老年骨质疏松性椎体压缩骨折患者经皮椎体后凸成形术术后下腰痛缓解效果的列线图模型构建

Construction of a nomogram model for efficacy of percutaneous kyphoplasty in low back pain relief in elderly patients with osteoporotic vertebral compression fractures

目的探讨老年骨质疏松性椎体压缩骨折(OVCF)患者经皮椎体后凸成形术(PKP)后下腰痛缓解效果的影响因素,建立列线图模型并分析其预测作用。方法选择2020年1月至2022年12月江苏省南通市海门区人民医院接受PKP治疗的218例老年OVCF患者为研究对象,入院后完善检查并进行PKP治疗,术后随访6个月并采用日本骨科学会(JOA)下腰痛量表评估疗效。根据治疗效果将患者分为有效组(n=187)和无效组(n=31),分析老年OVCF患者PKP疗效并建立列线图模型。采用SPSS 23.0统计软件进行数据分析。根据数据类型,分别采用t检验或χ^(2)检验进行组间比较。采用多因素logistic回归分析评估老年OVCF患者PKP治疗效果的影响因素。采用R软件中Rstudio程序包构建列线图预测模型,并采用Boot strap法验证预测结果与实际观察结果间的一致性,采用受试者工作特征(ROC)曲线评估列线图在预测PKP疗效中的价值。结果术后6个月,JOA评分有效者187例(85.78%)。多因素logistic回归分析提示,年龄(OR=1.887,95%CI 1.273~2.798)、骨折椎体数量(OR=2.980,95%CI 1.291~6.882)、骨折至手术时间(OR=1.281,95%CI 1.128~1.456)、术前Cobb角(OR=0.687,95%CI 0.523~0.902)及规范抗骨质疏松治疗(OR=2.596,95%CI 1.228~5.489)均为老年OVCF患者PKP疗效的影响因素(P<0.05)。预测PKP疗效的列线图模型Hosmer-Lemeshow拟合度检验结果为χ^(2)=1.685,P=0.247,提示该模型精准性良好。ROC曲线分析显示,该列线图模型预测老年OVCF患者PKP治疗无效的ROC曲线下面积为0.816(95%CI 0.617~0.894;P<0.001)。结论影响老年OVCF患者PKP治疗效果的因素有年龄、骨折椎体数量、术前Cobb角、骨折至手术时间及规范抗骨质疏松治疗,以此为基础建立列线图模型对判断疗效具有良好价值。

Objective To explore the influencing factors of low back pain relief efficacy in elderly patients with osteoporotic vertebral compression fractures(OVCF)after percutaneous kyphoplasty(PKP)and construct a nomogram model for the efficacy and analyze its predictive effect.Methods A total of 218 elderly OVCF patients undergoing PKP treatment in our hospital from January 2020 to December 2022 were enrolled in this study.After admission,they all underwent PKP treatment after completion of examinations.Japanese Orthopaedic Association(JOA)low back pain scale was used to evaluate the efficacy after 6 months of follow-up.According to the efficacy,they were divided into effective group(n=187)and ineffective group(n=31).The efficacy of PKP for elderly OVCF patients was analyzed and then a nomogram model was constructed to predict the PKP efficacy.SPSS statistics 23.0 was used for data analysis.Depending on data type,t test or Chi-square test was applied for comparison between groups.Multivariate logistic regression analysis was performed to confirm the influencing factors for PKP treatment efficacy in elderly OVCF patients.Rstudio program package in R software was employed to construct a nomogram prediction model,and the consistency between the predicted results and the actual observation results was verified by Boot strap method.Receiver operating characteristic(ROC)curve was drawn to evaluate the value of the nomogram in the prediction of PKP efficacy.Results At 6 months after surgery,JOA score indicated that the surgery was effective in 187 cases(85.78%).Multivariate logistic regression analysis suggested that age(OR=1.887,95%CI 1.273-2.798),number of fractured vertebral bodies(OR=2.980,95%CI 1.291-6.882),time from fracture to surgery(OR=1.281,95%CI 1.128-1.456),preoperative Cobb angle(OR=0.687,95%CI 0.523-0.902)and standardized anti-osteoporosis treatment(OR=2.596,95%CI 1.228-5.489)were all influencing factors of PKP efficacy in elderly patients with OVCF(P<0.05).Hosmer-Lemeshow fit test revealed that the nomogram model in predicting the efficacy of PKP had aχ^(2)=1.685 and a P=0.247,suggesting that the model had good accuracy.ROC curve analysis showed that the ROC area under the curve of the nomogram model in predicting ineffective PKP treatment in elderly OVCF patients was 0.816(95%CI 0.617-0.894;P<0.001).Conclusion The influencing factors for PKP efficacy in elderly OVCF patients are age,number of fractured vertebral bodies,preoperative Cobb angle,time from fracture to surgery and standardized anti-osteoporosis treatment.Our nomogram model based on these factors has good value in prediction of treatment efficacy.