老年骨质疏松性椎体压缩性骨折PVP术后再骨折风险的列线图预测模型构建

Establishment of nomogram prediction model for the risk of refracture after PVP for senile osteoporotic vertebral compression fractures

目的 分析骨质疏松性椎体压缩性骨折(OVCF)患者经皮椎体成形术(PVP)后再骨折发生影响因素,建立列线图预测模型评估术后再骨折发生风险。方法 OVCF并行PVP的患者155例根据PVP后再骨折发生情况分为再骨折组(32例)和未再骨折组(123例)。采用Logistic分析OVCF患者PVP后再骨折发生的影响因素,利用R软件绘制列线图预测模型,并对模型进行验证。结果 再骨折组年龄、骨水泥注射率、脊柱矢状面失衡比例、骨水泥椎间盘渗漏比例均明显高于未再骨折组,骨密度明显低于未再骨折组(P<0.05)。年龄、骨水泥注射率、脊柱矢状面失衡、骨水泥椎间盘渗漏是OVCF患者PVP后再骨折发生的独立危险因素(P<0.05),骨密度是保护因素(P<0.05)。受试者工作特征曲线结果显示,预测OVCF患者PVP后再骨折发生风险的曲线下面积为0.885,校准曲线斜率接近1,Hosmer-Lemeshow检验χ^(2)=2.541,P=0.960。结论 基于年龄、骨水泥注射率、脊柱矢状面失衡、骨密度、骨水泥椎间盘渗漏这5项影响因素构建预测患者术后再骨折发生风险的列线图模型区分度、准确度均较好。

Objective To analyze the influencing factors of refracture in patients with osteoporotic vertebral compression fracture(OVCF)after percutaneous vertebroplasty(PVP),the nomogram prediction model was established to evaluate the risk of postoperative refracture.Methods A total of 155 patients with OVCF and PVP were divided into refracture group(32 cases)and non refracture group(123 cases)according to whether there was refracture after PVP.Logistic regression was used to analyze the influencing factors of refracture after PVP in OVCF patients.R software was used to draw a nomogram prediction model and verify the model.Results The age,bone cement injection rate,the ratio of spinal sagittal imbalance and the ratio of bone cement intervertebral disc leakage in the refracture group were significantly higher than those in the non refracture group,and the bone density was significantly lower than that of the non refracture group(P<0.05).The age,bone cement injection rate,spinal sagittal imbalance and bone cement intervertebral disc leakage were independent risk factors for refracture after PVP in OVCF patients(P<0.05),bone mineral density was a protective factor for refracture after PVP in OVCF patients(P<0.05).Receiver operating characteristic curve results showed that the area under curve of predicting the risk of refracture after PVP in OVCF patients was 0.885,the slope of the calibration curve was close to 1,Hosmer-Lemeshow testχ^(2)=2.541,P=0.960.Conclusions Based on five influencing factors,including age,bone cement injection rate,spine sagittal imbalance,bone density and bone cement intervertebral disc leakage,a nomogram model is constructed to predict the risk of postoperative refracture in patients.The model has good discrimination and accuracy.