基于Nomogram建立老年胸腰椎爆裂骨折后神经损伤的风险预测模型

Preliminary exploration of establishing the risk prediction model of nerve injury after thoracolumbar burst fracture in the elderly based on nomogram

目的 基于Nomogram初步构建老年胸腰椎爆裂骨折后神经损伤的风险预测模型。方法选取2020年1月至2022年1月收治的169例胸腰椎爆裂骨折患者作为研究对象,依据神经损伤发生情况分为神经损伤组(n=54)和非神经损伤组(n=115),使用单因素分析筛选有统计学差异的变量进行多因素logistic回归分析,并据此建立列线图预测模型。结果 单因素分析显示年龄、损伤节段T12/L1、椎管内占位和后方韧带复合体损伤两组间差异有统计学意义(P <0.05)。多因素logistic回归提示年龄≥70岁(OR=2.684,P=0.010)、损伤节段T12/L1(OR=2.173,P=0.042)、椎管内占位(OR=2.595,P=0.010)和后方韧带复合体损伤(OR=3.416,P=3.416)是老年胸腰椎爆裂骨折后神经损伤的独立危险因素(P <0.05)。依此建立预测老年胸腰椎爆裂骨折后神经损伤风险的列线图模型,模型验证结果显示C-index为0.773,校正曲线趋近于理想曲线,ROC曲线下面积(AUC)为0.755(95%CI:0.715~0.794),在8%~82%范围内,列线图模型净获益。结论 年龄≥70岁、损伤节段T12/L1、椎管内占位和后方韧带复合体损伤会增加老年胸腰椎爆裂骨折后神经损伤的风险,据此构建的列线图模型能有效预测老年胸腰椎爆裂骨折后神经损伤的风险概率。

Objective To construct a risk prediction model of nerve injury after thoracolumbar burst fracture in the elderly based on nomogram.Methods 169 patients with thoracolumbar burst fractures treated in hospital from January 2020 to January 2022 were selected as the research object.According to the occurrence of nerve injury,they were divided into nerve injury group(n=54)and non⁃nerve injury group(n=115).The vari⁃ables with statistical differences were screened by univariate analysis for multivariate logistic regression analysis,and the nomogram prediction model was established.Results Univariate analysis showed that there were significant differences between the two groups in age,injured segment T12/L1,intraspinal space occupying and posterior liga⁃ment complex injury(P<0.05).Multivariate logistic regression showed that age≥70 years old(OR=2.684,P=0.010),injured segment T12/L1(OR=2.173,P=0.042),intraspinal space occupying(OR=2.595,P=0.010)and posterior ligament complex injury(OR=3.416,P=3.416)were independent risk factors for nerve injury after thoracolumbar burst fracture in the elderly(P<0.05).Based on this,a nomogram model for predicting the risk of nerve injury after thoracolumbar burst fracture in the elderly was established.The model verification results showed that the C⁃index was 0.773,the correction curve was close to the ideal curve,and the area under the ROC curve(AUC)was 0.755(95%CI:0.715~0.794).Within the range of 8%~82%,the nomogram model had a net benefit.Conclusion Age≥70 years old,injured segment T12/L1,intraspinal space occupying and posterior ligament complex injury will increase the risk of nerve injury after thoracolumbar burst fracture in the elderly.The nomogram model can effectively predict the risk probability of nerve injury after thoracolumbar burst fracture amongst the elderly.