机器人辅助椎弓根螺钉内固定术对无神经损伤胸腰椎骨折患者临床疗效的影响因素分析  

Impact factors on the clinical efficacy of robot-assisted pedicle screw internal fixation in thoracolumbar fracture patients without nerve injury

作　　者：王彭 张德光[1] WANG Peng;ZHANG Deguang(Orthopedic Center,Beijing Pinggu Hospital,Beijing 101200,China)

机构地区：[1]北京市平谷区医院骨科中心,北京101200

出　　处：《机器人外科学杂志(中英文)》2025年第2期222-228,234,共8页Chinese Journal of Robotic Surgery

基　　金：平谷区医院科研项目(pgyyqn2024-02)。

摘　　要：目的:探究机器人辅助椎弓根螺钉内固定术对无神经损伤胸腰椎骨折患者的临床疗效及其影响因素。方法:选取2021年1月-2024年3月在北京市平谷区医院行机器人辅助椎弓根螺钉内固定术的149例无神经损伤胸腰椎骨折患者为研究对象,依据其术后临床疗效分为发生组(n=25,临床疗效不佳)和未发生组(n=124,临床疗效良好)。对比两组患者临床相关资料,针对差异指标进行共线性分析,未存在共线性问题的指标纳入Logistic回归模型中分析患者术后疗效不佳的相关因素,并构建临床预测模型,通过绘制受试者工作特征(ROC)曲线评估列线图模型的预测能力。结果:两组患者亚洲人骨质疏松自我筛查工具(OSTA)指数、术前椎体压缩程度、骨密度、术后早期负重、异体红细胞输注、术前白蛋白浓度对比存在显著差异(P<0.05)。采用R语言将所有差异变量进行VIF共线性分析,各差异变量VIF≤10,容忍度≥0.1,不存在共线性问题。将上述指标纳入Logistic回归模型中,结果发现术前椎体压缩程度、术后早期负重、异体红细胞输注、术前白蛋白浓度为术后临床疗效不佳发生的危险因素(P<0.05),OSTA指数、骨密度为临床疗效不佳发生的保护因素(P<0.05)。建立列线图预测模型,ROC曲线下面积(AUC)值为0.948,表示该模型具有较好的风险预测度。结论:OSTA指数、术前椎体压缩程度、骨密度、术后早期负重、异体红细胞输注、术前白蛋白浓度均为影响无神经损伤胸腰椎骨折患者术后临床疗效的独立影响因素,通过上述指标能够为临床术前筛查高危群体并采取相关措施提供理论参考依据。Objective:To explore impact factors on clinical efficacy of robot-assisted pedicle screw internal fixation in thoracolumbar fracture patients without nerve injury.Methods:149 thoracolumbar fracture patients without nerve injury who underwent robot-assisted pedicle screw internal fixation in Beijing Pinggu Hospital from January 2021 to March 2024 were selected.They were divided into the occurrence group(n=25,poor clinical outcomes)and the non-occurrence group(n=124,good clinical outcomes)based on the different clinical outcomes.Clinical data of the two groups of patients were compared to analyze the collinearity for the different indicators,and the indicators without collinearity were included in the logistic regression model to analyze the factors related to the poor postoperative outcomes by constructing a clinical prediction model,and the receiver operating characteristic(ROC)curves was drawn to assess the predictive ability of the model.Results:Significant differences were found in the Osteoporosis Self-screening Tool for Asians(OSTA)index,preoperative vertebral compression,bone mineral density,early postoperative weight-bearing,allogeneic red blood cell transfusion,and preoperative albumin concentration between the two groups of patients(P<0.05).The above difference variables were subjected to VIF collinearity analysis using the R language,and there was no collinearity for each difference variable with VIF≤10 and tolerance≥0.1.These variables were included in a logistic regression model,and it was found that the degree of preoperative vertebral compression,early postoperative weight-bearing,allogeneic red blood cell transfusion,and preoperative albumin concentration were all risk factors for poor postoperative clinical outcomes(P<0.05),and the OSTA index and bone mineral density were all protective factors for poor clinical outcomes(P<0.05).The nomogram prediction model was developed,and the area under the ROC curve(AUC)was 0.948,indicated that the model had a good degree of risk prediction.Conclusion:OST

关 键 词：胸腰椎骨折 神经损伤 椎弓根螺钉内固定术 机器人辅助手术 

分 类 号：R687.3[医药卫生—骨科学]