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[1]何克,孫官軍,銀毅,等.高齡膝骨關(guān)節(jié)炎患者跌倒的危險因素分析及風(fēng)險預(yù)測模型建立[J].中醫(yī)正骨,2024,36(03):23-30.
　HE Ke,SUN Guanjun,YIN Yi,et al.Risk factors and a risk forecasting model for falls in aged patients with knee osteoarthritis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2024,36(03):23-30.
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高齡膝骨關(guān)節(jié)炎患者跌倒的危險因素分析及風(fēng)險預(yù)測模型建立()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第36卷
期數(shù):
2024年03期
頁碼:
23-30
欄目:
臨床研究
出版日期:
2024-03-20

文章信息/Info

Title:
Risk factors and a risk forecasting model for falls in aged patients with knee osteoarthritis
作者:
何克; 孫官軍; 銀毅; 彭旭
遂寧市中心醫(yī)院,四川 遂寧 629000
Author(s):
HE Ke; SUN Guanjun; YIN Yi; PENG Xu
Suining Central Hospital,Suining 629000,Sichuan,China
關(guān)鍵詞:
骨關(guān)節(jié)炎; 膝;  意外跌倒;  危險因素;  風(fēng)險;  預(yù)測
Keywords:
osteoarthritis; knee;  accidental falls;  risk factors;  risk;  forecasting
摘要:
目的:分析高齡膝骨關(guān)節(jié)炎患者跌倒的危險因素,建立跌倒風(fēng)險預(yù)測模型。方法:以2020年1月至2022年4月在遂寧市中心醫(yī)院就診的年齡≥65歲的膝骨關(guān)節(jié)炎患者為研究對象。根據(jù)6個月內(nèi)是否有排除外力因素的跌倒史進(jìn)行分組,有跌倒史者歸入跌倒組,無跌倒史者歸入未跌倒組。收集2組患者的年齡、性別、病程、體質(zhì)量指數(shù)(body mass index,BMI)、患病側(cè)別、其他部位疼痛情況、合并其他慢性病情況、其他部位關(guān)節(jié)置換史、經(jīng)常爬樓梯史、膝關(guān)節(jié)外傷史、Kellgren-Lawrence分級等一般資料。采用西安大略和麥克馬斯特大學(xué)骨關(guān)節(jié)炎指數(shù)(Western Ontario and McMaster Universities osteoarthritis index,WOMAC)評價患膝疼痛、僵硬和功能受限程度,采用Lysholm膝關(guān)節(jié)評分評價膝關(guān)節(jié)功能。進(jìn)行下肢三維運(yùn)動學(xué)和動力學(xué)測試,收集包括時空參數(shù)、運(yùn)動學(xué)參數(shù)和動力學(xué)參數(shù)在內(nèi)的各項(xiàng)數(shù)據(jù)。比較2組患者的一般資料、臨床評價結(jié)果及下肢各項(xiàng)力學(xué)參數(shù),進(jìn)行單因素分析。根據(jù)單因素分析結(jié)果采用Logistic回歸分析高齡膝骨關(guān)節(jié)炎患者跌倒的危險因素,構(gòu)建跌倒風(fēng)險預(yù)測模型,并對模型進(jìn)行評價。結(jié)果:①單因素分析結(jié)果。共納入140例患者,跌倒組78例,未跌倒組62例。2組患者病程、其他部位疼痛情況、其他部位關(guān)節(jié)置換史、經(jīng)常爬樓梯史、膝關(guān)節(jié)外傷史、Kellgren-Lawrence分級的組間比較,差異均有統(tǒng)計學(xué)意義。跌倒組患者WOMAC評分中疼痛、僵硬、功能障礙評分均高于未跌倒組,對側(cè)腿離地期、步時長于未跌倒組,步長短于未跌倒組,步速慢于未跌倒組,足跟著地期踝背伸角、支撐期最大踝跖屈角、最大踝背伸角、最大踝跖屈角、足跟著地期膝伸角、支撐期最大膝伸角均大于未跌倒組,支撐期最大膝屈角、最大膝屈角、最大髖伸角、髖屈力矩峰值、髖伸力矩峰值、膝屈力矩峰值、膝伸力矩峰值、踝跖屈力矩峰值均小于未跌倒組。②高齡膝骨關(guān)節(jié)炎患者跌倒的危險因素分析及風(fēng)險預(yù)測模型評價結(jié)果。Logistic回歸分析結(jié)果顯示,病程長、經(jīng)常爬樓梯、疼痛重、足跟著地期踝背伸角增大、足跟著地期膝伸角增大、最大膝屈角減小、膝屈力矩峰值減小、踝跖屈力矩峰值減小均為高齡膝骨關(guān)節(jié)炎患者跌倒的獨(dú)立危險因素[OR=5.230,95%CI(3.232,7.021),P=0.004; OR=4.367,95%CI(2.648,5.953),P=0.003; OR=4.252,95%CI(2.159,6.231),P=0.003; OR=3.473,95%CI(2.982,4.028),P=0.021; OR=6.977,95%CI(3.667,8.964),P=0.001; OR=3.989,95%CI(1.667,5.264),P=0.010; OR=7.051,95%CI(4.267,8.164),P=0.001; OR=4.675,95%CI(2.563,6.798),P=0.008]。跌倒風(fēng)險預(yù)測列線圖模型顯示,病程>6年、經(jīng)常爬樓梯、WOMAC疼痛評分>48分、足跟著地期踝背伸角>9.25°、足跟著地期膝伸角>2.35°、最大膝屈角<45°、膝屈力矩峰值<0.65 N·m·kg-1、踝跖屈力矩峰值<0.90 N·m·kg-1時,高齡膝骨關(guān)節(jié)炎患者跌倒風(fēng)險的預(yù)測值總分為409分,患者發(fā)生跌倒的概率為71.90%。受試者操作特征(receiver operating characteristics,ROC)曲線分析結(jié)果顯示,預(yù)測模型區(qū)分度較高,訓(xùn)練集ROC曲線下面積為0.698(P=0.000),靈敏性71.43%,特異性65.89%; 驗(yàn)證集ROC曲線下面積為0.699(P=0.000),靈敏性78.26%,特異性63.18%。Hosmer-Lemeshow擬合優(yōu)度檢驗(yàn)結(jié)果顯示,預(yù)測模型擬合優(yōu)度好(訓(xùn)練集:χ2=0.748,P=0.504; 驗(yàn)證集:χ2=1.328,P=0.263)。臨床決策曲線分析結(jié)果顯示,訓(xùn)練集閾概率在9%～88%時凈獲益率高; 驗(yàn)證集閾概率在11%～92%時凈獲益率高。結(jié)論:病程長、經(jīng)常爬樓梯、疼痛重、足跟著地期踝背伸角增大、足跟著地期膝伸角增大、最大膝屈角減小、膝屈力矩峰值減小、踝跖屈力矩峰值減小均為高齡膝骨關(guān)節(jié)炎患者跌倒的獨(dú)立危險因素; 根據(jù)這些危險因素建立的跌倒風(fēng)險預(yù)測模型,對于高齡膝骨關(guān)節(jié)炎患者的跌倒風(fēng)險具有一定的預(yù)測價值。
Abstract:
Objective:To analyze the risk factors for falls in aged patients with knee osteoarthritis(KOA),and to build a fall risk prediction model.Methods:The patients aged≥65 years who were treated in the Suining Central Hospital for KOA from January 2020 to April 2022 were selected as the subjects.The patients with and without the history of fall caused by non-external force factors within the past 6 months were assigned into a fall group and a non-fall group,respectively.The general information,including age,gender,disease course,body mass index(BMI),affected side,pain in other sites,combined with other chronic diseases,history of joint replacement in other parts,history of frequent stair climbing,history of knee trauma,Kellgren-Lawrence classification,was collected.The affected knee pain degree,stiffness and functional limitation degree were evaluated by using Western Ontario and McMaster Universities osteoarthritis index(WOMAC),and the knee function was assessed by using Lysholm knee score; furthermore,the three-dimensional kinematic and kinetic tests on the lower limbs were conducted,and the temporal-spatial parameters,kinematic parameters,and kinetic parameters were measured and extracted.Moreover,the general information,clinical evaluation results,and lower limb mechanical parameters were compared between the 2 groups,and based on the single factor analysis results,the risk factors for falls among aged KOA patients were analyzed by logistic regression,and then a fall risk prediction model was constructed and evaluated.Results:①One hundred and forty patients were included in the final analysis,78 ones in the fall group,and 62 ones in the non-fall group.The differences in disease course,pain in other sites,history of joint replacement in other parts,history of frequent stair climbing,history of knee trauma,and Kellgren-Lawrence classification were statistically significant between the 2 groups.The scores of pain,stiffness and dysfunction in WOMAC scores were higher,the contralateral leg off-ground time and step time were longer,the step length was shorter,and the step speed was slower in fall group compared to non-fall group; in addition,the ankle dorsal extension angle at the heel strike phase,maximum ankle plantarflexion angle at the support phase,maximum ankle dorsal extension angle,maximum ankle plantarflexion angle,knee extension angle at the heel strike phase,and the maximum knee extension angle at the support phase were all greater in fall group compared with those of non-fall group; while,the maximum knee flexion angle at the support phase,maximum knee flexion angle,maximum hip extension angle,peak hip flexion moment,peak hip extension moment,peak knee flexion moment,peak knee extension moment,and peak ankle plantarflexion moment were all smaller in fall group compared with those of non-fall group.②The results of logistic regression analysis revealed that a long disease course,frequent stair climbing,severe pain,increased ankle dorsal extension angle at the heel strike phase,increased knee extension angle at the heel strike phase,decreased maximum knee flexion angle,decreased peak knee flexion moment,and decreased peak ankle plantarflexion moment were all the independent risk factors for falls among the aged KOA patients(OR=5.230,95%CI(3.232,7.021),P=0.004; OR=4.367,95%CI(2.648,5.953),P=0.003; OR=4.252,95%CI(2.159,6.231),P=0.003; OR=3.473,95%CI(2.982,4.028),P=0.021; OR=6.977,95%CI(3.667,8.964),P=0.001; OR=3.989,95%CI(1.667,5.264),P=0.010; OR=7.051,95%CI(4.267,8.164),P=0.001; OR=4.675,95%CI(2.563,6.798),P=0.008).The fall risk prediction nomogram model showcased that a total score of 409 points for fall risk and a probability of 71.90% for falls were predicted in the aged KOA patients when the disease course>6 years,frequent stair climbing,WOMAC pain score>48 points,ankle dorsal extension angle>9.25 degrees at the heel strike phase,knee extension angle>2.35 degrees at the heel strike phase,maximum knee flexion angle<45 degrees,peak knee flexion moment<0.65 N·m/kg,and peak ankle plantarflexion moment<0.90 N·m/kg.The results of receiver operating characteristics(ROC)curve analysis showed that the risk forecasting model had high discrimination performance,with the area under ROC curve,sensitivity,and specificity as 0.698(P=0.000),71.43%,and 65.89%,respectively,in training set,and 0.699(P=0.000),78.26%,and 63.18%,respectively,in validation set.The results of Hosmer-Lemeshow goodness-of-fit(GOF)test showed that the model had a good GOF(training set:χ2=0.748,P=0.504; validation set:χ2=1.328,P=0.263).The results of clinical decision curve analysis indicated a high net benefit rate when threshold probability ranged from 9% to 88% in the training set,and 11% to 92% in the validation set.Conclusion:A long disease course,frequent stair climbing,severe pain,increased ankle dorsal extension angle at the heel strike phase,increased knee extension angle at the heel strike phase,decreased maximum knee flexion angle,decreased peak knee flexion moment,and decreased peak ankle plantarflexion moment are all the independent risk factors for falls in the aged KOA patients.The model established based on the above risk factors has a certain applied value in forecasting the risk for falls in the aged KOA patients.

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備注/Memo

備注/Memo:
基金項(xiàng)目:四川省醫(yī)學(xué)青年創(chuàng)新科研課題計劃項(xiàng)目(Q22045)
通訊作者:彭旭 E-mail:[email protected]
更新日期/Last Update: 1900-01-01