无神经症状胸腰椎骨折行Wiltse入路经伤椎置钉短节段内固定术后Cobb角增加的风险因素分析及预测模型构建  

Risk factors analysis for Cobb angle increase after short segment internal fixation with trans-injured vertebrae screw placement via Wiltse approach for thoracolumbar fracture without neurological symptoms and construction of prediction model

作　　者：戴栋栋 张波 汤卜赫 纪岳 吴苏东 DAI Dong-dong;ZHANG Bo;TANG Pu-he;JI Yue;WU Su-dong(Department of Orthopaedics,General Hospital of Huainan Oriental Hospital Group,Huainan,Anhui 232000,China)

机构地区：[1]淮南东方医院集团总院骨科,安徽淮南232000

出　　处：《颈腰痛杂志》2024年第4期668-672,677,共6页The Journal of Cervicodynia and Lumbodynia

摘　　要：目的分析无神经症状胸腰椎骨折行Wiltse入路经伤椎置钉短节段内固定术后Cobb角增加的风险因素,并构建预测模型。方法选取2018年6月~2021年12月淮南东方医院集团总院接受经Wiltse入路经伤椎置钉短节段内固定术的无神经症状胸腰椎骨折患者110例为研究对象,依据术后Cobb角度增加情况分为Cobb角增加组、对照组,对比两组临床资料、手术相关指标、术后随访资料,经多因素Logistic回归法分析术后Cobb角增加的风险因素并构建预测模型。结果术后随访17~36个月,失访5例。73例术后Cobb角度增加值≤3°(记为对照组)、32例≥4°(记为Cobb角增加组);两组在年龄和术前、术后1周、末次随访时椎体Cobb角及Cobb角增加值、术前椎体压缩率、术前伤椎前缘高度比、椎间隙高度改变、伤椎椎体复位程度、术后功能锻炼方面比较,差异有统计学意义(P<0.05);多因素Logistic回归分析显示,术前椎体Cobb角大、术前椎体压缩率>50%、术后功能锻炼不合理为术后Cobb角增加的独立危险因素,伤椎椎体复位程度高是保护因素(P<0.05);构建风险预测模型:Log(P)=1.205×术前椎体Cobb角+1.859×术前椎体压缩率-0.064×伤椎椎体复位程度+3.765×术后功能锻炼不合理-72.909;术前椎体Cobb角、伤椎椎体复位程度预测Cobb角增加的ROC曲线下面积分别为0.792、0.714。该模型的Hosmer-Lemeshow检验差异无统计学意义(χ^(2)=1.489,P=0.356),有较好的符合程度。结论术前椎体Cobb角、术前椎体压缩率、术后功能锻炼,为无神经症状胸腰椎骨折行Wiltse入路经伤椎置钉短节段内固定术后Cobb角增加的风险因素,伤椎椎体复位程度高是保护因素,可采取相应改进措施提高疗效。Objective To analyze the risk factors for Cobb angle increase after short segment internal fixation with trans-injured vertebrae screw placement via Wiltse approach for thoracolumbar fracture without neurological symptoms,and to construct a prediction model.Methods A total of 110 patients with thoracolumbar fractures but without neurological symptoms who underwent short segment internal fixation with trans-injured vertebrae screw placement via Wiltse approach in General Hospital of Huainan Oriental Hospital Group from June 2018 to December 2021 were selected as the research subjects.According to the situation of Cobb angle increase after operation,the subjects were divided into study group and control group.The clinical data,operation related indicators,postoperative follow-up data of the two groups were compared.Multivariate logistic regression analysis was conducted to identify the risk factors for Cobb angle increase after operation,and a prediction model was constructed.Results The patients were followed up for 17-36 months,and 5 patients were lost to follow up.There were 73 patients had Cobb angle increase≤3°(control group)and 32 patients had Cobb angle≥4°(Cobb angle increase group).There were statistically significant differences between the groups in terms of age,vertebral Cobb angle and Cobb angle increase before operation,at 1 week after operation and at the last time of follow-up,preoperative vertebral compression rate,preoperative anterior height ratio of the injured vertebral body,changes in intervertebral space height,reduction of the injured vertebral body,and postoperative functional exercise(P<0.05).Multivariate logistic regression analysis found that large vertebral Cobb angle before operation,preoperative vertebral compression rate>50%,and unreasonable postoperative functional exercise were independent risk factors for Cobb angle increase after operation,and well reduction of the injured vertebral body was a protective factor(P<0.05).The risk prediction model was as follow:Log(P)=1.205×pr

关 键 词：Wiltse肌间隙入路 伤椎置钉 内固定 胸腰椎骨折 COBB角 

分 类 号：R683.2[医药卫生—骨科学]