胸腰椎骨折患者内固定术后再发后凸畸形的影响因素及风险预测模型构建  

Influencing Factors and Risk Prediction Model Construction of Kyphosis Reccurrence in Patients with Thoracolumbar Fractures After Internal Fixation Surgery

作　　者：谢长伟 赵泽 杨永亮 林栋 崔新华 郭中帅 陈长青 XIE Changwei;ZHAO Ze;YANG Yongliang;LIN Dong;CUI Xinhua;GUO Zhongshuai;CHEN Changqing(Department of Spinal Surgery,the First Affiliated Hospital of Henan Polytechnic University(the Second People’s Hospital of Jiaozuo),Jiaozuo 454000,China)

机构地区：[1]河南理工大学第一附属医院(焦作市第二人民医院)脊柱外科,河南焦作454000

出　　处：《河南医学研究》2024年第18期3402-3404,共3页Henan Medical Research

摘　　要：目的探讨胸腰椎骨折患者内固定术后再发后凸畸形(KR)的影响因素并构建风险预测模型。方法回顾性分析焦作市第二人民医院2021年1月至2023年1月收治的经内固定术治疗后1 a内发生KR的50例胸腰椎骨折患者病历资料,作为发生组,另收集同期于医院接受内固定术治疗后1 a内未发生后凸畸形的50例胸腰椎骨折患者病历资料,作为未发生组。对比两组临床病历资料,通过logistic回归分析影响因素,并依据logistic回归分析结果构建风险预测模型。结果发生组骨密度、术前伤椎前缘高度比(AVH)、血尿酸水平低于未发生组,糖尿病占比高于未发生组(P<0.05);经logistic回归分析显示,骨密度、糖尿病史、术前AVH、血尿酸是胸腰椎骨折患者内固定术后KR发生的影响因素(P<0.05)。绘制列线图构建胸腰椎骨折患者内固定术后KR发生的风险预测模型,验证模型区分度显示C-index值=0.895,具有良好的区分度;绘制标准曲线显示,校准曲线和Y-X直线相近,模型准确度良好。结论骨密度、糖尿病史、术前AVH、血尿酸是胸腰椎骨折患者内固定术后KR的影响因素,基于上述指标所得的风险预测模型预测效能较好。Objective To explore the influencing factors of kyphosis reccurrence(KR)in patients with thoracolumbar fractures after internal fixation surgery and construct a risk prediction model.Methods A retrospective study was conducted to select 50 cases of thoracolumbar fracture with KR within one year after internal fixation in the Second People’s Hospital of Jiaozuo from January 2021 to January 2023 as the occurrence group,and 50 cases of thoracolumbar fractures without KR within one year after internal fixation in the same period were collected as the non occurrence group.The clinical medical records of the two groups were compared,the influencing factors were analyzed by logistic regression,and the risk prediction model was constructed according to the results of logistic regression analysis.Results Bone mineral density,anterior vertebral height ratio(AVH)and blood uric acid level in the occurrence group were significantly lower than those in the non occurrence group,and the proportion of diabetes was significantly higher than that in the non occurrence group(P<0.05).Logistic regression analysis showed that bone mineral density,history of diabetes,preoperative AVH and blood uric acid were the influencing factors of KR after internal fixation of thoracolumbar fractures(P<0.05).A nomogram was drawn to construct a risk prediction model for KR after internal fixation in patients with thoracolumbar fractures.The discrimination of the model showed that the C-index value was 0.895,which had good discrimination.The standard curve showed that the calibration curve was similar to the Y-X line,and the model accuracy was good.Conclusion Bone mineral density,history of diabetes,preoperative AVH,and blood uric acid are the influencing factors of KR in patients with thoracolumbar fractures after internal fixation.The risk prediction model based on the above indicators has a good prediction effect.

关 键 词：胸腰椎骨折 内固定术 后凸畸形 影响因素 风险预测模型 

分 类 号：R687.3[医药卫生—骨科学]