骨质疏松性胸椎压缩骨折术后遗留肋间痛的风险模型建立及应用评价  

Establishment and application evaluation of risk model of intercostal pain after operation of osteoporotic thoracic compression fracture

作　　者：吴宇 刘轶寅 WU Yu;LIU Yi-yin(Department of Orthopedics and Traumatology,Zhangjiagang Traditional Chinese Medicine Hospital,Zhangjiagang,Jiangsu 215600,China)

机构地区：[1]张家港市中医医院骨伤科,江苏张家港215600

出　　处：《颈腰痛杂志》2024年第2期320-324,共5页The Journal of Cervicodynia and Lumbodynia

摘　　要：目的建立骨质疏松性胸椎压缩骨折术后遗留肋间痛的风险预测模型。方法纳入本院2018年3月~2023年3月收治的342例骨质疏松性胸椎压缩骨折患者,按照3∶1比例使用随机数字表法分别纳入训练集(n=257)、验证集(n=85)。以术后1 d肋间区域疼痛视觉模拟评分(visual analogue scale,VAS)≥4分为肋间痛标准,评估训练集患者术后肋间痛遗留率,并按照患者是否遗留肋间痛,将其分别纳入肋间痛组、非肋间痛组;使用Logistic多因素回归模型,探索影响患者术后遗留肋间痛的风险因素并建立列线图模型,完善模型内部验证、效能分析和决策曲线分析(decision curve analysis,DCA)。结果342例患者术后遗留肋间痛发生率为19.01%。Logistic多因素回归分析显示,椎间孔减小率每升高5%、重度骨折、胸腰筋膜损伤,均为影响骨质疏松性胸椎压缩骨折术后遗留肋间痛的独立风险因素,楔形骨折为保护性因素(P<0.05)。内部验证结果示,训练集、验证集的AUC分别为0.935、0.954。Kolmogorov-Smimov拟合优度检验结果显示模型校准度良好(P>0.05)。DCA结果显示,在5%~92%阈值范围内,训练集、测试集决策曲线均位于All、None上方。结论骨质疏松性胸椎压缩骨折患者术后遗留肋间痛风险较高,风险因素包括椎间孔减小率、骨折严重度等,基于风险因素建立的列线图模型效能良好、净收益率较高,能够为术后遗留肋间痛的风险评估提供可靠参考。Objective To establish a risk prediction model of intercostal pain after operation of osteoporotic thoracic compression fracture and evaluate its application value.Methods A total of 342 patients with osteoporotic thoracic vertebral compression fractures admitted to our hospital from March,2018 to March,2023 were enrolled in the training set(n=257)and the verification set(n=85)according to the ratio of 3∶1.One day after operation,the visual analogue scale(VAS)of intercostal pain≥4 was used as the intercostal pain standard,and the patients in the training group were evaluated for the rate of intercostal pain after operation.According to whether the patients left intercostal pain or not,they were divided into intercostal pain group and non-intercostal pain group respectively.Logistic multivariate regression model was used to explore the risk factors affecting the patients’intercostal pain after operation,and a nomogram model was established based on the risk factors,and the internal verification,efficacy analysis and decision curve analysis(DCA)of the model were improved.Results The incidence of postoperative intercostal pain in 342 patients was 19.01%.Logistic multivariate regression analysis showed that every 5% increase in intervertebral foramen reduction rate,severe fracture and thoracolumbar fascia injury were independent risk factors for intercostal pain after operation of osteoporotic compression fracture,and wedge fracture was a protective factor(P<0.05).The internal verification results showed that the AUC of the training set and the verification set was 0.935 and 0.954 respectively.Kolmogorov-Smimov goodness-of-fit test results showed that the model had good calibration(P>0.05).DCA results showed that the decision curves of training set and test set were above All and None in the threshold range of 5%~92%.Conclusion Patients with osteoporotic thoracic vertebral compression fracture have a high risk of postoperative intercostal pain,and its risk factors include the reduction rate of intervertebral fo

关 键 词：骨质疏松 胸椎压缩骨折 肋间痛 风险模型 模型验证 

分 类 号：R683.2[医药卫生—骨科学]