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目的 探讨人工髋关节置换术后发生深静脉血栓（DVT）的独立风险因素，并构建预测DVT发生的列线图模型。方法 回顾分析了2022年9月—2023年12月在天津大学天津医院行人工髋关节置换术的350例髋部骨折患者临床资料，根据术后彩超结果，将病例分为血栓组及非血栓组，采用单因素及多因素Logistic回归分析人工髋关节置换术后患者发生DVT的危险因素，建立列线图预测模型并进行验证，采用受试者操作特征曲线评价各独立危险因素及列线图模型对DVT的诊断效能。结果 多因素Logistic分析显示：年龄、受伤—手术时间间隔、术后D-二聚体、纤维蛋白原及术前DVT是术后DVT发生的独立危险因素。多种因素联合诊断的列线图模型曲线下面积为0.790(95%CI:[0.742,0.839])，大于各独立因素，具有良好的诊断价值；校准曲线显示列线图对人工髋关节术后DVT的预测概率具有较好的校正效果；决策曲线显示列线图具有较高的临床应用价值。结论 本文构建的列线图对人工髋关节置换术后DVT的发生具有良好的预测价值。
Abstract：Objective To investigate the independent risk factors for deep vein thrombosis(DVT) in patients with hip fracture after hip arthroplasty, and construct a nomogram model for predicting the risk of DVT. Methods The clinical data of 350 patients with hip fracture who underwent hip arthroplasty in our hospital from September 2022 to December 2023 were retrospectively analyzed. According to the results of color Doppler ultrasound, the cases were divided into thrombus group and non-thrombus group. Meanwhile, univariate and multivariate logistic analyses were applied to analyze the risk factors of DVT. A nomogram prediction model was accordingly established and validated, whose diagnostic efficacy for deep vein thrombosis was analyzed by receiver operator characteristic curve. Results Multivariate analysis results showed that age, time from injury to operation, postoperative D-dimer, fibrinogen levels and preoperative DVT were independent risk factors for postoperative DVT. The area under curve of the nomogram model was 0.790(95% CI: [0.742, 0.839]), which was more higher than the independent factors and had a good diagnostic value. The calibration curve demonstrated that the nomogram exhibited favorable calibration in predicting the probability of DVT after artificial hip arthroplasty. The decision curve analysis further indicated that the nomo-gram holds significant clinical application value. Conclusion The nomogram model based on these factors demonstrated a good predictive value for postoperative DVT after hip fracture.
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基本信息:
DOI：10.13885/j.issn.2097-681X.2025.07.007
中图分类号:R687.4
引用信息:
[1]陈晓宇,孛茹婷,袁宇.人工髋关节置换术后深静脉血栓列线图预测模型[J].兰州大学学报(医学版),2025,51(07):46-53.DOI:10.13885/j.issn.2097-681X.2025.07.007.
基金信息:
天津市卫生健康科技项目（TJWJ2023ZD005）; 天津市医学重点学科（专科）建设资助项目（TJYXZDXK-026A）