桡骨远端骨折内固定后背侧关节内骨块移位的列线图模型

潘汝南; 唐承杰; 贾军锋; 李峰; 刘晶晶; 蒋柒

doi:10.11659/jjssx.10E022112

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桡骨远端骨折内固定后背侧关节内骨块移位的列线图模型

临床研究 | 更新时间：2023-07-31

- 桡骨远端骨折内固定后背侧关节内骨块移位的列线图模型
- Nomogram model of displacement of bone mass in dorsal joint of distal radius fracture after internal fixation
- 局解手术学杂志 2023年32卷第8期页码：720-725
- 作者机构：
  
  四川省骨科医院老年骨科2，四川成都 610045
- 作者简介：
  
  唐承杰，E-mail：2272216499@qq.com
- 基金信息：
  
  成都市卫生健康委员会(2021473)
- DOI：10.11659/jjssx.10E022112
  中图分类号： R683
- 纸质出版日期：2023-08-25，
  
  收稿日期：2022-10-21，
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潘汝南,唐承杰,贾军锋等.桡骨远端骨折内固定后背侧关节内骨块移位的列线图模型[J].局解手术学杂志,2023,32(08):720-725.

PAN Ru-nan,TANG Cheng-jie,JIA Jun-feng,et al.Nomogram model of displacement of bone mass in dorsal joint of distal radius fracture after internal fixation[J].JOURNAL OF REGIONAL ANATOMY AND OPERATIVE SURGERY,2023,32(08):720-725.
潘汝南,唐承杰,贾军锋等.桡骨远端骨折内固定后背侧关节内骨块移位的列线图模型[J].局解手术学杂志,2023,32(08):720-725. DOI： 10.11659/jjssx.10E022112.

PAN Ru-nan,TANG Cheng-jie,JIA Jun-feng,et al.Nomogram model of displacement of bone mass in dorsal joint of distal radius fracture after internal fixation[J].JOURNAL OF REGIONAL ANATOMY AND OPERATIVE SURGERY,2023,32(08):720-725. DOI： 10.11659/jjssx.10E022112.

摘要

目的

探究桡骨远端骨折（DRF）内固定后出现背侧关节内骨块移位的影响因素及列线图模型的构建。

方法

选取我院老年骨科收治的225例DRF患者为研究对象，随机分为训练集（158例）和验证集（67例），训练集根据患者术后1年内背侧关节内骨块的移动距离分为移位组（41例）和未移位组（117例）。采用单因素及多因素

Logistic

回归分析术后背侧关节内骨块移位的影响因素；构建列线图预测模型，以受试者工作特征（

ROC

）曲线及校准曲线评价模型效能。

结果

移位组骨折AO分型构成比、骨质疏松患者比例、受伤至手术时间、术后3个月和12个月VAS评分及DASH评分高/长于未移位组，而术后使用外固定患者比例、术后3个月握力低于未移位组（

0.05）。多因素

Logistic

回归分析显示，骨折AO分型为C3型、合并骨质疏松、术后12个月VAS评分≥2分、术后3个月DASH评分≥18分是独立危险因素。训练集和验证集的列线图模型

ROC

的曲线下面积分别为0.885（95%

：0.786~0.915，

0.01）和0.851（95%

：0.641~0.903，

0.01），校准曲线

Hosmer-Lemeshow

检验结果差异无统计学意义（

0.05）。

结论

骨折AO分型为C3型、合并骨质疏松、术后12个月VAS评分≥2分、术后3个月DASH评分≥18分是导致DRF患者内固定后背侧关节内骨块移位的危险因素，以此构建的列线图区分度较好，准确性较高。

Abstract

Objective

To investigate the influencing factors of displacement of bone mass in dorsal joint of distal radius fracture （DRF） after internal fixation and the construction of a nomogram model.

Methods

A total of 225 patients with DRF admitted to department of geriatric osteology in our hospital were selected as the research subjects， and the patients were randomly divided into the training set （158 cases） and the validation set （67 cases）. In the training set， the patients were divided into the displaced group （41 cases） and the non-displaced group （117 cases） according to the distance of movement of the bone mass in dorsal joint within 1 year after surgery. Univariate and multivariate

Logistic

regression were used to analyze the influencing factors of displacement of bone mass in dorsal joint after operation. A nomogram prediction model was constructed， and the efficacy of the model was evaluated by

receiver operating characteristics

（

ROC

） curves and calibration curves.

Results

The constituent ratio of AO classification of fracture， proportion of patients with osteoporosis， time from injury to surgery， VAS score and DASH score 3 and 12 months after operation were higher/longer in the displaced group than those in the non-displaced group， while the proportion of patients with postoperative external fixation and grip strength 3 months after operation in the displaced group were lower than those in the non-displaced group （

0.05）. Multivariate

Logistic

regression analysis showed that AO classification of fracture was C3， combined with osteoporosis， VAS score ≥2 at 12 months postoperatively， and DASH score ≥18 at 3 months postoperatively were independent risk factors. The area under the curve of nomogram model

ROC

in training set and validation set were 0.885 （95%

： 0.786 to 0.915，

0.01） and 0.851 （95%

： 0.641 to 0.903，

0.01）， respectively. The difference in the calibration curve

Hosmer-Lemeshow

test results was not statistically significant （

0.05）.

Conclusion

AO classification of fracture was C3， combined with osteoporosis， VAS score ≥2 at 12 months postoperatively， and DASH score ≥18 at 3 months postoperatively were the risk factors for displacement of bone mass in dorsal joint after internal fixation in patients with DRF， and the nomogram graph constructed from this has good discrimination and high accuracy.

关键词

桡骨远端骨折掌侧背侧内固定背侧关节内骨块移位

Keywords

distal radius fracturevolar sidedorsal sideinternal fixationdisplacement of bone mass in dorsal joint

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