老年全膝关节置换术后膝关节活动受限的影响因素及预测模型的构建与验证OA
Influencing factors for restricted knee joint movement after total knee arthroplasty in the elderly and construction and verification of prediction model
目的 探讨老年全膝关节置换术(TKA)后膝关节活动受限的影响因素及预测模型的构建与验证.方法 选取2021年12月至2024年5月宜春市人民医院320例老年TKA患者作为研究对象,按7∶3比例分为训练组(n=224)和验证组(n=96),术后随访1年,训练组按膝关节活动情况分为受限组与未受限组.采用单因素和多因素logistic回归分析活动受限的独立危险因素,验证组行外部验证.结果 训练组38例(16.96％)出现膝关节活动受限;单因素分析结果显示,体重指数(BMI)、术前膝关节活动度、术中切口缝合屈曲角度、术后关节线高度变化及膝关节体位与术后活动受限有关,差异有统计学意义(P＜0.05).多因素logistic回归分析结果显示,BMI(β=1.343,OR=3.830,95％CI:1.516～9.675)、术前膝关节活动度(β=0.984,OR=2.675,95％CI:1.092～6.553)、术后关节线高度变化(β=1.251,OR=3.494,95％CI:1.391～8.779)、术后膝关节体位(β=1.055,OR=2.873,95％CI:1.173～7.036)、术中切口缝合屈曲 90°(β=2.446,OR=11.537,95％CI:3.114～42.735)及伸直(β=1.896,OR=6.661,95％CI:1.988～22.317)均为老年TKA患者术后膝关节活动受限的独立危险因素(P＜0.05).列线图模型Hos-mer-Lemeshow 检验 x2=3.737(P＞0.05),训练组 ROC 曲线 AUC=0.796(95％CI:0.728～0.863),敏感度为 53.2％、特异度为94.7％,区分度良好;验证组ROC曲线的AUC为0.857(95％CI:0.743～0.970),敏感度为75.0％,特异度为90.0％,两组的DCA阈值为0.00～1.00.结论 本研究构建的风险预测模型具有良好临床预测价值,可协助医护人员早期识别高危患者,为临床诊疗与护理提供参考.
Objective To explore the influencing factors of restricted knee joint movement in elderly undergoing total knee arthroplasty(TKA)and to construct and validate a predictive model.Methods A total of 320 elderly TKA patients from Yichun People's Hospital from December 2021 to May 2024 were selected as the research subjects.They were divided into training group(n=224)and validation group(n=96)at a ratio of 7∶3.The patients were followed up for 1 year after surgery.The training group was further divided into restricted group and unrestricted group based on the knee joint activity.Univariate and multivariate logistic regression analyses were used to identify the independent risk factors for restricted knee joint movement.The validation group underwent external validation.Results A total of 38 cases(16.96％)in the training group experienced restricted knee joint movement.The results of univariate analysis showed that body mass index(BMI),preoperative knee joint range of motion,intraoperative incision suture flexion angle,postoperative joint line height change,and knee joint position were associated with postoperative knee joint dysfunction,and the differences were statistically significant(P＜0.05).The results of multivariate logistic regression analysis showed that BMI(β=1.343,OR=3.830,95％CI:1.516-9.675),preoperative knee joint range of motion(β=0.984,OR=2.675,95％CI:1.092-6.553),postoperative joint line height change(β=1.251,OR=3.494,95％CI:1.391-8.779),postoperative knee joint position(β=1.055,OR=2.873,95％CI:1.173-7.036),intraoperative incision suture flexion 90°(β=2.446,OR=11.537,95％CI:3.114-42.735),and exten-sion(β=1.896,OR=6.661,95％CI:1.988-22.317)were all independent risk factors for postoperative knee joint dysfunc-tion in elderly TKA patients(P＜0.05).The Hosmer-Lemeshow test of the nomogram model showed x2=3.737(P＞0.05),the ROC curve of the training group had an AUC of 0.796(95％CI:0.728-0.863),with sensitivity was 53.2％and specificity was 94.7％,and the discrimination was good.The AUC of the ROC curve for the validation group was 0.857(95％CI:0.743-0.970),with sensitivity was 75.0％and specificity was 90.0％.The DCA thresholds for both groups ranged from 0.00-1.00.Conclusion The constructed risk prediction model in this study has good clinical warning value and can assist medical staff in early identification of high-risk patients,providing a reference for clinical diagnosis and treatment and nursing.
晏淑芬;陈长莲;简梦琪
江西省宜春市人民医院骨科二病区,江西宜春 336000江西省宜春市人民医院骨科二病区,江西宜春 336000江西省宜春市人民医院骨科二病区,江西宜春 336000
医药卫生
全膝关节置换术膝关节活动受限危险因素风险预测模型模型验证
Total knee arthroplastyRestricted knee joint movementRisk factorsRisk prediction modelModel validation
《中国当代医药》 2026 (19)
4-9,6
江西省卫生健康委科技计划项目(202312208).
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