84年鼠女哪年财运最旺,857comvvv色九欧美激情|85PO_87国产精品欲av国产av资源

[1]羅程,宋忱,龔健,等.老年髖部骨折手術(shù)延遲的影響因素分析及風(fēng)險(xiǎn)預(yù)測模型構(gòu)建[J].中醫(yī)正骨,2024,36(02):32-38,59.
　LUO Cheng,SONG Chen,GONG Jian,et al.Influencing factors and a risk forecasting model of delayed operation for hip fractures in the aged[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2024,36(02):32-38,59.
點(diǎn)擊復(fù)制

老年髖部骨折手術(shù)延遲的影響因素分析及風(fēng)險(xiǎn)預(yù)測模型構(gòu)建()
分享到：

《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第36卷
期數(shù):
2024年02期
頁碼:
32-38,59
欄目:
臨床研究
出版日期:
2024-02-20

文章信息/Info

Title:
Influencing factors and a risk forecasting model of delayed operation for hip fractures in the aged
作者:
羅程; 宋忱; 龔健; 劉弘揚(yáng)
(唐山市第二醫(yī)院,河北 唐山 063000)
Author(s):
LUO Cheng; SONG Chen; GONG Jian; LIU Hongyang
The Second Hospital of Tangshan,Tangshan 063000,Hebei,China
關(guān)鍵詞:
髖骨折;  股骨頸骨折;  股骨轉(zhuǎn)子間骨折;  老年人;  手術(shù)延遲;  Logistic模型;  因素分析; 統(tǒng)計(jì)學(xué);  風(fēng)險(xiǎn);  預(yù)測模型
Keywords:
hip fractures;  femoral neck fractures;  femoral intertrochanteric fractures;  aged;  operation delay;  logistic models;  factor analysis; statistical;  risk;  forecasting model
摘要:
目的:探討老年髖部骨折手術(shù)延遲的影響因素,構(gòu)建老年髖部骨折手術(shù)延遲風(fēng)險(xiǎn)預(yù)測模型。方法:選取2019年11月至2022年11月采用手術(shù)治療的老年髖部骨折患者的病例資料進(jìn)行研究,將納入研究的患者按照2:1的比例隨機(jī)分為訓(xùn)練集(用于模型構(gòu)建)和驗(yàn)證集(用于模型驗(yàn)證)。從病歷系統(tǒng)中提取納入患者的信息,包括年齡、性別、體質(zhì)量指數(shù)、骨折類型、美國麻醉醫(yī)師協(xié)會(huì)(American Society of Anesthesiologists,ASA)分級(jí)、傷前日常活動(dòng)能力(activities of daily living,ADL)、是否服用影響凝血功能的藥物、入院至手術(shù)時(shí)間、手術(shù)方式,是否合并精神障礙、高血壓、糖尿病、呼吸系統(tǒng)疾病、心功能不全、肝功能不全、腎功能不全、電解質(zhì)紊亂、尿酮體異常、下肢靜脈血栓、凝血功能異常,以及入院后血清腫瘤壞死因子-α、C反應(yīng)蛋白水平等。將訓(xùn)練集中的患者根據(jù)入院至手術(shù)時(shí)間分為早期手術(shù)組(入院至手術(shù)時(shí)間<48 h)和延遲手術(shù)組(入院至手術(shù)時(shí)間≥48 h)。先對2組患者的相關(guān)信息進(jìn)行單因素對比分析,再對單因素分析中組間差異有統(tǒng)計(jì)學(xué)意義的因素進(jìn)行多因素Logistic回歸分析及多重共線性診斷; 采用R軟件基于貝葉斯網(wǎng)絡(luò)模型構(gòu)建老年髖部骨折手術(shù)延遲風(fēng)險(xiǎn)預(yù)測模型,并采用Netica軟件進(jìn)行貝葉斯網(wǎng)絡(luò)模型推理。采用受試者操作特征(receiver operating characteristic,ROC)曲線評(píng)價(jià)老年髖部骨折手術(shù)延遲風(fēng)險(xiǎn)預(yù)測模型的區(qū)分度,采用校準(zhǔn)曲線評(píng)價(jià)老年髖部骨折手術(shù)延遲風(fēng)險(xiǎn)預(yù)測模型的校準(zhǔn)度。結(jié)果:①分組結(jié)果。共納入老年髖部骨折患者318例,訓(xùn)練集212例、驗(yàn)證集106例。根據(jù)入院至手術(shù)時(shí)間,訓(xùn)練集中早期手術(shù)組78例、延遲手術(shù)組134例。②老年髖部骨折手術(shù)延遲影響因素的單因素分析結(jié)果。2組患者ASA分級(jí)、是否服用影響凝血功能的藥物及是否合并精神障礙、高血壓、糖尿病、呼吸系統(tǒng)疾病、心功能不全、電解質(zhì)紊亂、凝血功能異常的比較,組間差異均有統(tǒng)計(jì)學(xué)意義(χ2=3.862,P=0.049; χ2=26.806,P=0.000; χ2=29.852,P=0.000; χ2=21.743,P=0.000; χ2=25.226,P=0.000; χ2=5.415,P=0.020; χ2=11.683,P=0.001; χ2=14.686,P=0.000; χ2=6.057,P=0.014)。③老年髖部骨折手術(shù)延遲影響因素的多因素分析及多重共線性診斷結(jié)果。多因素Logistic回歸分析結(jié)果顯示,服用影響凝血功能的藥物及合并精神障礙、高血壓、糖尿病、呼吸系統(tǒng)疾病、心功能不全、電解質(zhì)紊亂、凝血功能異常均是老年髖部骨折手術(shù)延遲的影響因素[β=0.328,P=0.000,OR=5.112,95%CI(2.686,9.728); β=0.322,P=0.000,OR=5.425,95%CI(2.884,10.203); β=0.302,P=0.000,OR=3.956,95%CI(2.189,7.148); β=0.312,P=0.000,OR=4.560,95%CI(2.476,8.398); β=0.291,P=0.021,OR=1.962,95%CI(1.108,3.474); β=0.296,P=0.001,OR=2.713,95%CI(1.520,4.844); β=0.303,P=0.000,OR=3.133,95%CI(1.729,5.679); β=0.296,P=0.015,OR=2.061,95%CI(1.154,3.680)]; 多重共線性診斷結(jié)果顯示,上述影響因素均不存在共線性(VIF=1.134,VIF=1.266,VIF=1.465,VIF=1.389,VIF=1.342,VIF=1.183,VIF=1.346,VIF=1.259)。④基于貝葉斯網(wǎng)絡(luò)模型的老年髖部骨折手術(shù)延遲風(fēng)險(xiǎn)預(yù)測模型的構(gòu)建與推理結(jié)果。基于貝葉斯網(wǎng)絡(luò)模型構(gòu)建的老年髖部骨折手術(shù)延遲風(fēng)險(xiǎn)預(yù)測模型包括8個(gè)節(jié)點(diǎn)、8條有向邊。模型顯示,服用影響凝血功能的藥物及合并精神障礙、呼吸系統(tǒng)疾病、電解質(zhì)紊亂、凝血功能異常直接影響手術(shù)延遲的發(fā)生,合并心功能不全、高血壓、糖尿病間接影響手術(shù)延遲的發(fā)生; 推理結(jié)果顯示,患者合并心功能不全、凝血功能異常及精神障礙時(shí),手術(shù)延遲發(fā)生率為64.1%。⑤老年髖部骨折手術(shù)延遲風(fēng)險(xiǎn)預(yù)測模型的評(píng)價(jià)結(jié)果。采用訓(xùn)練集數(shù)據(jù)進(jìn)行老年髖部骨折手術(shù)延遲風(fēng)險(xiǎn)預(yù)測模型評(píng)價(jià),ROC曲線下面積為0.861[P=0.000,95%CI(0.810,0.912)],靈敏度為91.29%,特異度為93.35%; 校準(zhǔn)曲線顯示其一致性指數(shù)為0.866[P=0.000,95%CI(0.702,0.943)]; 采用驗(yàn)證集數(shù)據(jù)進(jìn)行老年髖部骨折手術(shù)延遲風(fēng)險(xiǎn)預(yù)測模型評(píng)價(jià),ROC曲線下面積為0.848[P=0.000,95%CI(0.795,0.901)],靈敏度為91.62%,特異度為92.46%; 校準(zhǔn)曲線顯示其一致性指數(shù)為0.879[P=0.000,95%CI(0.723,0.981)]。結(jié)論:服用影響凝血功能的藥物以及合并精神障礙、高血壓、糖尿病、呼吸系統(tǒng)疾病、心功能不全、電解質(zhì)紊亂、凝血功能異常均為老年髖部骨折手術(shù)延遲的影響因素,基于上述因素構(gòu)建的老年髖部骨折手術(shù)延遲風(fēng)險(xiǎn)預(yù)測模型具有較高的應(yīng)用價(jià)值。
Abstract:
Objective:To explore the factors influencing delay of operation for hip fractures in the aged,and to build a risk forecasting model.Methods:The medical records of aged patients who underwent operation for hip fractures from November 2019 to November 2022 were selected.The information of the included patients,including age,gender,body mass index,fracture type,American Society of Anesthesiologists(ASA)classification,activities of daily living(ADL)before injury,whether taking medications affecting blood coagulation function,time from hospital admission to operation,operation method,whether combined with mental disorder,hypertension,diabetes mellitus,respiratory system diseases,cardiac insufficiency,hepatic insufficiency,renal insufficiency,electrolyte disorders,urinary ketone body abnormalities,lower-extremity venous thrombosis,and coagulation abnormalities,as well as the serum levels of tumor necrosis factor-α(TNF-α)and C-reaction protein(CRP)after hospital admission,was extracted from the electronic medical record system(EMRS).The included patients were randomized into a training set(for model building)and a validation set(for model validation)in a ratio of 2:1.According to the time from hospital admission to operation,the patients in the training set were further assigned into early operation group(time from hospital admission to operation of <48 hours)and delayed operation group(time from hospital admission to operation of ≥48 hours).The single-factor comparative analysis was performed on the relevant information of patients in the 2 groups,followed by multi-factor logistic regression analysis and multicollinearity diagnosis on the factors with statistically significant differences between the 2 groups.A Bayesian network-based model for predicting the risk of delayed operation in aged patients with hip fractures was constructed by using the R software,and the model was inferred by using the Netica software; meanwhile,the discrimination and calibration performance of the risk forecasting model were analyzed and evaluated by using receiver operating characteristic(ROC)curve and calibration curve,respectively.Results:①Three hundred and eighteen aged patients with hip fractures were enrolled in the study,212 ones in training set,and 106 ones in validation set; furthrtmore,according to the time from hospital admission to operation,78 ones of training set were assigned into early operation group,and 134 ones of training set into delayed operation group.②The difference was statistically significant in ASA classification,whether taking medications affecting blood coagulation function,whether combined with mental disorder,hypertension,diabetes mellitus,respiratory system diseases,cardiac insufficiency,electrolyte disorders,and coagulation abnormalities between the 2 groups(χ2=3.862,P=0.049; χ2=26.806,P=0.000; χ2=29.852,P=0.000; χ2=21.743,P=0.000; χ2=25.226,P=0.000; χ2=5.415,P=0.020; χ2=11.683,P=0.001; χ2=14.686,P=0.000; χ2=6.057,P=0.014).③The results of multi-factor logistic regression analysis revealed that taking medications affecting blood coagulation function,combined with mental disorder,hypertension,diabetes mellitus,respiratory system diseases,cardiac insufficiency,electrolyte disorders,and coagulation abnormalities were the factors influencing delay of operation for hip fractures in the aged(β=0.328,P=0.000,OR=5.112,95%CI(2.686,9.728); β=0.322,P=0.000,OR=5.425,95%CI(2.884,10.203); β=0.302,P=0.000,OR=3.956,95%CI(2.189,7.148); β=0.312,P=0.000,OR=4.560,95%CI(2.476,8.398); β=0.291,P=0.021,OR=1.962,95%CI(1.108,3.474); β=0.296,P=0.001,OR=2.713,95%CI(1.520,4.844); β=0.303,P=0.000,OR=3.133,95%CI(1.729,5.679); β=0.296,P=0.015,OR=2.061,95%CI(1.154,3.680)).The results of multicollinearity diagnosis showed that there was no collinearity between the above-mentioned influencing factors(VIF=1.134,VIF=1.266,VIF=1.465,VIF=1.389,VIF=1.342,VIF=1.183,VIF=1.346,VIF=1.259).④The Bayesian network-based risk forecasting model consisted of 8 nodes and 8 directed edges.The model showcased that taking medications affecting blood coagulation function,combined with mental disorder,respiratory system diseases,electrolyte disorders,and coagulation abnormalities directly affected the occurrence of operation delay; while,combined with cardiac insufficiency,hypertension,and diabetes mellitus indirectly affected the occurrence of operation delay.The results of inference showed that the incidence rate of delayed operation was 64.1% in aged patients with cardiac insufficiency,coagulation abnormalities,and mental disorders.⑤The evaluation on risk forecasting model with the training set data showed that the area under the ROC curve,sensitivity,specificity,and consistency index was 0.861(P=0.000,95%CI(0.810,0.912)),91.29%,93.35%,and 0.866(P=0.000,95%CI(0.702,0.943)),respectively.The evaluation on risk forecasting model with the validation set data showed that the area under the ROC curve,sensitivity,specificity,and consistency index was 0.848(P=0.000,95%CI(0.795,0.901)),91.62%,92.46%,and 0.879(P=0.000,95%CI(0.723,0.981)),respectively.Conclusion:Taking medications affecting blood coagulation function,combined with mental disorder,hypertension,diabetes mellitus,respiratory system diseases,cardiac insufficiency,electrolyte disorders,and coagulation abnormalities are the factors influencing the delay of operation for hip fractures in the aged.The risk forecasting model built based on the above factors demonstrates a high application value.

參考文獻(xiàn)/References:

[1] LAI S W.Gamma-glutamyl-transferase and hip fracture[J].Osteoporos Int,2022,33(8):1825-1826.
[2] PASS B,MALEK F,ROMMELMANN M,et al.The influence of malnutrition measured by hypalbuminemia and body mass index on the outcome of geriatric patients with a fracture of the proximal femur[J].Medicina(Kaunas),2022,58(11):1610.
[3] 韓雪昆,楊文貴.老年髖部骨折防治[J].創(chuàng)傷外科雜志,2020,22(10):798-801.
[4] PROBERT N,L??W A,AKNER G,et al.A comparison of patients with hip fracture,ten years apart:morbidity,malnutrition and sarcopenia[J].J Nutr Health Aging,2020,24(8):870-877.
[5] 李澗,常留輝,顧頎,等.老年髖部骨折48小時(shí)內(nèi)手術(shù)的療效分析[J].中華骨科雜志,2019,39(17):1037-1043.
[6] YAACOBI E,MAROM O,GUTMAN N,et al.Mortality following surgery for geriatric hip fractures:is it the timing or the co-morbidities?[J].Hip Int,2022,32(2):271-275.
[7] VAN RIJCKEVORSEL V A J I M,DE JONG L,VERHOFSTAD M H J,et al.Dutch hip fracture registry collaboration.Influence of time to surgery on clinical outcomes in elderly hip fracture patients:an assessment of surgical postponement due to non-medical reasons[J].Bone Joint J,2022,104-B(12):1369-1378.
[8] 卓澤銘,邢勢,王和杰,等.手術(shù)時(shí)機(jī)選擇對老年髖部骨折預(yù)后的影響[J].中國醫(yī)藥導(dǎo)報(bào),2021,18(9):95-98.
[9] 曹東東,韓哲,紀(jì)能能,等.老年髖部骨折的手術(shù)時(shí)機(jī)對預(yù)后的影響[J].醫(yī)學(xué)研究雜志,2022,51(7):11-14.
[10] 楊靈,王志聰,陳曦,等.891例老年髖部骨折患者合并基礎(chǔ)疾病的特點(diǎn)及Charlson合并癥指數(shù)對預(yù)后的影響[J].山東醫(yī)藥,2022,62(2):67-70.
[11] 游月烊,孫凱,嚴(yán)敏.手術(shù)時(shí)機(jī)對老年髖部骨折患者術(shù)后病死率影響的研究進(jìn)展[J].中華創(chuàng)傷雜志,2020,36(1):58-62.
[12] 趙建文,王曉偉,劉智,等.手術(shù)時(shí)機(jī)的選擇對90歲以上髖部骨折患者預(yù)后的影響[J].中國骨與關(guān)節(jié)雜志,2020,9(5):390-393.
[13] 姚東晨,楊明輝,朱仕文,等.氯吡格雷對老年髖部骨折手術(shù)時(shí)機(jī)的影響[J].中華創(chuàng)傷骨科雜志,2018,20(7):594-600.
[14] 黃宇光,張俊華.北京協(xié)和醫(yī)院麻醉科效率手冊[M].北京:人民衛(wèi)生出版社,2016:2-3.
[15] 葉欣,高嘉琪,勾洋,等.合并心臟瓣膜病對老年髖部骨折患者圍術(shù)期并發(fā)癥的影響[J].中國醫(yī)刊,2022,57(9):985-987.
[16] 于靜.老年髖部骨折病人預(yù)防下肢血栓形成的護(hù)理措施探討[J].安徽醫(yī)藥,2019,23(8):1596-1599.
[17] WANG T,GUO J,LONG Y,et al.Risk factors for preoperative deep venous thrombosis in hip fracture patients:a meta-analysis[J].J Orthop Traumatol,2022,23(1):19.
[18] 楊陽,馬信龍,崔爽爽,等.老年髖部骨折延遲手術(shù)的影響因素分析[J].中華骨科雜志,2021,41(15):1046-1051.
[19] SCHUETZE K,EICKHOFF A,RUTETZKI K S,et al.Geriatric patients with dementia show increased mortality and lack of functional recovery after hip fracture treated with hemiprosthesis[J].Eur J Trauma Emerg Surg,2020,48(3):1827-1833.
[20] LIZAUR-UTRILLA A,GONZALEZ-NAVARRO B,VIZCAYA-MORENO M F,et al.Reasons for delaying surgery following hip fractures and its impact on one year mortality[J].Int Orthop,2019,43(2):441-448.
[21] 王曉偉,孫天勝,劉智,等.老年髖部骨折的手術(shù)時(shí)機(jī)選擇與預(yù)后分析[J].中華創(chuàng)傷骨科雜志,2020,22(3):206-211.
[22] SPAETGENS B,BROUNS S H A,LINKENS A E M J H,et al.Associations between presence of diabetes,mortality and fracture type in individuals with a hip fracture[J].Diabetes Res Clin Pract,2022,192:110084.
[23] UEOKA K,SAWAGUCHI T,GOSHIMA K,et al.The influence of preoperative antiplatelet and anticoagulant agents on the outcomes in elderly patients undergoing early surgery for hip fracture[J].J Orthop Sci,2019,24(5):830-835.

相似文獻(xiàn)/References:

[1]溫超海,何忠,李永斌,等.閉合復(fù)位伽瑪釘改良成鎖定支架內(nèi)固定治療 老年股骨轉(zhuǎn)子間骨折[J].中醫(yī)正骨,2015,27(11):32.
[2]孫群周,阮成群,李光明,等.股骨近端防旋髓內(nèi)釘內(nèi)固定治療 老年不穩(wěn)定型股骨轉(zhuǎn)子間骨折[J].中醫(yī)正骨,2015,27(10):20.
[3]方策,倪新宇,王宏偉,等.遲氏正骨手法復(fù)位單臂外固定支架固定治療 老年股骨轉(zhuǎn)子間骨折[J].中醫(yī)正骨,2015,27(10):22.
[4]趙云昌.人工股骨頭置換治療老年粉碎性股骨轉(zhuǎn)子間骨折[J].中醫(yī)正骨,2015,27(08):31.
[5]姜自偉,黃楓,鄭曉輝,等.老年股骨轉(zhuǎn)子間骨折患者的圍手術(shù)期風(fēng)險(xiǎn)評(píng)估與控制[J].中醫(yī)正骨,2015,27(08):33.
[6]倪新宇,方策.外固定器治療股骨轉(zhuǎn)子間骨折的研究進(jìn)展[J].中醫(yī)正骨,2015,27(07):48.
[7]徐偉鋒,葉健,吳連國.強(qiáng)骨飲對骨質(zhì)疏松性股骨頸骨折患者全髖關(guān)節(jié)置換術(shù)后 血清骨代謝生化指標(biāo)和骨密度的影響[J].中醫(yī)正骨,2015,27(02):12.
　XU Weifeng,YE Jian,WU Lianguo.Effect of Qianggu Yin(強(qiáng)骨飲,QGY)on serum bone metabolism indexes and bone density after total hip arthroplasty in patients with osteoporotic femoral neck fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(02):12.
[8]張明強(qiáng).生物型加長柄半髖關(guān)節(jié)置換術(shù)治療 高齡不穩(wěn)定股骨轉(zhuǎn)子間骨折療效觀察[J].中醫(yī)正骨,2015,27(02):56.
[9]李書良,李啟義,李建明,等.鎖定鋼板內(nèi)固定聯(lián)合自體髂骨植骨治療 股骨近端粉碎性骨折[J].中醫(yī)正骨,2015,27(05):31.
[10]王智勇,陳柯,田可為,等.聯(lián)合應(yīng)用搖桿技術(shù)和鉗夾技術(shù)微創(chuàng)治療股骨轉(zhuǎn)子部骨折[J].中醫(yī)正骨,2015,27(05):36.

備注/Memo

備注/Memo:
通訊作者:劉弘揚(yáng) E-mail:[email protected]
更新日期/Last Update: 1900-01-01