关节镜肩袖修补术后再撕裂风险的影响因素及预测模型构建

doi:10.11958/20252352

摘要/Abstract

摘要：

目的探究行关节镜肩袖修补术的患者术后出现再撕裂风险的影响因素，并以此构建列线图预测模型。方法将587例行关节镜下肩袖修补术患者分为训练集470例和验证集117例，根据术后12个月内是否发生再撕裂将训练集分为再撕裂组和愈合组。对比2组临床资料，采用多因素Logistic回归分析再撕裂的影响因素，绘制再撕裂的列线图预测模型。应用受试者工作特征（ROC）曲线和校准曲线评价模型，临床决策曲线评估其临床适用性。结果训练集发生再撕裂97例（再撕裂组），愈合373例（愈合组），验证集发生再撕裂23例。多因素Logistic回归分析结果显示，年龄≥60岁、伴骨质疏松、撕裂长度>3 cm、肌腱回缩、脂肪浸润分级≥2级、应用皮质类固醇是再撕裂的独立危险因素（P<0.05）。据此绘制的列线图模型的C指数为0.814（95%CI：0.810~0.819），训练集和验证集中校准曲线与理想曲线均趋近，Bootstrap法内部验证显示，平均绝对误差分别为0.011、0.027，Hosmer-Lemeshow检验有较好的拟合优度（χ²=4.531，P=0.806），临床决策曲线显示该模型具有明显正向净获益；列线图模型预测患者术后再撕裂曲线下面积（AUC）、敏感度、特异度，在训练集分别为0.818（95%CI：0.771~0.865）、78.69%、79.60%，在验证集分别为0.807（95%CI：0.730~0.884）、77.94%、76.82%。结论基于危险因素构建的列线图模型可较好地预测关节镜修补术后再撕裂的发生风险。

关键词: 回旋套损伤, 关节镜, 撕裂伤, 列线图, 关节镜肩袖修补术, 术后再撕裂

Abstract:

Objective To explore the factors affecting the risk of postoperative re-tearing in patients undergoing arthroscopic rotator cuff repair, and to construct a nomogram prediction model. Methods A total of 587 patients who underwent arthroscopic rotator cuff repair were divided into the training set (470 cases) and the validation set (117 cases). The training set was sub-divided into the re-tearing group and the healing group based on whether re-tearing occurred within 12 months after surgery. Clinical data were compared between the two groups. Multivariate Logistic regression analysis was used to identify the influencing factors of re-tearing, and a nomogram prediction model for re-tearing was constructed. The receiver operating characteristic (ROC) curve and calibration curve were used to evaluate the model. The clinical decision curve was used to evaluate its clinical applicability. Results In the training set, re-tearing occurred in 97 cases (the re-tearing group) and healing was observed in 373 cases (the healing group). There were 23 cases of re-tearing in the validation set. Multivariate Logistic regression analysis results showed that age ≥ 60 years, osteoporosis, length of tearing >3 cm, tendon retraction, fat infiltration ≥ grade 2 and use of corticosteroids were independent risk factors for re-tearing (P<0.05). The C-index of the constructed nomogram model was 0.814 (95%CI: 0.810-0.819). The calibration curve and the ideal curve were close in both the training and validation sets. Internally validation using Bootstrap method found that the mean absolute errors were 0.011 and 0.027, respectively. Hosmer-Lemeshow test showed good goodness of fit (χ²=4.531, P=0.806). The clinical decision curve showed that the model had a significant positive net benefit. The area under the curve (AUC), sensitivity and specificity of the nomogram prediction model for predicting postoperative re-tearing in the training set were 0.818 (95%CI: 0.771-0.865), 78.69% and 79.60%, which in the validation set were 0.807 (95%CI: 0.730-0.884), 77.94% and 76.82%, respectively. Conclusion The nomogram model constructed based on risk factors can better predict the risk of re-tearing after arthroscopic repair.

Key words: rotator cuff injury, arthroscopy, laceration, nomogram, arthroscopic rotator cuff repair, postoperative re-tearing

中图分类号:

R687.4

图/表 6

参考文献 20

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组别	n	女性	年龄≥60岁	BMI/（kg/m²）	吸烟	饮酒	高血压	糖尿病	高脂血症	伴骨质疏松	病程/月
愈合组	373	250（67.02）	153（41.02）	22.62±1.33	35（9.38）	16（4.29）	138（37.00）	95（25.47）	91（24.40）	104（27.88）	5.23±1.32
再撕裂组	97	71（73.20）	62（63.92）	22.85±1.34	12（12.37）	7（7.22）	40（41.24）	40（41.24）	30（30.93）	50（51.55）	5.37±1.32
χ²或t		1.354	16.264^＊＊	1.567	0.764	1.417	0.588	9.349^＊＊	1.718	19.569^＊＊	0.936
组别	撕裂长度		疼痛VAS评分/分	肌腱回缩	脂肪浸润分级		手术方式		应用皮质类固醇
组别	>3 cm	≤3 cm	疼痛VAS评分/分	肌腱回缩	≥2级	<2级	单排	双排	应用皮质类固醇
愈合组	150（40.21）	223（59.79）	6.48±1.35	112（30.03）	49（13.14）	324（86.86）	142（38.07）	231（61.93）	86（23.06）
再撕裂组	70（72.16）	27（27.84）	6.30±1.28	49（50.52）	35（36.08）	62（63.92）	47（48.45）	50（51.55）	33（34.02）
χ²	31.562^＊＊		1.252	14.349^＊＊	27.613^＊＊		3.452		4.894^＊

组别	n	女性	年龄≥60岁	BMI/（kg/m²）	吸烟	饮酒	高血压	糖尿病	高脂血症	伴骨质疏松	病程/月
愈合组	373	250（67.02）	153（41.02）	22.62±1.33	35（9.38）	16（4.29）	138（37.00）	95（25.47）	91（24.40）	104（27.88）	5.23±1.32
再撕裂组	97	71（73.20）	62（63.92）	22.85±1.34	12（12.37）	7（7.22）	40（41.24）	40（41.24）	30（30.93）	50（51.55）	5.37±1.32
χ²或t		1.354	16.264^＊＊	1.567	0.764	1.417	0.588	9.349^＊＊	1.718	19.569^＊＊	0.936
组别	撕裂长度		疼痛VAS评分/分	肌腱回缩	脂肪浸润分级		手术方式		应用皮质类固醇
组别	>3 cm	≤3 cm	疼痛VAS评分/分	肌腱回缩	≥2级	<2级	单排	双排	应用皮质类固醇
愈合组	150（40.21）	223（59.79）	6.48±1.35	112（30.03）	49（13.14）	324（86.86）	142（38.07）	231（61.93）	86（23.06）
再撕裂组	70（72.16）	27（27.84）	6.30±1.28	49（50.52）	35（36.08）	62（63.92）	47（48.45）	50（51.55）	33（34.02）
χ²	31.562^＊＊		1.252	14.349^＊＊	27.613^＊＊		3.452		4.894^＊

变量	β	SE	Wald χ²	P	OR	95% CI
年龄	0.980	0.268	13.406	<0.001	2.664	1.577~4.502
合并糖尿病	0.519	0.272	3.647	0.056	1.680	0.986~2.862
伴骨质疏松	0.905	0.265	11.641	<0.001	2.473	1.470~4.159
撕裂长度	1.230	0.274	20.171	<0.001	3.422	2.001~5.854
肌腱回缩	0.835	0.265	9.912	0.002	2.304	1.370~3.874
脂肪浸润分级	1.461	0.299	23.864	<0.001	4.311	2.399~7.748
应用皮质类固醇	0.606	0.283	4.592	0.032	1.832	1.053~3.188
常数项	-3.943	0.371	112.746	<0.001	0.019	-

变量	β	SE	Wald χ²	P	OR	95% CI
年龄	0.980	0.268	13.406	<0.001	2.664	1.577~4.502
合并糖尿病	0.519	0.272	3.647	0.056	1.680	0.986~2.862
伴骨质疏松	0.905	0.265	11.641	<0.001	2.473	1.470~4.159
撕裂长度	1.230	0.274	20.171	<0.001	3.422	2.001~5.854
肌腱回缩	0.835	0.265	9.912	0.002	2.304	1.370~3.874
脂肪浸润分级	1.461	0.299	23.864	<0.001	4.311	2.399~7.748
应用皮质类固醇	0.606	0.283	4.592	0.032	1.832	1.053~3.188
常数项	-3.943	0.371	112.746	<0.001	0.019	-