髋关节置换术后脱位的多因素分析和列线图 预测模型的构建

Multifactorial Analysis and Construction of a Nomogram Prediction Model for Dislocation after Hip Arthroplasty

摘要: 目的：对髋关节置换术(THA)后发生假体脱位的情况及其相关危险因素进行探讨，构建出THA术后发生假体脱位的列线图预测模型。方法：采用回顾性分析法，对2021年1月至2024年12月在安徽医科大学附属六安医院接受髋关节置换手术的555名患者的临床资料进行研究，记录髋关节脱位情况，脱位患者均由髋关节X线片检查确诊，依照THA术后是否发生脱位，将患者分为非脱位组(515例)和脱位组(40例)，通过多因素Logistic回归分析术后脱位发生的危险因素，构建列线图预测模型，对THA术后假体脱位进行预测，进而对该预测模型的有效性和可靠性进行验证。结果：555例行髋关节置换术治疗患者术后脱位的发生率为7.21% (40/555)，经多因素Logistic回归分析显示，性别为女性、高龄、有肢体或精神疾病、后外侧入路、假体放置在安全区外、人工股骨头直径较小、既往有髋部手术史均是导致THA术后关节脱位的危险因素(P < 0.05)。THA术后假体脱位的列线图模型的校正曲线基本与理想曲线一致，受试者工作特征曲线下面积(AUC)为0.961 (95% CI: 0.925~0.997)，表明该模型能够准确地预测THA术后假体脱位的风险。结论：性别为女性、高龄、有肢体或精神疾病、后外侧入路、假体放置在安全区外、人工股骨头直径较小、既往有髋部手术史均是THA术后假体脱位的影响因素，通过建立预测模型，可以较好地预测THA术后假体脱位的风险，临床上可据此制定个性化的干预措施，减少THA术后假体脱位的发生。

Abstract: Objective: To explore the occurrence of prosthesis dislocation following total hip arthroplasty (THA) and its associated risk factors, and to construct a nomogram prediction model for prosthesis dislocation after THA. Methods: A retrospective analysis was conducted on the clinical data of 555 patients who underwent hip replacement surgery at the Affiliated Lu’an Hospital of Anhui Medical University from January 2021 to December 2024. The occurrence of hip dislocation was documented, with all dislocations confirmed by hip X-ray examination. Based on whether dislocation occurred after THA, the patients were divided into a non-dislocation group (515 cases) and a dislocation group (40 cases). Risk factors for postoperative dislocation were identified through multivariate logistic regression analysis, and a nomogram prediction model was constructed to predict prosthesis dislocation after THA. Subsequently, the validity and reliability of this prediction model were validated. Results: The postoperative dislocation incidence was 7.21% (40/555). Multivariate logistic regression analysis revealed that female gender, advanced age, presence of limb or mental disorders, posterolateral surgical approach, prosthesis placement outside the safe zone, smaller artificial femoral head diameter, and a history of previous hip surgery were all risk factors for joint dislocation after THA (P < 0.05). The calibration curve of the nomogram model for prosthesis dislocation after THA is essentially consistent with the ideal curve. The area under the receiver operating characteristic curve (AUC) was 0.961 (95% confidence interval [CI]: 0.925~0.997), indicating excellent predictive accuracy. Conclusion: Female gender, advanced age, presence of limb or mental disorders, posterolateral surgical approach, prosthetic placement outside the safe zone, small artificial femoral head diameter, and a history of prior hip surgery are all influencing factors for prosthetic dislocation after total hip arthroplasty (THA). By establishing a prediction model, the risk of prosthetic dislocation after THA can be effectively predicted, enabling the development of personalized intervention measures in clinical practice to reduce the incidence of prosthetic dislocation following THA.