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| 基于口腔衰弱构建老年患者髋或膝关节置换术后并发症的列线图预测模型 |
| A nomogram prediction model for postoperative complications based on oral frailty in elderly patients undergoing hip or knee joint replacement |
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| DOI：10.12089/jca.2025.12.004 |
| 中文关键词: 口腔衰弱 老年 列线图 预测模型 术后并发症 全髋关节置换术 全膝关节置换术 |
| 英文关键词: Oral frailty Aged Nomogram Prediction model Postoperative complications Knee joint replacement Hip joint replacement |
| 基金项目:中国人民解放军东部战区总医院临床研究专项续航项目（2024LCYYXH010） |
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| 中文摘要: |
目的：建立并验证基于口腔衰弱（OF）的老年患者髋或膝关节置换术后并发症的列线图预测模型。
方法：选择2024年3—10月择期于椎管内麻醉下行髋或膝关节置换术的老年患者220例，男66例，女154例，年龄65～95岁，ASA Ⅱ或Ⅲ级。根据术后30 d内是否出现并发症将患者分为两组：非并发症组和并发症组。术前评估患者OF情况。记录术前Hb、白蛋白、中性粒细胞等实验室指标、手术类型、手术时间、失血量、补液量和术后镇痛泵的使用情况。采用多因素Logistic回归分析筛选术后并发症的危险因素，构建列线图模型。采用受试者工作特征（ROC）曲线、校准曲线和决策曲线分析（DCA）评估列线图模型的预测性能。
结果：有79例（35.9）发生术后并发症。与非并发症组比较，并发症组OF比例明显偏高（P＜0.05）。多因素Logistic回归分析显示，年龄偏大（OR=1.117，95%CI 1.043~1.197）、术前Hb浓度偏低（OR=1.058, 95%CI 1.030~1.088）、术前OF（OR=3.660，95%CI 1.564~8.563）和全髋关节置换术（OR=3.740，95%CI 1.730～8.085）是老年患者髋或膝关节置换术后并发症的独立危险因素（P＜0.05）。基于上述危险因素构建的列线图模型曲线下面积（AUC）为0.888（95%CI 0.840～0.936），敏感性为0.787，特异性为0.873。校准曲线显示，模型与实际结果一致性良好。DCA曲线显示，该模型具有较好的临床实用性。
结论：年龄偏大、术前Hb浓度偏低、术前OF和全髋关节置换术是老年患者髋或膝关节置换术后并发症的独立危险因素，基于术前OF构建的列线图预测模型有较高的预测价值。 |
| 英文摘要: |
Objective: To develop and validate a nomogram prediction model for postoperative complications based on oral frailty in elderly patients undergoing hip or knee joint replacement.
Methods: A total of 220 patients were selected, 66 males and 154 females, aged 65-95 years, ASA physical status Ⅱ or Ⅲ, undergoing knee and hip joint replacement under spinal anesthesia between March and October 2024. The patients were divided into two groups based on the occurrence of complications within 30 days postoperatively: non-complication group and complication group. Preoperative evaluation of the OF status was performed. Clinical indicators, such as preoperative Hb, albumin, and neutrophil count, were measured. Data on surgery type, operation time, blood loss, fluid replacement volume, and postoperative analgesic pump use were also collected. Multivariate logistic regression analysis was conducted to identify risk factors for postoperative complications, and a nomogram was then developed. The calibration curve and decision curve analysis (DCA) were generated to assess the predictive efficacy of the nomogram.
Results: Complications occurred in 79 patients (35.9%). The incidence of OF in the complication group was significantly higher than that in the non-complication group (P < 0.05). Multivariate logistic regression analysis identified increased age (OR = 1.117, 95% CI 1.043-1.197), decreased preoperative Hb concentration (OR = 1.058, 95% CI 1.030-1.088), preoperative OF (OR = 3.660, 95% CI 1.564-8.563), and hip arthroplasty (OR = 3.740, 95% CI 1.730-8.085) as independent risk factors for postoperative complications in elderly patients undergoing knee and hip arthroplasty (P < 0.05). A nomogram based on these factors yielded an AUC of 0.888 (95% CI 0.840-0.936), while the sensitivity was 0.787 and the specificity was 0.873. The calibration curve demonstrated strong alignment between the model's predictions and actual outcomes. The DCA curve revealed the model's good clinical applicability.
Conclusion: Increased age, decreased preoperative Hb concentration, preoperative OF, and hip arthroplasty are independent risk factors for postoperative complications in elderly patients undergoing knee or hip arthroplasty. The nomogram prediction model based on OF demonstrates high predictive value. |
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