骨质疏松性胸腰椎骨折PVP术后新发骨折的列线图预测模型构建与验证

doi:10.3969/j.issn.1003-9198.2023.03.017

摘要/Abstract

摘要： 目的探究骨质疏松性胸腰椎骨折(OTF)病人行经皮椎体成形术(PVP)后新发骨折的影响因素,建立列线图预警模型,并验证模型的预测效能。方法回顾性选取2017~2018年我院收治的193例行PVP的OTF病人作为建模组,2019年1~12月收治的63例行PVP的OTF病人作为验证组。以术后2年或诊断为术后新发骨折为随访终点,统计建模组术后骨折发生率。通过单因素与多因素Cox比例风险模型筛选影响术后新发骨折的独立危险因素,采用R软件建立列线图模型预测术后新发骨折风险,并对模型的预测效果进行内部及外部验证。结果建模组PVP术后新发骨折发生率为21.76%(42/193)。多因素Cox回归分析显示,腰椎T值、椎体内裂隙样变、伤椎前缘高度恢复率、骨水泥注入量、骨水泥渗漏是OTF病人PVP术后新发骨折的独立危险因素。基于多因素Cox回归分析结果建立预测术后新发骨折的列线图模型,预测模型中建模组的C-index为0.796(95%CI:0.724~0.836),验证组的C-index为0.730(95%CI:0.706~0.784);建模组预测术后1年及2年新发骨折发生率ROC的AUC分别为0.820、0.772,验证组的分别为0.778、0.721;建模组与验证组校准曲线斜率均接近1,决策曲线分析法(DCA)分析的阈概率在0.05～1之间,模型表现为正的净收益。结论本研究基于OTF病人行PVP术后新发骨折的5个独立危险因素建立的列线图预测模型具有良好的预测效能,能够为临床医护人员预防PVP术后骨折提供一定参考。

关键词: 骨质疏松, 胸腰椎骨折, 经皮椎体成形术, 新发椎体骨折

Abstract: Objective To explore the influencing factors of new fractures after percutaneous vertebroplasty (PVP) in the patients with osteoporotic thoracolumbar fractures (OTF), and to establish a nomogram early warning model and verify the predictive performance of the model. Methods A total of 193 patients with OTF who underwent PVP in our hospital from January 2017 to December 2018 were retrospectively selected as the modeling group, and 63 patients with OTF who underwent PVP from January to December 2019 were selected as the validation group. The end point of follow-up was 2 years after surgery or the time of diagnosis of new postoperative fractures. The incidence of postoperative fractures in the modeling group was observed, and the independent risk factors for new postoperative fractures were screened by univariate and multivariate Cox proportional hazards models. R software was used to establish a nomogram model to predict the risk of new fractures after surgery, and the predictive effect of the model was verified internally and externally. Results The incidence rate of new fractures after PVP was 21.76% (42/193). Multivariate Cox regression analysis showed that lumbar spine T value, intravertebral fissure-like degeneration, height recovery rate of injured vertebral anterior edge, bone cement injection volume, and bone cement leakage were the independent risk factors for new fractures after PVP in the patients with OTF. Based on the multivariate Cox regression analysis results, a nomogram model for predicting new postoperative fractures was established. The C-index of the prediction model was 0.730 (95%CI: 0.706-0.784) in the validation group and 0.796 (95%CI: 0.724-0.836) in the modeling group, and the areas under the receiver operating characteristic curve for predicting the incidence of new fractures at 1 year and 2 years after surgery were 0.778, 0.721 in the validation group and 0.820, 0.772 in the modeling group, respectively. The slopes of the calibration curves of the two groups were both close to 1, and the threshold probability of the decision curve analysis (DCA) was 0.05-1, and the model showed a positive net benefit. Conclusions This study establishes a nomogram prediction model based on five independent risk factors of new fractures after PVP for OTF, which has a good predictive performance and can provide a certain reference value for clinical medical staff to prevent fractures after PVP.

Key words: osteoporosis, thoracolumbar fractures, percutaneous vertebroplasty, new vertebral fracture

中图分类号:

R 683.2

沈嫣, 姜莺, 丁霞, 吕晋新. 骨质疏松性胸腰椎骨折PVP术后新发骨折的列线图预测模型构建与验证[J]. 实用老年医学, 2023, 37(3): 282-286.

SHEN Yan, JIANG Ying, DING Xia, LYU Jin-xin. Construction and validation of a nomogram prediction model for new fractures after PVP in patients with osteoporotic thoracolumbar fractures[J]. Practical Geriatrics, 2023, 37(3): 282-286.

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