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目的 基于多因素构建并验证列线图预测模型以提高对创伤性下肢骨折患者静脉血栓栓塞症(venous thromboembolism, VTE)风险早期识别和干预。方法 纳入2019年1月—2023年12月沧州市人民医院骨科接受治疗创伤性下肢骨折患者550例，根据术后和随访期间VTE发生情况，分为VTE组和非VTE组；收集两组患者人口学资料、手术特征、实验室指标及围手术期信息，进行单因素分析以筛选潜在危险因素，将P<0.10变量纳入多因素logistic回归模型明确VTE独立危险因素；构建列线图预测模型，运用C指数、受试者工作特征(ROC)曲线、校正曲线及决策曲线分析区分度、校准度及临床实用性。结果 共纳入550例创伤性下肢骨折患者，VTE组68例，非VTE组482例，VTE组在体质量指数(BMI)、合并高血压及糖尿病、术后卧床时间、手术时间、术中失血量、D-二聚体及开放性手术比例方面显著高于非VTE组(P<0.05);独立危险因素为年龄、高血压、开放性手术、术后卧床时间及D-二聚体及BMI(P<0.05);构建的列线图模型C指数为0.86(95%CI:0.82～0.90),ROC曲线下面积为0.87,具良好区分度、校准性与临床实用性，且在阈值0.1～0.4内净收益最高。结论 构建列线图模型能够为创伤性下肢骨折患者VTE风险评估提供准确且便捷临床工具，区分度和校正度表现优异。
Abstract：Objective To develop and validate a nomogram prediction model based on multifactorial analysis for early identification and intervention of venous thromboembolism(VTE) risk in patients with traumatic lower extremity fractures. Methods A total of 550 patients with traumatic lower extremity fractures who received treatment in Cangzhou People's Hospital's Orthopedics Department between January 2019 and December 2023 were included. Based on the occurrence of VTE during the postoperative period and follow-up, the patients were divided into a VTE group and a non-VTE group. Demographic data, surgical characteristics, laboratory indicators, and perioperative information of both groups were collected. Univariate analysis was conducted to screen for potential risk factors. Variables with a P-value <0.10 were included in a multivariate logistic regression model to identify independent risk factors for VTE. A nomogram prediction model was constructed and its performance was assessed using the C-index, receiver operating characteristic(ROC) curve analysis, calibration curve analysis, and decision curve analysis to evaluate its discrimination, calibration, and clinical utility. Results Among the 550 patients with traumatic lower extremity fractures included, 68 were in the VTE group and 482 in the non-VTE group. The VTE group had significantly higher body mass index, proportions of comorbid hypertension and diabetes, postoperative bed rest time, surgical duration, intraoperative blood loss, D-dimer levels, and proportion of open surgery compared with the non-VTE group(P<0.05). Independent risk factors identified were age, hypertension, open surgery, postoperative bed rest time, D-dimer levels, and BMI(P<0.05). The constructed nomogram model demonstrated good performance: the C-index was 0.86(95%CI was 0.82-0.90), and the area under the ROC curve(AUC) was 0.87, indicating good discrimination, calibration, and clinical utility. The model showed the highest net benefit within a probability threshold range of 0.1 to 0.4. Conclusion The constructed nomogram model provides an accurate and convenient clinical tool for VTE risk assessment in patients with traumatic lower extremity fractures, exhibiting excellent performance in terms of discrimination and calibration.
[1] O′TOOLE R V,STEIN D M,O′HARA N N.Aspirin or low-molecular-weight heparin for thromboprophylaxis after a fracture[J].N Engl J Med,2023,388(3):203-213.
[2] SCHROEDER J D,TURNER S P,BUCK E.Hip fractures:diagnosis and management[J].Am Fam Physician,2022,106(6):675-683.
[3] 庄俊鸿，夏鹰，杨国帅.缩短DNT对急性脑梗死溶栓患者神经功能的影响[J].贵州医科大学学报，2023,48(3):368-372.
[4] GREWAL K,ATZEMA C L,SUTRADHAR R.Venous thromboembolism in patients discharged from the emergency department with ankle fractures:a population-based cohort study[J].Ann Emerg Med,2022,79(1):35-47.
[5] GRIFFIN M,LIP G Y.In limb or pelvic fracture,aspirin was noninferior to enoxaparin for reducing all-cause death[J].Ann Intern Med,2023,176(5):JC56.
[6] XING J,FU Y H,SONG Z.Predictive model for deep venous thrombosis caused by closed lower limb fracture after thromboprophylactic treatment[J].Eur Rev Med Pharmacol Sci,2022,26(22):8508-8522.
[7] CALOTTA N A,SHORES J T,COON D.Upper-extremity venous thromboembolism following operative treatment of distal radius fractures:an uncommon but dangerous complication[J].J Hand Surg Am,2021,46(12):1123.
[8] ZHU J K,WU F F,YANG R F.Postoperative subacute static progressive stretch does not increase the risk of distal lower limb venous thromboembolism[J].Chin J Traumatol,2023,26(3):178-182.
[9] ST??LLBERGER C,FINSTERER J,SCHNEIDER B.Adverse events and drug-drug interactions of sodium glucose co-transporter 2 inhibitors in patients treated for heart failure[J].Expert Rev Cardiovasc Ther,2023,21(11):803-816.
[10]GLAZIER C R,BACIEWICZ J R.Epidemiology,etiology,and pathophysiology of pulmonary embolism[J].Int J Angiol,2024,33(2):76-81.
[11]COSTA M.Thromboprophylaxis after extremity fracture - time for aspirin[J].N Engl J Med,2023,388(3):274-275.
[12]马景滔，黄劼，张烨，等.下肢不同部位深静脉血栓抗凝疗程的研究新进展[J].中国全科医学，2025,28(29):3721-3728.
[13]WEI B,ZHOU H,LIU G.Risk factors for venous thromboembolism in patients with spinal cord injury:a systematic review and meta-analysis[J].J Spinal Cord Med,2023,46(2):181-193.
[14]SALOTTOLO K,CARRICK M,NWAFO N.Timing of venous thromboembolism chemoprophylaxis with major surgery of lower-extremity long bone fractures[J].J Trauma Acute Care Surg,2023,94(1):169-176.
[15]BURNETT J L,SRINIVASAN A,MEAD A.Intervention to improve compliance with national guidelines on venous thromboembolism chemoprophylaxis for patients with operatively managed ankle fractures[J].Ochsner J,2022,22(4):319-323.
[16]LUO X,HUANG X,SHI J.The impacts of fast-track surgery on postoperative deep venous thrombosis among patients with lower limb fracture[J].Altern Ther Health Med,2024,16(8):707-712.
[17]KOBAYASHI K,SHIMIZU Y,HAGINOYA A.Safety of venous thromboembolism prophylaxis protocol using a novel leg exercise apparatus in bedridden patients due to spinal diseases[J].Cureus,2021,13(10):e19136.
[18]HAWKES D,BROOKES F S,ROBINSON S.Intraoperative and early postoperative complications of reverse shoulder arthroplasty:a current concepts review[J].J Orthop,2022,35:120-125.
[19]TAN Z,HU H,WANG Z.Prevalence and risk factors of preoperative deep venous thrombosis in closed patella fracture:a prospective cohort study[J].J Orthop Surg Res,2021,16(1):404.
[20]JUTO H,HULTIN M,M??LLER M.Routine use of lmwh prophylaxis is associated with a lower incidence of venous thromboembolic events following an ankle fracture[J].Injury,2022,53(2):732-738.
[21]WAEVER D,LEWIS D,SAKS?? H.The effectiveness and safety of direct oral anticoagulants following lower limb fracture surgery:a systematic review and meta-analysis[J].J Orthop Trauma,2021,35(4):217-224.
[22]解银立，张大春，支兴兴，等.可取回型下腔静脉滤器预防下肢骨折合并深静脉血栓形成患者围术期肺动脉栓塞的价值研究[J].中国全科医学，2019,22(6):715-719.
[23]PREP-IT INVESTIGATORS.Aqueous skin antisepsis before surgical fixation of open fractures(aqueous-prep):a multiple-period,cluster-randomised,crossover trial[J].Lancet,2022,400(10360):1334-1344.
[24]SVEDMAN S,ALKNER B,BERG H E.Stop leg clots-swedish multicentre trial of outpatient prevention of leg clots[J].BMJ Open,2021,11(5):e044103.
[25]CAPARROTTA T M,GREENHALGH A M,OSINSKI K.Sodium-glucose co-transporter 2 inhibitors(sglt2i) exposure and outcomes in type 2 diabetes:a systematic review[J].Diabetes Ther,2021,12(4):991-1028.
[26]KOMISARCZUK M,PIECH P,STA■.Comparative analysis of venous thromboembolic complications in diverse groups of orthopaedic patients[J].Ann Agric Environ Med,2024,31(1):119-124.
[27]潘彩燕，林晓坚，袁兆伟，等.牛蒡苷元对小鼠断尾出血时间和血栓形成的影响[J].贵州医科大学学报，2022,47(7):791-795.
[28]FERRAO A M,FERNANDES P,WIRCKER P.Deep vein thrombosis after a supracondylar fracture of the humerus in a child[J].Rev Bras Ortop,2021,58(4):e672-e675.
[29]MILES M V P,BROWN C N H,WEBSTER C C.Routine lower extremity screening ultrasound protocols in trauma patients are not cost effective[J].Am Surg,2022,88(7):1490-1495.
基本信息:
DOI：10.19367/j.cnki.2096-8388.2026.02.018
中图分类号:R543.6;R687.3
引用信息:
[1]董庆龙,李胜男,熊文瑞,等.基于多因素建立列线图模型预测创伤性下肢骨折患者并发静脉血栓栓塞症的风险[J].贵州医科大学学报,2026,51(02):288-295+304.DOI:10.19367/j.cnki.2096-8388.2026.02.018.
基金信息:
河北省医学科学研究课题计划项目(20240527)
2026-02-11
2026-02-11