| 摘要: |
| ［摘要］ 目的 构建老年骨质疏松患者膝关节单髁置换术（UKA）后胫骨假体早期松动的列线图预测模型并内部验证。方法 回顾性收集2022年5月至2023年5月山西医科大学附属运城市中心医院收治的因膝关节骨性关节炎行UKA的125例老年骨质疏松患者的临床资料，其中术后发生胫骨假体早期松动21例（松动组），未发生胫骨假体早期松动104例（未松动组）。多因素logistic回归分析老年骨质疏松患者UKA术后胫骨假体早期松动的影响因素。基于独立预测因子构建列线图模型，并以Bootstrap（1 000次）进行内部验证，ROC曲线评估列线图预测模型对UKA术后胫骨假体早期松动的预测效能。结果 与未松动组相比，松动组放射立体测量技术（RSA）最大总点运动（MTPM）显著增大（P<0.05），定量计算机断层扫描（QCT）近端胫骨体积骨密度（vBMD）显著降低（P<0.05），且β-胶原C端交联肽（β-CTX）水平显著升高（P<0.05）。多因素logistic回归分析显示，RSA MTPM［OR（95%CI）=3.32（2.11～5.21）］和β-CTX［OR（95%CI）=1.13（1.06～1.20）］是促进UKA术后胫骨假体早期松动发生的独立危险因素（P<0.05），而QCT近端胫骨vBMD［OR（95%CI）=0.63（0.44～0.82）］是抑制UKA术后胫骨假体早期松动发生的独立保护因素（P<0.05）。基于上述三项指标构建的列线图模型，经内部验证，其具有良好的区分度（C-index=0.785，AUC=0.792），决策曲线分析显示其在阈值概率0.15～0.38范围内具有较高的临床净收益。结论 基于QCT近端胫骨vBMD、RSA MTPM及骨吸收指标β-CTX三者构建的列线图模型具有良好的预测性能和临床应用潜力，可用于术后早期松动风险评估与分层管理。 |
| 关键词: 膝关节单髁置换术 骨质疏松 放射立体测量分析 定量计算机断层扫描 列线图 |
| DOI：10.3969/j.issn.1674-3806.2026.02.05 |
| 分类号:R 687.4 |
| 基金项目:陕西省自然科学基础研究计划项目（编号：2023-JC-YB-710）；山西省运城市科技局基础研究计划项目（编号：YCKJ-2022079） |
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| Construction and internal validation of a nomogram model for predicting early tibial component loosening after unicompartmental knee arthroplasty in elderly patients with osteoporosis |
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LI Jiangbo1, ZHANG Eryang2, WANG Kunzheng3,4
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1.Department of Orthopaedics, Peking University First Hospital Taiyuan Branch, Taiyuan 030000, China; 2.Department of Orthopaedics, Yuncheng Central Hospital Affiliated to Shanxi Medical University, Yuncheng 044000, China; 3.Department of Orthopaedics, the Second Affiliated Hospital of Xi′an Jiaotong University, Xi′an 710000, China; 4.Joint Center, School of Medicine, Xi′an Jiaotong University, Xi′an 710000, China
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| Abstract: |
| ［Abstract］ Objective To construct and internally validate a nomogram model for predicting early tibial component loosening after unicompartmental knee arthroplasty(UKA) in elderly patients with osteoporosis. Methods The clinical data of 125 elderly patients with osteoporosis who underwent UKA in Yuncheng Central Hospital Affiliated to Shanxi Medical University due to knee osteoarthritis from May 2022 to May 2023 were retrospectively collected. Among the patients, 21 patients had early tibial component loosening after the operation(loosening group), and 104 patients did not have early tibial component loosening after the operation(non-loosening group). Multivariate logistic regression was used to analyze the influencing factors for developing early tibial component loosening after UKA in the elderly patients with osteoporosis. A nomogram model was constructed based on the independent predictors and was internally validated by using Bootstrap(1 000 iterations), and the prediction efficacy of the nomogram model for developing early tibial component loosening after UKA in the elderly patients with osteoporosis was evaluated by using receiver operating characteristic(ROC) curve. Results Compared with those in the non-loosening group, the maximum total point motion(MTPM) measured by radiostereometric analysis(RSA) was significantly increased(P<0.05), and the volumetric bone mineral density(vBMD) of proximal tibia measured by quantitative computed tomography(QCT) was significantly decreased(P<0.05), and the beta-carboxy-terminal cross-linking telopeptide of type Ⅰ collagen(β-CTX) level was significantly increased in the loosening group(P<0.05). Multivariate logistic regression analysis showed that MTPM measured by RSA［OR(95%CI)=3.32(2.11-5.21)］ and β-CTX［OR(95%CI)=1.13(1.06-1.20)］ were independent risk factors for developing early tibial component loosening after UKA(P<0.05), while the vBMD of proximal tibia measured by QCT［OR(95%CI)=0.63(0.44-0.82)］ was an independent protective factor inhibiting development of early tibial component loosening after UKA(P<0.05). The nomogram model constructed based on the above 3 indicators was verified internally to have good discrimination(C-index=0.785, AUC=0.792), and the decision curve analysis showed that the model had high net clinical benefit within the threshold probability range of 0.15-0.38. Conclusion The nomogram model constructed according to the vBMD of proximal tibia measured by QCT, MTPM measured by RSA and bone resorption indicator β-CTX has good predictive performance and clinical application potential, and can be used for risk assessment of early tibial component loosening and stratified management. |
| Key words: Unicompartmental knee arthroplasty(UKA) Osteoporosis Radiostereometric analysis(RSA) Quantitative computed tomography(QCT) Nomogram |
