急性骨质疏松性椎体压缩性骨折保守治疗失败的预测模型  

A predictive model for failure of conservative management of acute osteoporotic vertebral compression fractures

作　　者：韩毅[1] 蔡力[1] 冯枭[1] HAN Yi;CAI Li;FENG Xiao(The Second People’s Hospital of Guangyuan City,Guangyuan,Sichuan 628000,China)

机构地区：[1]广元市第二人民医院,四川广元628000

出　　处：《颈腰痛杂志》2023年第5期779-783,共5页The Journal of Cervicodynia and Lumbodynia

摘　　要：目的探讨急性骨质疏松性椎体压缩性骨折(OVCFs)患者保守治疗失败的危险因素,并构建其Nomogram预测模型。方法前瞻性研究2018年1月~2022年1月于本院就诊的207例急性OVSFs患者,根据保守治疗效果分为保守失败组和保守成功组。采用多因素Logistic回归模型分析急性OVCFs患者保守治疗失败的危险因素,并构建Nomogram预测模型;采用内部数据集验证及决策曲线评估Nomogram模型的预测性能及临床净收益。结果OVCFs患者保守治疗失败率39.1%。两组患者在年龄、BMI、陈旧性椎体骨折及椎体内裂比例、椎体前缘压缩率、Cobb角、VAS及MNA-SF(营养不良)比例、BMD(T值)方面的差异具有统计学意义(P<0.05)。年龄、BMD(T值)、BMI、椎体前缘压缩率、Cobb角、VAS的AUC为0.779、0.758、0.834、0.734、0.649、0.659,最佳截断值为≥74岁、<-2.8分、≥24.8 kg/m^(2)、≥25.65%、≥11.68°、≥6.75分。年龄、BMD(T值)、BMI、椎体前缘压缩率及MNA-SF是保守治疗失败的危险因素(P<0.05)。内部数据集验证C-index为0.827(95%CI:0.745~0.895)。当Nomogram模型预测急性OVCFs患者保守治疗失败风险阈值>0.04时,提供显著附加临床净收益,Nomogram模型的临床净收益显著高于单个指标预测结果。结论本研究基于年龄、BMD、BMI、椎体前缘压缩率及MNA-SF构建Nomogram模型,该模型可以早期有效识别保守治疗失败的高风险患者,避免无效保守治疗。Objective To explore therisk factors for failure of conservative treatment in patients with acute osteoporotic vertebral compression fractures(OVCFs)and to construct a Nomogram prediction model.Methods A prospective study was performed on the clinical data of 207 patients with acute OVCFs who attended our hospital from January 2018 to January 2022.The patients were divided into the conservative failure group and the conservative success group according to the effect of conservative treatment.Multifactorial logistic regression modeling was used to analyze the risk factors for conservative treatment failure in patients with acute OVCFs.Nomogram prediction model was constructed.Internal dataset validation and decision curves were used to assess the predictive performance of the Nomogram model and the net clinical benefit.Results The failure rate of conservative treatment in patients with OVCFs was 39.1%.The differences between the two groups in terms of age,BMI,proportion of old vertebral fracture and vertebral body endolysis,anterior vertebral compression compression ratio,Cobb angle,VAS and proportion of MNA-SF(dystrophy),and BMD(T-score)were statistically significant(P>0.05).The AUCs for age,BMD(T score),BMI,anterior margin vertebral compression,Cobb angle,and VAS was 0.779,0.758,0.834,0.734,0.649,and 0.659,respectively,and the optimal cutoff values were≥74 years,<-2.8 points,≥24.8 kg/m^(2),≥25.65%,≥11.68°,and≥6.75 points.Age,BMD(T-score),BMI,anterior margin vertebral compression ratio,and MNA-SF were risk factors for failure of conservative treatment(P<0.05).The internal dataset validation C-index was 0.827(95%CI:0.745-0.895).The Nomogram model provided significant additional net clinical benefit when it predicted a risk threshold>0.04 for conservative treatment failure in patients with acute OVCFs,and the net clinical benefit of the Nomogram model was significantly higher than that predicted by the individual metrics.Conclusion In this study a Nomogram model is constructed based on age,BMD,BMI,anteri

关 键 词：骨质疏松症 压缩性椎体骨折 保守治疗 NOMOGRAM 

分 类 号：R683.2[医药卫生—骨科学]