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中华老年骨科与康复电子杂志

中华老年骨科与康复电子杂志 ›› 2023, Vol. 09 ›› Issue (04) : 226 -232. doi: 10.3877/cma.j.issn.2096-0263.2023.04.005

膝关节

开放式楔形胫骨高位截骨术后下肢深静脉血栓形成的危险因素分析及预测列线图的构建
宋碧萱, 郭海川, 韩子钰, 周瑞娟, 李承思, 姬晨妮†()   
  1. 999077　香港中文大学医学院
    050051　石家庄，河北医科大学第三医院骨科
    050011　石家庄，河北医科大学基础医学院
    050010　石家庄，河北师范大学教育学院
  • 收稿日期:2023-01-02 出版日期:2023-08-05
  • 通信作者: 姬晨妮
  • 基金资助:
    河北省科技厅高水平人才团队建设专项(No. 225A7703D)

Analysis of risk factors and construction of predictive nomogram for deep vein thrombosis in the lower extremity after open wedge high tibial osteotomy

Bixuan Song, Haichuan Guo, Ziyu Han, Ruijuan Zhou, Chengsi Li, Chenni Ji†()   

  1. School of Medicine, Chinese University of Hong Kong, Hong Kong 999077, China
    Department of Orthopedics, the Third Hospital of Hebei Medical University, Shijiazhuang 050051, China
    School of Basic Medicine, Hebei Medical University, Shijiazhuang 050051, China
    School of Education, Hebei Normal University, Shijiazhuang 050010, China
  • Received:2023-01-02 Published:2023-08-05
  • Corresponding author: Chenni Ji
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宋碧萱, 郭海川, 韩子钰, 周瑞娟, 李承思, 姬晨妮. 开放式楔形胫骨高位截骨术后下肢深静脉血栓形成的危险因素分析及预测列线图的构建[J]. 中华老年骨科与康复电子杂志, 2023, 09(04): 226-232.

Bixuan Song, Haichuan Guo, Ziyu Han, Ruijuan Zhou, Chengsi Li, Chenni Ji. Analysis of risk factors and construction of predictive nomogram for deep vein thrombosis in the lower extremity after open wedge high tibial osteotomy[J]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2023, 09(04): 226-232.

目的

利用患者医疗数据探索开放式楔形胫骨高位截骨术（OWHTO）后发生下肢深静脉血栓形成（DVT）的危险因素，并构建预测列线图模型。

方法

回顾性地收集2021年9月至2023年5月期间于河北医科大学第三医院骨科接受OWHTO治疗内侧间室膝骨关节炎伴内翻畸形的患者的临床数据。以术后是否存在DVT的发生将人群分为DVT组与非DVT组。通过单因素及多因素逻辑回归分析，确定与OWHTO术后发生DVT独立相关的危险因素，并根据结果构建预测列线图。采用受试者操作曲线下面积AUC，Brier评分，C指数，Bootstrap500次重复抽样验证，以及校准曲线和决策曲线分析进一步评估和验证模型的预测效能。

结果

744例患者被纳入该研究。多因素逻辑回归表明撑开高度≥13 mm、高水平的空腹血糖、低水平的ALB，以及D-二聚体>1.07 mg/L被确认为与OWHTO术后DVT发生的高风险独立相关。根据多因素分析结果构建的预测列线图表现良好，AUC为0.775，波尔分数为0.031，C指数为0.775，经Bootstrap500次重复抽样验证，校正后的Brier评分和C指数分别为0.033和0.747，此外校准曲线显示模型的预测概率和DVT发生的实际概率之间具有良好的一致性。决策曲线分析表明该列线图模型可以很好地指导临床实践。

结论

撑开高度≥13mm、高水平的空腹血糖、低水平的ALB，以及D-二聚体>1.07 mg/L是OWHTO术后DVT的独立危险因素，并且据此构建的列线图模型具有良好的预测性能。

关键词: 开放式楔形胫骨高位截骨术, 下肢深静脉血栓形成, 危险因素, 列线图
Objective

To explore the risk factors for developing lower extremity deep vein thrombosis (DVT) after open wedge high tibial osteotomy (OWHTO) using patient medical data and construct a predictive line graph model.

Methods

Clinical data were retrospectively collected from patients who underwent OWHTO for medial compartment knee osteoarthritis with inversion deformity at the Department of Orthopedics, 3rd Hospital of Hebei Medical University between May 2022 and May 2023. The population was divided into a DVT group and a non-DVT group by the presence or absence of DVT after surgery. Risk factors independently associated with the occurrence of DVT after OWHTO were identified by univariate and multifactorial logistic regression analysis, and predictive nomogram were constructed based on the results. The predictive efficacy of the model was further evaluated and validated using the area under the subject operating curve AUC, Poe's score, C index, Bootstrap 500 replicate sampling validation, and calibration curve and decision curve analysis.

Results

372 patients were included in the study. Multifactorial logistic regression showed that a propped height ≥13 mm, high levels of fasting glucose, low levels of ALB, and D-dimer >1.07 mg/L were identified as independently associated with a high risk of developing DVT after OWHTO. The predictive nomogram constructed from the results of the multifactorial analysis performed well with an AUC of 0.775, a Brier score of 0.031, and a C-index of 0.775, which were validated by Bootstrap 500 replicate sampling with a corrected Brier score and C-index of 0.747 and 0.033, respectively, in addition to calibration curves showing that the model's predicted probability and the actual probability of DVT occurrence between with good agreement. The decision curve analysis showed that the nomogram model could guide clinical practice well.

Conclusion

The propped height ≥13 mm, high fasting glucose levels, low ALB levels, and D-dimer >1.07 mg/L were independent risk factors for postoperative DVT after OWHTO, and the nomogram model constructed accordingly had a good predictive performance.

Key words: Open wedge high tibial osteotomy, Deep venous thrombosis, Risk factors, Nomogram
表1 DVT组与非DVT组之间的单变量分析
变量 非DVT组（n=706） DVT组（n=38） 统计值（χ2或t） P值
性别（女性） 474（67.1%） 24（63.2%） 0.258 0.611
年龄 56.7±5.4 58.2±6.1 2.020 0.152
BMI（kg/m2）≥28 130（18.4%） 10（18.4%） 1.474 0.225
居住地（农村） 496（70.3%） 30（78.9%） 1.315 0.251
高血压 228（32.3%） 17（44.7%） 2.527 0.112
糖尿病 84（11.9%） 8（21.1%） 2.789 0.095
心脏病 56（7.9%） 5（13.2%） 1.308 0.253
吸烟 98（13.9%） 7（18.4%） 0.613 0.434
饮酒 64（9.1%） 5（13.2%） 0.718 0.397
手术史 147（20.8%） 12（31.6%） 2.483 0.115
K-L分级（Ⅳ级） 112（15.9%） 11（28.9%） 4.473 0.034
撑开高度≥13 mm 104（14.7%） 14（36.8%） 10.519 0.001
植骨类型     0.098 0.862
无植骨 166（23.5%） 8（21.1%）    
自体骨 64（9.1%） 4（10.5%）    
异体骨 476（67.4%） 26（68.4%）    
ASA分级（≥Ⅲ级） 116（16.4%） 9（23.7%） 1.357 0.244
术中出血量（ml） 109.1±53.7 114.5±47.2 0.278 0.602
手术时长（min） 113.1±35.8 122.5±41.4 1.365 0.218
止血带时间（min） 93.3±33.5 99.8±36.7 2.013 0.192
红细胞计数（<下限） 106（15.0%） 6（15.8%） 0.017 0.896
红细胞比容（<下限） 114（16.1%） 7（18.4%） 0.137 0.711
血红蛋白浓度（<下限） 98（13.9%） 6（15.8%） 0.109 0.741
白细胞计数（<下限） 47（6.7%） 5（13.2%） 2.344 0.126
PHR（>1.82） 185（26.2%） 15（39.5%） 3.230 0.072
PLR（>142.38） 274（38.8%） 20（52.6%） 2.882 0.090
NLR（>2.07） 381（54.0%） 27（71.1%） 4.251 0.039
MLR（>0.31） 252（35.7%） 17（44.7%） 1.277 0.258
超敏C反应蛋白（>2.6 mg/L） 289（40.9%） 21（55.3%） 3.046 0.081
总蛋白（g/L） 66.7±5.3 65.3±5.1 0.147 0.783
白蛋白（g/L） 43.2±3.2 41.3±3.9 6.186 0.012
D-二聚体（>1.07） 148（21.0%） 17（44.7%） 10.092 0.001
空腹血糖（mmol/L） 5.2±1.5 5.9±1.5 4.928 0.036
表2 与术后DVT相关的独立风险因素的多变量分析结果
变量 P值 OR值 95%置信区间
白蛋白（g/L） 0.002 0.79 0.67，0.92
空腹血糖mmol/L 0.043 1.34 1.01，1.79
撑开高度（≥13 mm） 0.005 4.77 1.35，16.85
D-二聚体（>1.07 mg/L） 0.028 3.52 1.01，12.29
图4 列线图模型的临床决策曲线
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