老年全膝关节置换术后股骨假体周围骨折的危险因素及预测模型

朱萌; 胡学昱; 赵婷婷; 邱荣; 雷可; 宋瑶

doi:10.11659/jjssx.02E023095

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老年全膝关节置换术后股骨假体周围骨折的危险因素及预测模型

临床研究 | 更新时间：2024-02-02

- 老年全膝关节置换术后股骨假体周围骨折的危险因素及预测模型
- Risk factors and prediction model for periprosthetic femoral fracture after total knee arthroplasty in the elderly
- 局解手术学杂志 2024年33卷第2期页码：157-161
- 作者机构：
  
  1.空军军医大学第一附属医院骨科手术室，陕西西安 710032
  2.空军军医大学第一附属医院骨三科，陕西西安 710032
- 作者简介：
  
  宋瑶，E-mail：791863328@qq.com
- 基金信息：
  
  陕西省重点研发项目(2017SF-021)
- DOI：10.11659/jjssx.02E023095
  中图分类号： R683.42
- 纸质出版日期：2024-02-25，
  
  收稿日期：2023-02-17，
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朱萌,胡学昱,赵婷婷等.老年全膝关节置换术后股骨假体周围骨折的危险因素及预测模型[J].局解手术学杂志,2024,33(02):157-161.

ZHU Meng,HU Xue-yu,ZHAO Ting-ting,et al.Risk factors and prediction model for periprosthetic femoral fracture after total knee arthroplasty in the elderly[J].JOURNAL OF REGIONAL ANATOMY AND OPERATIVE SURGERY,2024,33(02):157-161.
朱萌,胡学昱,赵婷婷等.老年全膝关节置换术后股骨假体周围骨折的危险因素及预测模型[J].局解手术学杂志,2024,33(02):157-161. DOI： 10.11659/jjssx.02E023095.

ZHU Meng,HU Xue-yu,ZHAO Ting-ting,et al.Risk factors and prediction model for periprosthetic femoral fracture after total knee arthroplasty in the elderly[J].JOURNAL OF REGIONAL ANATOMY AND OPERATIVE SURGERY,2024,33(02):157-161. DOI： 10.11659/jjssx.02E023095.

摘要

目的

探讨老年全膝关节置换术（TKA）后股骨假体周围骨折（PFF）的危险因素并构建预测模型，为临床术后PFF的预防提供参考。

方法

回顾性分析2016年10月至2021年10月空军军医大学第一附属医院骨科收治的537例行TKA治疗的老年患者的临床资料。统计随访期间PFF的发生情况，收集临床资料。二元

Logistic

回归分析老年TKA后PFF的危险因素，基于危险因素构建老年TKA后PFF的预测模型。受试者工作特征（

ROC

）曲线和

Hosmer-Lemeshow

（

H-L

）检验预测模型的区分度和校准度。

结果

患者出院后随访12～72个月，中位时间47个月。随访期间31例（5.77%）患者发生PFF。年龄、骨质疏松、帕金森病、股骨前切迹（AFN）是老年TKA后PFF的危险因素（

0.05），假体十字固位、骨水泥固定是保护因素（

0.05）。

H-L

检验结果显示，老年TKA后PFF的风险预测模型具有较好的校准度（

0.05）；

ROC

曲线分析显示，老年TKA后PFF的风险预测模型具有较高的区分度（曲线下面积为0.858，95%

：0.826～0.887），敏感度为83.87%，特异度为88.34%。结论　老年TKA后PFF的发生风险较大，应针对高危因素进行防范，根据高危因素建立的预测模型具有较好的预测效能。

Abstract

Objective

To investigate the risk factors of periprosthetic femoral fracture （PFF） after total knee arthroplasty （TKA） in the elderly and to construct a predictive model for the prevention of PFF after clinical operation.

Methods

The clinical data of 537 elderly

patients who underwent TKA in the orthopedic department of the First Affiliated Hospital of Air Medical University from October 2016 to October 2021 were retrospectively analyzed. The occurrence of PFF during the follow-up period was statistically analyzed and the clinical data were collected. Binary

Logistic

regression was used to analyze the risk factors of PFF after TKA in the elderly， and a predictive model of PFF after TKA in the elderly was constructed based on the risk factors.

Receiver operating characteristic

（

ROC

） curve and

Hosmer-Lemeshow

（

H-L

） were used to test the discrimination and calibration of prediction model.

Results

The patients were followed up for 12 to 72 months after discharge， with a median time of 47 months. During the follow-up period， 31 patients （5.77%） developed PFF. Age， osteoporosis， Parkinson's disease and anterior femoral notch （AFN） were the risk factors for PFF after TKA in the elderly （

0.05）， and cross fixation of prosthesis and bone cement fixation were the protective factors （

0.05）. The results of

H-L

test showed that the risk prediction model of PFF after TKA in the elderly had good calibration （

0.05）.

ROC

curve analysis showed that the risk prediction model of PFF after TKA in the elderly has high discrimination （

area under the curve

was 0.858， 95%

： 0.826 to 0.887）， the sensitivity was 83.87%， the specificity was 88.34%.

Conclusion

The risk of PFF after TKA in the elderly is high， and prevention should be carried out according to the high risk factors. The prediction model constructed based on the high risk factors has good prediction efficiency.

关键词

全膝关节置换术股骨假体周围骨折预测模型危险因素

Keywords

total knee arthroplastyperiprosthetic femoral fractureprediction modelrisk factors

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