摘要
Abstract
Objective To analyze the risk factors of adjacent vertebral re-fracture after percutaneous vertebroplasty(PVP)in patients with osteoporotic vertebral compression fractures(OVCF)and construct a prediction model.Methods A retrospective study was conducted to select the clinical data of 300 patients with OVCF who underwent PVP treatment in our hospital from November 2021 to November 2023.The patients were followed up for 12 months.According to the postoperative adjacent vertebral re-fracture,they were divided into a re-fracture group(67 cases,22.33％)and a non-fracture group(257 cases,77.67％).The general data of the two groups were compared.Logistic regression was used to test the effects of various factors on adja-cent vertebral re-fracture after PVP.R4.1.3 was used to construct a nomogram model of adjacent vertebral re-fracture after PVP in OVCF patients and to test the predictive value of the model.Results In the re-frac-ture group,the average age of the patients was(79.64±5.31)years,the amount of bone cement injection was(5.12±0.63)mL,and the vertebral height recovery rate was 16.25％±5.32％.All were higher than those in the non-fracture group,which was(73.14±6.32)years,(4.72±0.58)mL,and 11.87％±5.50％.The T-value of bone density in the re-fracture group was-3.24±0.51,which was lower than-2.89±0.52 of the non-fracture group.The proportion of patients receiving standardized anti-osteoporosis treatment in the re-fracture group was lower than that in the non-fracture group,and the proportion of patients with ≥ 2 fractured vertebrae,bone cement leakage rate,and bone cement mass distribution were all higher than that in the non-fracture group(P＜0.05).Logistic regression analysis showed that older age,lack of standardized anti-osteoporosis treatment,high injection volume of bone cement,bone cement leakage,blocky distribution of bone cement,and high re-covery rate of vertebral height were risk factors for adjacent vertebral fractures in OVCF patients after PVP(OR＞1,P＜0.05),and high bone density T-value was a protective factor(OR＜1,P＜0.05).Based on the above influencing factors,a column chart prediction model was constructed and validated,with a C-index value of 0.908.The receiver operating characteristic curve(ROC)for internal validation of the model showed an AUC of 0.908(95％ CI:0.873-0.944,P＜0.05),with specificity,sensitivity,and Youden index of 0.734,0.940,and 0.674,respectively.Conclusions Older age,no standardized anti-osteoporosis treatment,more bone cement injection,bone cement leakage,mass distribution of bone cement,and high recovery rate of vertebral height are risk factors for adjacent vertebral re-fracture after PVP in OVCF patients.High T-value of bone mineral density is a protective factor.The nomogram model based on the above influencing factors has high predictive value,which is helpful to screen high-risk groups,take targeted intervention measures in clinical practice,reduce the incidence of adjacent vertebral re-fracture after PVP,and improve the prognosis of patients.关键词
骨质疏松性椎体压缩性骨折/经皮椎体成形术/邻椎再骨折/预测模型Key words
osteoporotic vertebral compression fractures/percutaneous vertebroplasty/adjacent vertebral re-fracture/prediction model
