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目的 构建股骨近端髓内钉治疗不稳定型股骨转子间骨折患者术后髋关节功能康复的预测模型，并进行验证。方法 选取2023年1月至2024年2月接受股骨近端髓内钉治疗的不稳定型股骨转子间骨折患者361例，失访3例，问卷调查不合格6例，最终纳入352例。根据术后康复情况分为康复良好组(n=276)与康复不佳组(n=76)。多因素logistic回归分析患者髋关节功能康复不佳的影响因素，构建列线图预测模型并予以评价。结果 年龄、骨质疏松症、美国麻醉医师协会分级、延迟负重、恐动症、术后并发症、血管内皮生长因子低水平、血小板源性生长因子低水平是股骨近端髓内钉治疗不稳定型股骨转子间骨折患者术后髋关节功能康复不佳的危险因素，而24 h内急诊手术、功能锻炼依从性、自我效能是其保护因素(P<0.05,P<0.01)。据此构建预测患者术后髋关节功能康复不佳的列线图模型，验证结果显示，该模型准确度较高，预测效能、临床效用良好。结论 影响不稳定型股骨转子间骨折患者术后髋关节功能康复的因素较多，基于此构建的列线图模型具有较高准确度以及良好的预测价值、临床效用。
Abstract：Objective To construct a predictive model for postoperative hip functional recovery in patients with unstable femoral intertrochanteric fractures treated with proximal femoral intramedullary nail, and to validate it. Methods A total of 361 patients with unstable femoral intertrochanteric fractures who underwent proximal femoral intramedullary nail treatment from January 2023 to February 2024 were selected. Among them, 3 patients were lost to follow-up, 6 patients were non-compliant in the questionnaire survey, and 352 patients were ultimately included. Patients were assigned to two groups based on their postoperative rehabilitation status: the good recovery group(n=276) and the poor recovery group(n=76). Multivariate Logistic regression analysis was used to identify the factors influencing poor hip functional recovery in patients. A nomogram prediction model was constructed and evaluated. Results Age, osteoporosis, American Society of Anesthesiologists classification, delayed weight-bearing, phobia of movement, postoperative complications, low levels of vascular endothelial growth factor, and low levels of platelet-derived growth factor were risk factors for poor hip functional recovery in patients with unstable femoral intertrochanteric fractures treated with proximal femoral intramedullary nail. Emergency surgery within 24 h, compliance with functional exercise, and self-efficacy were protective factors(P<0.05, P<0.01). Based on this, a nomogram model was constructed to predict poor postoperative hip functional recovery in patients. The validation results showed that the model had high accuracy, good predictive performance, and clinical utility. Conclusion There are numerous factors that influence the postoperative hip functional recovery of patients with unstable femoral intertrochanteric fractures. Based on this, the nomogram model constructed exhibits high accuracy, excellent predictive value, and clinical utility.
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基本信息:
DOI：
中图分类号:R687.3
引用信息:
[1]韩双杨,赵李奔,陆泉秀.股骨近端髓内钉治疗不稳定型股骨转子间骨折术后髋关节功能康复的预测模型构建及评价[J].临床误诊误治,2025,38(10):59-65+72.
基金信息:
2020年度河北省医学科学研究重点课题(20201374)