再植指功能恢复效果的列线图预测模型构建

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摘要目的探讨再植指功能恢复差的危险因素，建立患指功能恢复差的预测模型。方法回顾性分析2017年5月至2022年5月在唐山市人民医院行断指再植术的309例(断指376个)手指离断患者的资料，其中男性231例断指274个，女性78例断指102个；年龄19~67岁，平均(41.57±8.59)岁。术后1年对患指功能的恢复效果进行判定，并分成恢复差组和对照组。收集患者一般人口特征、病情信息、手术信息、术前血常规指标行单变量筛查，通过多因素分析确定患指功能恢复差的危险因素，以森林图展现各指标效应大小。依据预测变量构建列线图模型，并通过受试者工作特征(receiver operating characteristic，ROC)曲线下面积(area under curve，AUC)、校准曲线及决策曲线(decision curve analysis，DCA)检验其效能。结果〓309例(断指376个)患者中，有68例(断指81个)术后功能恢复差，占比21.54%。两组吸烟史、损伤性质、离断程度、离断平面、断指暴露时间、断指保存方式、是否遵医开展康复锻炼情况比较差异有统计学意义(P＜0.05)。Logistic回归分析显示，术后患指功能恢复差的危险因素主要为有吸烟史、撕脱伤、离断平面为非末节指骨、断指暴露时间≥8 h、未遵医开展康复锻炼。内部验证显示，AUC为0.819(95%CI：0.762~0.875)，模型预测患指功能恢复差的概率与实际概率高度吻合，拟合优度HL检验χ2=7.389，P＝0.286。DCA显示模型在风险阈值12%~75%时具有较好的实用性。结论〓根据有吸烟史、损伤性质、离断平面、断指暴露时间、是否遵医开展康复锻炼构建的列线图模型对断指再植术后患指功能恢复差的预测效果较好。

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	李建强
	靳宇
	赵文献
	孙虹斐

关键词 ：断指再植术, 再植指功能, 危险因素, 列线图模型

Abstract：Objective To explore the risk factors for poor functional recovery of replanted fingers，and establish a predictive model for poor functional recovery of severed fingers.Methods A retrospective analysis was performed on the data of 309 patients (376 severed fingers) who underwent finger replantation surgery at Tangshan People’s Hospital between May 2017 and May 2022.Among them，231 males accounted for 274 severed fingers，while 78 females accounted for 102 severed fingers，with ages ranging from 19 to 67 years，and an average age of (41.57±8.59)years.One year post-surgery，the recovery of severed finger function was assessed，and patients were categorized into a poor recovery group and a control group.Univariate screening was conducted to collect data on patients’ general demographic characteristics，disease information，surgical details，and preoperative blood routine indicators.Multivariate analysis was then utilized to identify risk factors for poor finger function recovery，and the effect size of each indicator was visualized in a forest plot.Subsequently，a predictive model using column charts was constructed，and its efficacy was evaluated through the receiver operating characteristic (ROC) curve area under the curve (AUC)，calibration curve，and decision curve analysis (DCA).Results Among the 309 patients (376 severed fingers)，68 patients (81 severed fingers) exhibited poor postoperative functional recovery，representing 21.54% of the total.Statistically significant differences were observed between the two groups in smoking history，nature of injury，degree of amputation，amputation plane，exposure time of severed fingers，preservation method of severed fingers，and compliance with medical advice on rehabilitation exercise (P＜0.05).Logistic regression analysis revealed that the primary risk factors for poor functional recovery of severed fingers after surgery were smoking history，avulsion injury，amputation plane non-distal to the phalanx，exposure time of severed fingers ≥8 hours，and failure to adhere to medical advice on rehabilitation exercise.Internal validation indicated an AUC of 0.819 (95% CI：0.762~0.875)，suggesting a high consistency between the model’s predicted probability of poor functional recovery and the actual probability.The goodness-of-fit HL test yielded χ2=7.389 and P＝0.286，further supporting the model’s fit.DCA analysis demonstrated that the model exhibited good practicality within a risk threshold ranging from 12% to 75%.Conclusion The column chart model，constructed using variables such as smoking history，nature of injury，level of amputation，exposure time of severed finger，and compliance with medical advice on rehabilitation exercise，demonstrates a robust predictive effect for identifying poor functional recovery of severed fingers following replantation surgery.

Key words： severed finger replantation replanted fingers function risk factors nomogram model

通讯作者: 孙虹斐

作者简介: 李建强(1976－ )，男，副主任医师，唐山市人民医院骨一科，xiang30583@163.com

引用本文:

李建强，靳宇，赵文献，孙虹斐. 再植指功能恢复效果的列线图预测模型构建[J]. 实用骨科杂志, 2024, 30(5): 400-.
Li Jianqiang，Jin Yu，Zhao Wenxian，Sun Hongfei. Construction of a Column Chart Prediction Model for the Recovery Effect of Finger Replantation Function. sygkzz, 2024, 30(5): 400-.

链接本文:

http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2024/V30/I5/400

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