Abstract：【Objective】To establish and validate a prediction model for poor prognosis after total hip replacement in older adult patients. 【Methods】A total of 85 elderly patients who underwent hip arthroplasty from February 2019 to July 2022 were selected. After 1 year follow-up, patients were divided into the poor prognosis group and the good prognosis group according to the prognosis of older adult patients after hip arthroplasty. By comparing the clinical data of the two groups, the influencing factors of the poor prognosis after total hip replacement in elderly patients were analyzed by binary Logistic regression method, the prediction model of the poor prognosis after total hip replacement in older adult patients was constructed by Logistic method, and the fitting degree was evaluated by Hosmer-Lemeshow test. Receiver operating characteristic curve (ROC) was plotted to evaluate the prediction model differentiation. 【Results】After 1 year of follow-up, 2 cases of the 85 patients were lost to follow-up, the follow-up rate was 97.65%. Among them, 22 patients had poor prognosis, the incidence of poor prognosis was 26.51%(22/83). The surgical severity score (P-POSSUM score) ≥15 points, rehabilitation intervention time of 7 days after surgery, bone density <-3 SD, controlled nutritional status (CONUT) score ≥5 points, monocyte-to-lymphocyte ratio (MLR) ≥1.13, and bone alkaline phosphatase (BLAP) and thyroid hormone (PTH) levels in the poor prognosis group were significantly higher than those in the good prognosis group (P<0.05).Binary Logistic regression analysis showed that P-POSSUM score, rehabilitation intervention time, bone mineral density, CONUT score and MLR were the influencing factors for poor prognosis after total hip replacement in older adult patients (P<0.05). Taking the above influencing factors as predictive variables, a nomogram prediction model was established. The total score of each factor ranged from 76 to 426, and the corresponding risk rate ranged from 0.05 to 0.80. The C-index of the nomogram model was 0.825, and the correction curve for predicting the risk of poor prognosis after total hip replacement in older adult patients was close to the ideal curve (P>0.05). ROC curve results showed that the sensitivity and specificity of the nomogram model in predicting total poor prognosis after hip replacement in older adult patients were 90.91% and 88.52%, respectively. The area under the curve (AUC) was 0.903. 【Conclusion】P-POSSUM score, rehabilitation intervention time, bone mineral density, CONUT score and MLR are associated with the risk of poor prognosis after total hip arthroplasty in older adult patients. The construction of a nomogram model is helpful for early screening of the risk of poor prognosis after total hip arthroplasty in older adult patients.
易鑫明, 万顺新, 张杰, 陈明波. 高龄患者髋关节置换术后预后不良的预测模型构建及验证[J]. 医学临床研究, 2024, 41(8): 1148-1151.
YI Xinming, WAN Shunxin, ZHANG Jie, et al. Construction and Validation of Prediction Model for Poor Prognosis after Total Hip Replacement in Older Adult Patients. JOURNAL OF CLINICAL RESEARCH, 2024, 41(8): 1148-1151.
[1] HAFFER H, WANG Z, HU Z Y, et al. Total hip replacement influences spinopelvic mobility: a prospective observational study[J].J Arthroplasty,2022,37(2):316-324.
[2] PEARCE A N, STAMBOUGH J B, MEARS S C, et al. Diagnosis and treatment options of abductor insufficiency after total hip replacement[J].Orthop Clin North Am,2022,53(3):255-265.
[3] KAPPENSCHNEIDER T, MADERBACHER G, WEBER M, et al. Special orthopaedic geriatrics (SOG) - a new multiprofessional care model for elderly patients in elective orthopaedic surgery: a study protocol for a prospective randomized controlled trial of a multimodal intervention in frail patients with hip and knee replacement[J].BMC Musculoskelet Disord,2022,23(1):1079.
[4] JONES H, GENDRE A, MCHUGH A, et al. Use of the portsmouth physiological and operative severity score for the enumeration of mortality and morbidity ('P-POSSUM') to predict morbidity in patients undergoing surgery with reconstruction for temporal bone malignancy[J].J Laryngol Otol,2022,136(12):1271-1274.
[5] PENG L, MENG C Y, LI J Z, et al. The prognostic significance of controlling nutritional status (CONUT) score for surgically treated renal cell cancer and upper urinary tract urothelial cancer: a systematic review and meta-analysis[J].Eur J Clin Nutr,2022,76(6):801-810.
[6] 韩云毅,孙永青,康建国,等. 高龄脆性髋部骨折保守治疗住院期间死亡因素分析[J].中华骨与关节外科杂志,2020,13(9):747-751.
[7] 费联成,泮海国,于金磊. 高龄患者髋关节置换术后院内病死率与影响因素分析[J].中国基层医药,2022,29(7):1049-1053.
[8] 朱江龙,陈跃平,董盼锋,等. 老年骨质疏松症患者髋关节置换术后预后及相关因素分析[J].中国骨质疏松杂志,2019,25(8):1073-1077.
[9] 韦先梅,韩毓,杜就旧. 血清催产素浓度与绝经后女性骨密度相关性研究[J].中国骨质疏松杂志,2021,27(8):1159-1162.
[10] 郭小荣,郭成龙,崔巧梅,等. 预后营养指数对老年骨质疏松症患者髋关节置换术后风险预测及影响因素分析[J].中国骨质疏松杂志,2020,26(7):967-971.
[11] DALMIGLIO C, BRILLI L, CAMPANILE M, et al. CONUT score: a new tool for predicting prognosis in patients with advanced thyroid cancer treated with TKI[J].Cancers (Basel),2022,14(3):724.
[12] 李亚利,邹莹,张玲芝,等. 术前控制营养状况评分及单核细胞/淋巴细胞值对老年髋部骨折患者预后的预测价值[J].东南大学学报(医学版),2022,41(3):379-385.
[13] 邓春花,孙美娟,张娟娟,等. NRS2002在老年髋部骨折患者术前营养筛查和预测临床转归中的应用[J].现代医学,2021,49(3):321-325.
[14] 靳永俊,肖鹏,朱旭,等. 髋部骨折手术预后的预测:Nottingham髋部骨折评分的独立验证和重新校准[J].中华创伤骨科杂志,2023,25(9):777-784.
2024, Vol. 41 
