Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
Shanghai Engineering Research Center for Orthopaedic Material Innovation and Tissue Regeneration, Shanghai, China.
Bone Joint J. 2022 Aug;104-B(8):963-971. doi: 10.1302/0301-620X.104B8.BJJ-2022-0206.R2.
Heterotopic ossification (HO) is a common complication after elbow trauma and can cause severe upper limb disability. Although multiple prognostic factors have been reported to be associated with the development of post-traumatic HO, no model has yet been able to combine these predictors more succinctly to convey prognostic information and medical measures to patients. Therefore, this study aimed to identify prognostic factors leading to the formation of HO after surgery for elbow trauma, and to establish and validate a nomogram to predict the probability of HO formation in such particular injuries.
This multicentre case-control study comprised 200 patients with post-traumatic elbow HO and 229 patients who had elbow trauma but without HO formation between July 2019 and December 2020. Features possibly associated with HO formation were obtained. The least absolute shrinkage and selection operator regression model was used to optimize feature selection. Multivariable logistic regression analysis was applied to build the new nomogram: the Shanghai post-Traumatic Elbow Heterotopic Ossification Prediction model (STEHOP). STEHOP was validated by concordance index (C-index) and calibration plot. Internal validation was conducted using bootstrapping validation.
Male sex, obesity, open wound, dislocations, late definitive surgical treatment, and lack of use of non-steroidal anti-inflammatory drugs were identified as adverse predictors and incorporated to construct the STEHOP model. It displayed good discrimination with a C-index of 0.80 (95% confidence interval 0.75 to 0.84). A high C-index value of 0.77 could still be reached in the internal validation. The calibration plot showed good agreement between nomogram prediction and observed outcomes.
The newly developed STEHOP model is a valid and convenient instrument to predict HO formation after surgery for elbow trauma. It could assist clinicians in counselling patients regarding treatment expectations and therapeutic choices. Cite this article: 2022;104-B(8):963-971.
异位骨化（HO）是肘部创伤后的常见并发症，可导致严重的上肢残疾。尽管已经报道了多种与创伤后 HO 发生相关的预后因素，但尚无模型能够更简洁地将这些预测因子结合起来，以向患者传达预后信息和医疗措施。因此，本研究旨在确定导致肘部创伤后手术发生 HO 的预后因素，并建立和验证一种列线图来预测此类特定损伤中 HO 形成的概率。
这项多中心病例对照研究纳入了 200 例创伤后肘部 HO 患者和 229 例肘部创伤但未形成 HO 的患者，这些患者均于 2019 年 7 月至 2020 年 12 月期间入组。收集可能与 HO 形成相关的特征。采用最小绝对收缩和选择算子回归模型进行特征选择优化。多变量逻辑回归分析用于构建新的列线图：上海创伤后肘部异位骨化预测模型（STEHOP）。通过一致性指数（C 指数）和校准图验证 STEHOP。采用 bootstrap 验证进行内部验证。
男性、肥胖、开放性伤口、脱位、晚期确定性手术治疗以及未使用非甾体抗炎药被确定为不利预测因素，并纳入构建 STEHOP 模型。该模型具有良好的区分度，C 指数为 0.80（95%置信区间为 0.75 至 0.84）。在内部验证中，仍可达到 0.77 的高 C 指数值。校准图显示了列线图预测和观察结果之间的良好一致性。
新开发的 STEHOP 模型是一种预测肘部创伤后手术发生 HO 的有效且便捷的工具。它可以帮助临床医生为患者提供关于治疗预期和治疗选择的咨询。
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