| 摘要: |
| 目的 探讨老年骨质疏松患者单髁膝关节置换术(UKA)后胫骨假体早期松动的相关因素,并构建列线图预测模型,以实现早期风险分层管理。方法 采用单中心回顾性队列研究,纳入2023年5月至2025年1月因膝关节骨性关节炎行UKA的老年骨质疏松患者125例,其中胫骨假体早期松动21例(松动组),未松动104例(未松动组)。 术前3个月内基于QCT测量近端胫骨体积骨密度(vBMD),并检测血钙、磷及骨代谢标志物(β-CTX、P1NP、N-MID骨钙素、BALP等)；术后通过放射立体测量分析(RSA)获取胫骨假体三维迁移参数(含最大总点运动MTPM),并随访至术后24个月。 采用t检验/χ2检验进行组间比较；多因素Logistic回归筛选独立影响因素；基于独立预测因子构建列线图模型,并以Bootstrap(1000次)进行内部验证,ROC曲线评价预测效能。结果 两组基线资料差异无统计学意义。 与未松动组相比,松动组RSA MTPM显著增大(0.93±0.47 vs 0.58±0.23 mm,P<0.001),QCT测得近端胫骨vBMD显著降低(71.68±17.36 vs 87.12±20.72 mg/cm3,P<0.001),β-CTX水平显著升高(0.49±0.15 vs 0.35±0.12 ng/mL,P<0.001)。 多因素Logistic回归显示,RSA MTPM(OR=3.32,95%CI:2.11–5.21,P<0.001)与β-CTX(OR=1.13,95%CI:1.06–1.20,P<0.001)为独立危险因素,QCT vBMD为独立保护因素(OR=0.63,95%CI:0.44–0.82,P=0.001)。 基于上述3项指标构建列线图模型,内部验证C-index为0.785；ROC分析AUC为0.792；决策曲线提示当阈值概率在0.15–0.38时可获得较高临床净收益。结论 QCT评估的近端胫骨vBMD、RSA量化的假体早期迁移(MTPM)及骨吸收标志物β-CTX与老年骨质疏松患者UKA术后胫骨假体早期松动密切相关。基于三者构建的列线图模型具有较好的区分度与临床应用潜力,可为UKA术后早期松动风险预测与分层干预提供参考。 |
| 关键词: 单髁膝关节置换术 骨质疏松 放射立体测量分析 定量CT 列线图 |
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| Efficacy of Multimodal Integrated Assessment in Predicting Early Tibial Component Loosening After Unicompartmental Knee Arthroplasty in Elderly Patients with Osteoporosis |
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李江波
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Peking University First Hospital Taiyuan Hospital
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| Abstract: |
| Objective To investigate factors associated with early tibial component loosening after unicompartmental knee arthroplasty (UKA) in elderly patients with osteoporosis, and to develop a nomogram for early risk prediction to facilitate postoperative risk stratification.Methods A single-center retrospective cohort study was conducted, including 125 elderly patients with osteoporosis who underwent unicompartmental knee arthroplasty (UKA) for knee osteoarthritis between May 2023 and January 2025. Among these patients, 21 developed early tibial component loosening (loosening group), while 104 showed no signs of loosening (non-loosening group). Within 3 months preoperatively, proximal tibial volumetric bone mineral density (vBMD) was measured using quantitative computed tomography (QCT), and serum calcium, phosphorus, and bone turnover markers (β-CTX, P1NP, N-MID osteocalcin, BALP, etc.) were assessed. Postoperatively, radiostereometric analysis (RSA) was used to obtain three-dimensional tibial component migration parameters, including maximum total point motion (MTPM), and patients were followed for 24 months. Intergroup comparisons were performed using the t-test and χ2 test. Independent predictors were identified by multivariable logistic regression. A nomogram was constructed based on independent predictors and internally validated using bootstrap resampling (1,000 iterations). Predictive performance was evaluated with the receiver operating characteristic (ROC) curve.Results No significant differences were observed in baseline characteristics between the two groups. Compared with the non-loosening group, the loosening group had significantly greater RSA MTPM (0.93±0.47 vs 0.58±0.23 mm, P<0.001), lower proximal tibial vBMD on QCT (71.68±17.36 vs 87.12±20.72 mg/cm3, P<0.001), and higher β-CTX levels (0.49±0.15 vs 0.35±0.12 ng/mL, P<0.001). Multivariable logistic regression demonstrated that RSA MTPM (OR=3.32, 95%CI: 2.11–5.21, P<0.001) and β-CTX (OR=1.13, 95%CI: 1.06–1.20, P<0.001) were independent risk factors, whereas QCT-derived proximal tibial vBMD was an independent protective factor (OR=0.63, 95%CI: 0.44–0.82, P=0.001). The nomogram incorporating these three variables achieved a C-index of 0.785 on internal validation, with an AUC of 0.792 on ROC analysis. Decision curve analysis indicated a favorable clinical net benefit when the threshold probability ranged from 0.15 to 0.38.Conclusion Proximal tibial vBMD assessed by QCT, early tibial component migration quantified by RSA (MTPM), and the bone resorption marker β-CTX are closely associated with early tibial component loosening after UKA in elderly osteoporotic patients. The nomogram based on these factors shows good discrimination and potential clinical utility, and may support risk prediction and stratified early interventions after UKA. |
| Key words: unicompartmental knee arthroplasty osteoporosis radiostereometric analysis quantitative computed tomography nomogram |
