下颈椎骨折脱位合并关节突关节绞锁经颅骨牵引复位失败的危险因素分析  

Risk factors for failure in repositioning the dislocation of the subaxial cervical spine with locked facets by skull traction

作　　者：朱自强 上官泽宇 史学形 王春庆 何净明 简月奎[3] 李青 Zhu Ziqiang;Shangguan Zeyu;Shi Xuexing;Wang Chunqing;He Jingming;Jian Yuekui;Li Qing(Department of Orthopaedic Trauma,The Hospital Affiliated to Guizhou Medical University,Guiyang 550004,China;School of Clinical Medicine,Guizhou Medical University,Guiyang 550004,China;Department of Spine Surgery,The People's Hospital of Guizhou Province,Guiyang 550002,China)

机构地区：[1]贵州医科大学附属医院创伤骨科,贵阳550004 [2]贵州医科大学临床医学院,贵阳550004 [3]贵州省人民医院脊柱外科,贵阳550002

出　　处：《中华创伤骨科杂志》2024年第7期575-582,共8页Chinese Journal of Orthopaedic Trauma

基　　金：国家自然科学基金(82160249)。

摘　　要：目的探讨下颈椎骨折脱位合并关节突关节绞锁经颅骨牵引复位失败的危险因素,构建此类患者经颅骨牵引复位失败的Nomogram预测模型。方法回顾性分析2014年1月至2022年12月贵州医科大学附属医院、贵州省人民医院下颈椎骨折脱位合并关节突关节绞锁患者的临床资料。以贵州医科大学附属医院的患者资料为训练集,共计156例;以贵州省人民医院患者资料为外部验证集,共计54例。对训练集患者资料进行单因素分析及多因素logistic回归分析,筛选出独立危险因素后构建Nomogram预测模型,受试者操作特征(ROC)曲线、校正曲线、决策曲线,训练集内部验证及外部验证集对模型进行评价验证。结果颈椎Ⅰ度脱位(P=0.002)、颈椎Ⅱ度脱位(P=0.007)、损伤节段(P=0.042)、单侧关节突关节绞锁(P=0.027)及脊髓损伤美国脊髓损伤协会分级(P=0.008)为下颈椎骨折脱位合并关节突关节绞锁经颅骨牵引复位失败的独立危险因素,据此构建一致性指数为0.88的下颈椎骨折脱位合并关节突关节绞锁经颅骨牵引复位失败的Nomogram预测模型,训练集ROC曲线结果显示曲线下面积(AUC)为0.88,提示该模型具有较好的准确性;校正曲线分析结果显示:Nomogram模型预测的下颈椎骨折脱位合并关节突关节绞锁经颅骨牵引复位失败的概率与实际牵引失败概率吻合度较高;决策曲线分析结果显示:下颈椎骨折脱位合并关节突关节绞锁经颅骨牵引复位失败的净获益阈值为0.03~0.84时,应用该Nomogram图模型有较好的收益;外部验证集ROC曲线结果显示AUC为0.79,提示该模型具有较好的准确性;训练集Bootstrap法1000次抽样内部验证显示一致性指数为0.87,提示该模型有较好的区分度。结论颈椎Ⅰ度、Ⅱ度脱位、低位损伤节段、单侧关节突关节绞锁、不完全脊髓损伤为下颈椎骨折脱位合并关节突关节绞锁经颅骨牵引复位失败的独立危险因素;�ObjectiveTo develop a nomogram predictive model on the basis of identification of the risk factors associated with failure in repositioning the dislocation of the subaxial cervical spine with locked facets by skull traction.MethodsA retrospective study was conducted of the clinical data of the patients who had been treated for dislocation of the subaxial cervical spine with locked facets at Department of Orthopaedic Trauma,The Hospital Affiliated to Guizhou Medical University and Department of Spine Surgery,The People's Hospital of Guizhou Province from January 2014 to December 2022.The clinical data from The Hospital Affiliated to Guizhou Medical University were used as a training set(156 cases)and those from The People's Hospital of Guizhou Province as an external validation set(54 cases).Univariate analysis and multi-variate logistic regression analysis of the training set were conducted to screen out independent risk factors associated with the failure in repositioning the dislocation of the subaxial cervical spine with locked facets by skull traction.A nomogram predictive model was thus constructed and assessed by the receiver operating characteristic(ROC)curve,calibration curve,and decision curve.Internal validation of the training set and external validation set was used to evaluate and validate the model.ResultsThe multivariate logistic regression analysis revealed that cervical Ⅰ grade dislocation(P=0.002),cervical Ⅱ grade dislocation(P=0.007),low segment affected(P=0.042),unilateral facet locked(P=0.027),and the ASIA grading of spinal cord injury(P=0.008)were the independent risk factors associated with the failure in repositioning the dislocation of the subaxial cervical spine with locked facets by skull traction,based on which the nomogram model with a C-index of 0.88 was constructed to predict the failure in repositioning the dislocation of the subaxial cervical spine with locked facets by skull traction.Analysis of the ROC curve of the training set showed an area under the curve(AUC)of 0.88,indi

关 键 词：颈椎 椎关节突关节 脱位 脊髓损伤 列线图 

分 类 号：R687.3[医药卫生—骨科学]