Original Article
Analysis of factors affecting the postoperative development of femoral head necrosis in patients with femoral neck fracture and construction of a nomogram predictive model
Zhang Xihui, Li Zhengrong, Li Shineng, Xing Zengyu, Bai Wenbo
Published 2024-05-05
Cite as Chin J Postgrad Med, 2024, 47(5): 391-396. DOI: 10.3760/cma.j.cn115455-20221123-01021
Abstract
ObjectiveTo analyze the related factors that affect the occurrence of femoral head necrosis in patients with femoral neck fracture after surgery, and to build a nomogram predictive model.
MethodsUsing a retrospective study method, 180 patients with femoral neck fracture who were admitted to Hainan Provincial Hospital of Traditional Chinese Medicine from June 2019 to October 2021 were selected as the study objects. According to whether the patients had femoral head necrosis, they were divided into the occurrence group (75 cases) and the non occurrence group (105 cases). The receiver operating characteristic (ROC) curve was used to analyze the predictive value; Logistic regression was used to analyze the risk factors of postoperative femoral head necrosis; internal data were used to verify the clinical efficacy of nomogram model.
ResultsThere was no significant difference in age, sex, body mass index and other general data between the two groups (P>0.05); compared with the non occurrence group, Garden fracture in the occurrence group was mostly classified as type Ⅲ or Ⅳ, and more patients with preoperative traction, fracture displacement and unsatisfactory reduction quality, and the time from trauma to surgery was longer (P>0.05). The area under curve of the time from trauma to surgery was 0.766 (95% CI 0.697 to 0.826), and the optimal cutoff value was 42 h; Garden fracture classification (type Ⅲ or Ⅳ), preoperative traction (yes), fracture displacement (yes), reduction quality (unsatisfactory) and time from trauma to surgery (>42 h) were the risk factors affecting the postoperative femoral head necrosis in patients with femoral neck fracture (P<0.05). The risk of femoral head necrosis predicted by nomogram model was 0.802 (95% CI 0.692 to 0.873). The risk threshold of femoral head necrosis predicted by the model was >0.09, and nomogram model provides clinical net income.
ConclusionsGarden fracture classification (type Ⅲ or Ⅳ), preoperative traction (yes), fracture displacement (yes), reduction quality (unsatisfactory) and time from trauma to surgery (>42 h) are the risk factors affecting the postoperative femoral head necrosis in patients with femoral neck fracture, and the nomogram model based on variables has a better predictive ability.
Key words:
Femoral neck fracture; Femoral head necrosis; Influencing factors; Nomograms
Contributor Information
Zhang Xihui
Department of Orthopedics, Hainan Provincial Hospital of Traditional Chinese Medicine, Haikou 570203, China
Li Zhengrong
Department of Orthopedics, Hainan Provincial Hospital of Traditional Chinese Medicine, Haikou 570203, China
Li Shineng
Department of Orthopedics, Hainan Provincial Hospital of Traditional Chinese Medicine, Haikou 570203, China
Xing Zengyu
Department of Orthopedics, Hainan Provincial Hospital of Traditional Chinese Medicine, Haikou 570203, China
Bai Wenbo
Department of Orthopedics, Hainan Provincial Hospital of Traditional Chinese Medicine, Haikou 570203, China
