目的:本研究旨在确定改良“L”入路治疗跟骨骨折后切口并发症的相关危险因素。
方法:分析了2018年1月至2021年12月采用改良“L”入路治疗跟骨骨折的100例患者的数据。其中愈合不良组52例,愈合良好组48例。患者年龄等变量,性别,身体质量指数,骨折类型(Sanders分类),吸烟史,酒精消费,糖尿病状态,手术时机,止血带使用,骨移植,缝合方法,并对术后切口护理进行评价。使用R软件绘制列线图来预测切口并发症的风险,通过ROC曲线下面积验证,C指数,和决策曲线分析。
结果:单变量和多变量回归分析都确定了骨折类型,吸烟史,糖尿病,手术时机,止血带应用的持续时间是切口并发症的重要预测因素。这些因素被纳入临床预测列线图。列线图的校准曲线显示出高精度,内部和外部。未调整的一致性指数(C指数)为0.793[95%置信区间(CI),0.825-0.995],列线图的曲线下面积为0.7875882。决策曲线分析以20-60%的阈值概率证实了该模型的临床适用性。
结论:我们已经建立了可靠的临床列线图来预测跟骨骨折改良“L”入路切口并发症的危险因素,加强临床决策。
OBJECTIVE: This study aimed to identify risk factors associated with incision complications following the modified \"L\" approach for calcaneal fractures.
METHODS: Data from 100 patients treated with the modified \"L\" approach for calcaneal fractures between January 2018 and December 2021 were analyzed. These included 52 cases in the poorly healing group and 48 in the well-healing group. Variables such as patient age, sex, body mass index, fracture type (Sanders classification), smoking history, alcohol consumption, diabetes status, timing of surgery, tourniquet use, bone grafting, suture method, and postoperative incision care were evaluated. A nomogram was developed using R software to predict the risk of incision complications, validated through the area under the ROC curve, C-index, and decision curve analysis.
RESULTS: Both univariate and multivariate regression analyses identified fracture type, smoking history, diabetes, timing of surgery, and duration of tourniquet application as significant predictors of incision complications. These factors were incorporated into a clinical predictive nomogram. The nomogram\'s calibration curves demonstrated high accuracy, both internally and externally. The unadjusted concordance indes (C-index) was 0.793 [95% confidence interval (CI), 0.825-0.995], and the area under the curve for the nomogram was 0.7875882. Decision curve analysis confirmed the clinical applicability of the model at a threshold probability of 20-60%.
CONCLUSIONS: We have developed a reliable clinical nomogram to predict the risk factors for incision complications in the modified \"L\" approach for calcaneal fractures, enhancing decision-making in clinical settings.