老年髋部骨折患者术前深静脉血栓形成预测模型的构建

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【中图分类号】R683.3；R683.4 【文献标识码】A

【Abstract】Objective To identify risk factors for preoperative lower limb deep vein thrombosis （DVT） in elderly patients with hip fractures and to develop a predictive nomogram model.Methods Elderly patients with hip fractures admitted to the Third Afiliated Hospital of Guangzhou University of Chinese Medicine from June 2021 to June 2024 was enrolled. Clinical data were collected and analyzed.Independent influencing factors for preoperative DVT were screened using Lasso regression and multivariate Logistic regression. A nomogram model was developed and validated internally and externally. Model performance was evaluated using Bootstrap resampling， calibration curves， receiver operating characteristic （ROC）curves with area under the curve （AUC），and decision curve analysis （DCA） to assess discrimination，calibration，and clinical utility.Results A total of 644 patients were included， with 451 in the training setand 193 in the validation set.Multivariate Logistic regresson revealed that elevated D-dimer levels [OR ⋅=1.927 95%CI （1.675，2.257）]， prolonged time from injury to admission [ OR=1.023 ， 95%CI （1.012， 1.034）]， increased fibrinogen [OR=1.348 ， 95%CI （1.076，1.703）]，higher total cholesterol [ OR=1.256 95%CI （1.053， 1.504）]，and hypoalbuminemia [OR .=0.936 ， 95%CI （0.909， 0.965）] were independent predictors of preoperative DVT. The AUCs were 0.871 [95%C] （0.816， 0.925）] for the training set and 0.879 [95%C] （0.805， 0.953）] for the validation set. Calibration curves showed that the predicted probabilities were consistent with the actuality. DCA demonstrated that the model yielded a higher netbenefit than traditional strategies across a risk threshold range of 10% to 70% . Conclusion The nomogram-based predictive model developed in this study enables intuitive and accurate preoperative risk stratification for DVT in elderly patients with hipfractures.It serves as a robust scientific tool to guide early clinical screening and targeted interventions for thromboprophylaxis.

【Keywords】Elderly patients with hip fractures; Deep vein thrombosis; Nomogram; Risk prediction; Preoperativeriskassessment

老年髋部骨折是老龄化社会的重大公共卫生挑战，患者因骨质疏松、糖尿病、脑卒中等基础疾病导致围手术期并发症风险增高，其中下肢深静脉血栓形成（deepveinthrombosis，DVT）发病率高且具有潜在肺栓塞（pulmonaryembolism，PE）风险，已成为临床关注的核心问题[。（剩余10705字）