture nonunion after intramedullary nailing for closed fractures of the middle femur

Objective To investigate the risk factors of fracture nonunion after intramedullary nailing for closed fractures of the middle femur and construct a risk assessment model. Methods A retrospective analysis of 261 patients who were diagnosed with closed middle femoral fractures and treated with intramedullary nailing were conducted. All patients were randomly divided into two groups at a ratio of 7∶3. A total of 183 patients were included in the modeling group and 78 patients were included in the verification group. In the modeling group, age, gender, osteoporosis, smoking, internal fixation failure, fracture alignment, fracture type, fracture site, and infection were analyzed. Univariate analysis was conducted to clarify the risk factors of fracture nonunion after intramedullary nailing for closed femoral fractures. Logistic regression model was used for multivariate analysis, and regression equations were established. The nomogram diagram was conducted using R language software to build a risk assessment model. The patients in verification group were applied for calibration and discrimination of the risk assessment model. Results A total of 14 of the 183 patients in the modeling group had fracture nonunion. There was no correlation between age, gender, osteoporosis, fracture site, or postoperative infection and fracture nonunion. Smoking, failure of internal fixation, poor fracture alignment, and complex fractures were risk factors for fracture nonunion. The area under the ROC curve for risk assessment model drawn in the verification group to predict the occurrence of fracture nonunion after femoral closed fracture intramedullary nailing was 0.952 (>0.9, P=0.001). The goodness-of-fit test indicated that the model was well calibrated (2=1.757, P=0.882). Conclusion Smoking, internal fixation failure, complex fractures, and poor fracture alignment are risk factors for fracture nonunion after intramedullary nailing for closed femoral fractures. The risk assessment model has a good degree of discrimination and calibration, and can provide a reference for clinical prediction of the risk of fracture nonunion after intramedullary nailing for closed fractures of the middle femur.