Zhu Wanbo, Xie Kai, Zhang Xianzuo, Yang Jiazhao, Xu Lei, Zhu Junchen, Fang Shiyuan, Zhu Chen
Department of Orthopaedics, Affiliated Anhui Provincial Hospital of Anhui Medical University, Hefei, China.
Department of Orthopaedics, the First Affiliated Hospital of University of Science and Technology of China, Hefei, China.
Ann Transl Med. 2021 Feb;9(4):281. doi: 10.21037/atm-20-4866.
Osteonecrosis of the femoral head (ONFH) remains a major complication of femoral neck fractures. Early interventions require preliminary prediction and detection. In this study, we aimed to evaluate the perioperative variables of postoperative ONFH in femoral neck fracture patients with closed reduction and cannulated screw fixation. We also established and validated an individualized nomogram for the prediction of postoperative ONFH.
We included 470 patients with ONFH from two hospitals [First Affiliated Hospital of University of Science and Technology of China (n=360) and Southern Branch of the First Affiliated Hospital of the University of Science and Technology of China (n=110)]. We evaluated the prognostic value of multiple perioperative variables using a Cox regression model in the training cohort. We developed a nomogram for the prediction of ONFH using a logistic regression model. We assessed the performance of this nomogram in a validation cohort and evaluated its clinical value.
Of the 470 patients who met the inclusion criteria, 141 (30.0%) developed postoperative ONFH. We found alcohol use [odds ratio (OR), 1.743, 95% confidence interval (CI), 1.042-2.901, P=0.033], cerebrovascular disease (OR, 5.357, 95% CI, 2.318-13.13, P<0.001), interval to surgery (OR, 5.273, 95% CI, 2.724-10.43, P<0.001), Garden classification (OR, 23.17, 95% CI, 6.812-145.3, P<0.001), Garden index (OR, 5.935, 95% CI, 2.670-14.184, P<0.001), interval to partial weight-bearing (OR, 0.053, 95% CI, 0.006-0.296, P=0.002), and six-month Harris hip score (OR, 0.856; 95% CI, 0.792-0.919, P<0.001) were independent predictors of postoperative development of ONFH. Based on these variables, we developed a nomogram that showed good discrimination in both the training [area under the curve (AUC) =0.865] and the validation cohort (AUC =0.877). The favorable performance of this nomogram was also confirmed in the validation cohort.
We developed and validated an easy-to-use nomogram for predicting postoperative ONFH. This nomogram can aid decision-making of intraoperative interventions and postoperative rehabilitation plans for patients, surgeons, and osteo-rehabilitative physicians.
股骨头坏死（ONFH）仍然是股骨颈骨折的主要并发症。早期干预需要进行初步预测和检测。在本研究中，我们旨在评估闭合复位空心钉内固定治疗股骨颈骨折患者术后发生ONFH的围手术期变量。我们还建立并验证了一个用于预测术后ONFH的个体化列线图。
我们纳入了来自两家医院的470例ONFH患者[中国科学技术大学附属第一医院（n = 360）和中国科学技术大学附属第一医院南区（n = 110）]。我们在训练队列中使用Cox回归模型评估多个围手术期变量的预后价值。我们使用逻辑回归模型开发了一个预测ONFH的列线图。我们在验证队列中评估了该列线图的性能并评估了其临床价值。
在符合纳入标准的470例患者中，141例（30.0%）发生了术后ONFH。我们发现饮酒[比值比（OR），1.743，95%置信区间（CI），1.042 - 2.901，P = 0.033]、脑血管疾病（OR，5.357，95% CI，2.318 - 13.13，P < 0.001）、手术间隔时间（OR，5.273，95% CI，2.724 - 10.43，P < 0.001）、Garden分型（OR，23.17，95% CI，6.812 - 145.3，P < 0.001）、Garden指数（OR，5.935，95% CI，2.670 - 14.184，P < 0.001）、部分负重间隔时间（OR，0.053，95% CI，0.006 - 0.296，P = 0.002）和6个月Harris髋关节评分（OR，0.856；95% CI，0.792 - 0.919，P < 0.001）是术后发生ONFH的独立预测因素。基于这些变量，我们开发了一个列线图，其在训练队列[曲线下面积（AUC） = 0.865]和验证队列（AUC = 0.877）中均显示出良好的区分度。该列线图在验证队列中的良好性能也得到了证实。
我们开发并验证了一个易于使用的列线图来预测术后ONFH。该列线图可为患者、外科医生和骨康复医生在术中干预决策及术后康复计划制定方面提供帮助。
