双侧经皮椎体成形术后相邻椎体骨折列线图预测模型构建  

Based on Nomogram model predicting the risk of adjacent vertebral fractures after bilateral vertebroplasty

作　　者：崔善林 陈勇喜[2] 刘科第 范俊鸿 覃忠设 郭圣挥 蒙觉威 李品元 CUI Shanlin;CHEN Yongxi;LIU Kedi;FAN Junhong;QIN Zhongshe;GUO Shenghui;MENG Juewei;LI Pinyuan(Graduate School of Guangxi University of Traditional Chinese Medicine,Nanning 530003,China;Department of Spinal Surgery,the First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine,Nanning 530003,China;Department of Orthopedics and TraumatologyⅡ,Hengzhou Traditional Chinese Medicine Hospital,Nanning 530300,China)

机构地区：[1]广西中医药大学研究生学院,广西南宁530003 [2]广西中医药大学第一附属医院脊柱外科,广西南宁530003 [3]横州市中医医院骨伤二科,广西南宁530300

出　　处：《老年医学研究》2023年第6期1-5,共5页Geriatrics Research

基　　金：广西壮族自治区中医药管理局适宜技术开发与推广项目(GZSY23-28,补肝强肾壮骨方治疗老年性骨质疏松症的疗效评价与推广)。

摘　　要：目的探讨骨质疏松性椎体压缩骨折(OVCF)患者行双侧经皮椎体成形术(PVP)后相邻椎体骨折的影响因素,并构建列线图预测模型。方法选取2019年8月—2022年8月广西中医药大学第一附属医院脊柱外科收治的174例行双侧PVP的OVCF患者。根据术后是否新发生相邻椎体骨折分为相邻椎体骨折者与未骨折者。采用LASSO回归法和二元logistic回归分析OVCF患者双侧PVP后相邻椎体骨折的危险因素,应用R Studio构建列线图预测模型,并对其预测效能进行评价。结果OVCF患者双侧PVP后相邻椎体骨折47例,未骨折127例。LASSO回归与二元Logistic回归分析结果显示,BMI、术前椎体压缩比、术后椎体恢复比、伤椎Cobb角矫正度、腰椎骨密度、骨水泥渗漏是OVCF患者双侧PVP后相邻椎体骨折的影响因素。采用上述6个影响因素成功构建列线图预测模型,该模型预测OVCF患者双侧PVP后相邻椎体骨折的受试者工作特征曲线下面积为0.838(95%CI:0.679~0.875)。Boostrap法对模型内部进行验证,结果显示该模型预测与实际情况较为一致(C-index为0.838)。结论骨水泥渗漏、术前椎体压缩比、低BMI、伤椎Cobb角矫正度、腰椎低骨密度、术后椎体恢复比是OVCF患者双侧PVP术后发生相邻椎体骨折的危险因素,基于上述危险因素建立的列线图模型能为临床上防治术后相邻锥体骨折提供一定的参考。Objective To explore the influencing factors of adjacent vertebral fractures(AVCF)in patients with osteoporotic vertebral compression fractures(OVCF)after percutaneous vertebroplasty(PVP),and construct a Nomogram prediction model.Methods A total of 174 patients after bilateral PVP who had suffered from OVCF and hospitalized in Spinal Surgery Department of the First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine from August 2019 to August 2022 were selected.According to whether there was a new occurrence of postoperative AVCF,patients were divided into those with fractures and those without fractures.LASSO regression and binary logistic regression were used to analysis risk factors for AVCF in OVCF patients after bilateral PVP.R Studio was applied to construct a Nomogram prediction model,and its predictive performance was evaluated.Results There were 47 cases of AVCF and 127 cases of no fractures in OVCF patients after bilateral PVP.LASSO regression and binary logistic regression analysis showed that BMI,preoperative vertebral compression ratio,postoperative vertebral recovery ratio,postoperative Cobb angle correction,lumbar bone density,and bone cement leakage were independent risk factors for AVCF after bilateral PVP for OVCF.Subsequently,the six independent risk factors mentioned above was used to construct a Nomogram prediction model.The area under the working characteristic curve of the model subjects was 0.838(95%CI:0.679-0.875).The Bootstrap method was used to validate the internal performance of the model,and the results showed that the model's predictions were consistent with the actual situation(C-index of 0.838).Conclusions Bone cement leakage,preoperative vertebral compression ratio,low BMI,Cobb angle correction of the injured vertebra,lumbar spine bone density,and postoperative vertebral recovery ratio are risk factors for AVCF after bilateral PVP.The Nomogram model based on the above risk factors can provide some reference for prevention and treatment of AVCF after bilatera

关 键 词：骨质疏松性椎体压缩骨折 双侧经皮椎体成形术 相邻椎体压缩骨折 列线图风险预测模型 

分 类 号：R683.2[医药卫生—骨科学]