Department of Orthopaedics Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand.
Int J Environ Res Public Health. 2021 Dec 24;19(1):177. doi: 10.3390/ijerph19010177.
Individualized prediction of postoperative ambulatory status for patients with intertrochanteric fractures is clinically relevant, during both preoperative and intraoperative periods. This study intended to develop clinical prediction rules (CPR) to predict one-year postoperative functional outcomes in patients with intertrochanteric fractures. CPR development was based on a secondary analysis of a retrospective cohort of patients with intertrochanteric fractures aged ≥50 years who underwent a surgical fixation. Good ambulatory status was defined as a New Mobility Score ≥ 5. Two CPR for preoperative and intraoperative predictions were derived using clinical profiles and surgical-related parameters using logistic regression with the multivariable fractional polynomial procedure. In this study, 221 patients with intertrochanteric fractures were included. Of these, 160 (72.4%) had good functional status at one year. The preoperative model showed an acceptable AuROC of 0.77 (95% CI 0.70 to 0.85). After surgical-related parameters were incorporated into the preoperative model, the model discriminative ability was significantly improved to an AuROC of 0.83 (95% CI 0.77 to 0.88) ( = 0.021). The newly-derived CPR enable physicians to provide patients with intertrochanteric fractures with their individualized predictions of functional outcome one year after surgery, which could be used for risk communication, surgical optimization and tailoring postoperative care that fits patients' expectations.
对于接受股骨转子间骨折手术的患者，在术前和术中对术后步行状态进行个体化预测具有重要的临床意义。本研究旨在制定临床预测规则（CPR），以预测股骨转子间骨折患者术后一年的功能结局。CPR 的制定是基于对≥50 岁接受手术固定的股骨转子间骨折患者的回顾性队列的二次分析。良好的步行状态定义为新移动评分≥5。使用多变量分数多项式程序，通过逻辑回归，使用临床特征和手术相关参数，分别为术前和术中预测得出了 2 个 CPR。在本研究中，纳入了 221 例股骨转子间骨折患者。其中，160 例（72.4%）在一年后功能状态良好。术前模型的 AuROC 为 0.77（95%CI 0.70 至 0.85），具有可接受的预测能力。在将手术相关参数纳入术前模型后，模型的判别能力显著提高至 AuROC 为 0.83（95%CI 0.77 至 0.88）（=0.021）。新得出的 CPR 使医生能够为股骨转子间骨折患者提供术后一年功能结局的个体化预测，这可用于风险沟通、手术优化和制定符合患者预期的术后护理计划。
