第二跖骨下疼痛型拇外翻预测列线图的建立与验证
Establishment and Validation of a Predictive Nomogram for Hallux Valgus with Pain Under the Second Metatarsal.
作者信息
Bai Zixing, Cao Xuhan, Yang Yanjun, Sun Xudong, Dong Yongli, Wen Jianmin, Sun Weidong
机构信息
Second Department of Orthopedics, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, People's Republic of China.
Scientific Research Department, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, People's Republic of China.
出版信息
J Pain Res. 2022 Nov 7;15:3523-3536. doi: 10.2147/JPR.S386315. eCollection 2022.
OBJECTIVE
To investigate the risk factors for hallux valgus complicated with pain under the second metatarsal and construct an effective model and method for predicting hallux valgus complicated with pain under the second metatarsal based on risk factors.
METHODS
A total of 545 patients with hallux valgus who were admitted to our hospital were divided randomly into a training set and a validation set. The demographic characteristics, imaging indices and gait test indices of the patients were collected. The risk factors were identified by univariate and multivariate logistic regression analyses. A risk prediction model for hallux valgus with pain under the second metatarsal was established, and the area under the curve (AUC) of the receiver operating characteristic and a decision curve analysis were used for verification and identification. The value of the model was tested in the verification group.
RESULTS
Second metatarsal length, second metatarsal peak pressure, hallux valgus angle (HVA), intermetatarsal angle 1-2 (IMA1-2) and weight were the risk factors for hallux valgus complicated with pain under the second metatarsal. Based on the weighting of these seven risk factors, a prediction model was established. The AUC of the prediction model was 0.84 (95% confidence interval [CI]: 0.802~0.898, < 0.05), and the results of a Hosmer-Lemeshow test showed a good degree of calibration ( = 10.62, > 0.05). The internal validation of the AUC was 0.83 (95% CI: 0.737-0.885, < 0.05). The model had obvious net benefits when the threshold probability was 10%-70%.
CONCLUSION
Second metatarsal length, second metatarsal peak pressure, HVA, IMA1-2 and weight were the risk factors for hallux valgus combined with second metatarsal pain. The risk prediction model for hallux valgus complicated with pain under the second metatarsal based on these seven variables was proven effective.
LEVEL OF EVIDENCE
Level III, retrospective comparative study.
目的
探讨拇外翻合并第二跖骨下疼痛的危险因素，并基于危险因素构建预测拇外翻合并第二跖骨下疼痛的有效模型及方法。
方法
将我院收治的545例拇外翻患者随机分为训练集和验证集。收集患者的人口统计学特征、影像学指标及步态测试指标。通过单因素和多因素logistic回归分析确定危险因素。建立拇外翻合并第二跖骨下疼痛的风险预测模型，并采用受试者操作特征曲线下面积（AUC）及决策曲线分析进行验证和鉴别。在验证组中检验该模型的价值。
结果
第二跖骨长度、第二跖骨峰值压力、拇外翻角（HVA）、第1-2跖骨间角（IMA1-2）和体重是拇外翻合并第二跖骨下疼痛的危险因素。基于这七个危险因素的权重，建立了预测模型。该预测模型的AUC为0.84（95%置信区间[CI]：0.802~0.898，P<0.05），Hosmer-Lemeshow检验结果显示校准度良好（χ²=10.62，P>0.05）。AUC的内部验证结果为0.83（95%CI：0.737-0.885，P<0.05）。当阈值概率为10%-70%时，该模型具有明显的净效益。
结论
第二跖骨长度、第二跖骨峰值压力、HVA、IMA1-2和体重是拇外翻合并第二跖骨疼痛的危险因素。基于这七个变量构建的拇外翻合并第二跖骨下疼痛的风险预测模型被证明是有效的。
证据水平
III级，回顾性比较研究。
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