中国骨伤2024，Vol.37Issue(6)：553-559,7.DOI:10.12200/j.issn.1003-0034.20230652
预测骨质疏松性椎体压缩骨折经皮椎体成形术后残余背痛的列线图
A nomogram for predicting residual back pain after percutaneous vertebroplasty for osteoporotic vertebral compres-sion fractures
摘要
Abstract
Objective To construct percutaneous vertebroplasty for predicting osteoporotic vertebral compression fractures(OVCFs)nomogram of residual back pain(RBP)after percutaneous vertebroplasty(PVP).Methods Clinical data of 245 OVCFs patients who were performed PVP from January 2020 to December 2022 were retrospectively analyzed,including 47 males and 198 females,aged from 65 to 77 years old with an average of(71.47±9.03)years old,and were divided into RBP group and non-RBP group according to whether RBP occurred.Gender,age,comorbidities,fracture stage,body mass index(BMI),bone mineral density(BMD),visual analogue scale(VAS),Oswestry disability index(ODI)and other general infor-mation were collected;anterior vertebral height(AVH),anterior vertebral height ratio(AVH),anterior vertebral height ratio(AVHR),Cobb angle,intravertebral vacuum cleft(IVC),thoracolumbar fascia(TLF)injury,paravertebral muscle steatosis,injection volume and leakage of bone cement,bone cement dispersion pattern,anterior vertebral height recovery ratio(AVHRR),Cobb angle changes,etc.imaging parameters before operation and 24 h after operation were collected.Univariate analysis was performed to analysis above factors,and multivariate Logistic regression model was used to investigate indepen-dent risk factors for postoperative RBP,and Nomogram model was constructed and verified;receiver operating characteristic(ROC)curve and calibration curve were used to determine predictive performance and accuracy of the model,and Hosmer-Lemeshow(H-L)test was used for evaluation.The area under curve(AUC)of ROC was calculated,and Harrell consistency index(C index)was used to evaluate the predictive efficiency of model;decision curve analysis(DCA)was used to evaluate clinical practicability of model.Results There were 34 patients in RBP group and 211 patients in non-RBP group.There were no significant differences in gender,age,comorbidities,fracture stage,BMI,BMD,VAS,ODI,AVH,AVHR and Cobb angle be-tween two groups(P＞0.05).Univariate analysis showed 6 patients occurred IVC in RBP group and 13 patients in non-RBP,the number of IVC in RBP group was higher than that in non-RBP group(x2=5.400,P=0.020);6 patients occuured TLF injury in RBP group and 11 patients in non-RBP group,the number of TLF injury in RBP group was higher than that in non-RBP group(x2=7.011,P=0.008);In RBP group,18 patients with grade 3 to 4 paraptebral steatosis and 41 patients in non-RBP group,RBP group was higher than non-RBP group(x2=21.618,P＜0.001),and the proportion of bone cement mass in RBP group was higher than non-RBP group(x2=6.836,P=0.009).Multivariate Logistic regression analysis showed IVC(x2=4.974,P=0.025),TLF in-jury(x2=5.231,P=0.023),Goutallier grade of paravertebral steatosis＞2(x2=15.124,P＜0.001)and proportion of bone cement(x 2=4.168,P=0.038)were independent risk factors for RBP after PVP.ROC curve of model showed AUC of original model was 0.816[OR=2.862,95％CI(0.776,0.894),P＜0.001].The internal verification of model through 200 bootstrap samples showed the value of C index was 0.936,and calibration curve showed predicted probability curve was close to actual probability curve.H-L goodness of fit test results were x2=5.796,P=0.670.DCA analysis results showed the decision curve was above None line and All line when the threshold value ranged from 6％to 71％.Conclusion IVC,TLF combined injury,paravertebral muscle steatosis with Goutallier grade＞2,and bone cement diffusion with mass type are independent risk factors for RBP after PVP.The risk prediction model for RBP after PVP established has good predictive performance and good clinical practicability.关键词
骨质疏松性椎体压缩骨折/经皮椎体成形术/残余背痛/列线图Key words
Osteoporotic vertebral compression fractures/Percutaneous vertebroplasty/Residual back pain/Nomo-gram分类
医药卫生引用本文复制引用
李军科,马续彬,李亮,马晴,王旭东..预测骨质疏松性椎体压缩骨折经皮椎体成形术后残余背痛的列线图[J].中国骨伤,2024,37(6):553-559,7.基金项目
邯郸市科学技术研究与发展计划项目(编号:21422083063) （编号:21422083063）
2022年度河北省医学科学研究课题计划(编号:20220507)Handan City Science and Technology Research and Development Plan Project(No.21422083063) （编号:20220507）
