骨质疏松性椎体压缩性骨折患者PVP后新发椎体压缩骨折及骨水泥渗漏风险列线图预测模型的构建及应用

Establishment and validation of a nomogram for the risk of new vertebral compression fractures and cement leakage after percutaneous vertebroplasty in patients with osteoporotic vertebral compression fractures

目的 研究骨质疏松性椎体压缩性骨折(OVCF)患者经皮椎体成形术(PVP)后新发椎体压缩骨折(NVCF)和骨水泥渗漏(BCL)的危险因素,并建立和验证列线图预测模型。方法 将2019年1月至2021年1月海南医学院第一附属医院收治的经PVP治疗的OVCF患者纳入本次回顾性研究。收集患者相关临床资料。采用单变量和多因素Logistic分析筛选预测因子,构建列线图模型,用校准曲线对预测模型进行一致性评价,并通过十折交叉验证评估模型的预测性能;用决策曲线分析(DCA)和临床影响曲线评估列线图的临床应用价值。结果 共有295例患者入组,PVP后有48例发生NVCF,非NVCF有247例;术后发生BCL 73例,非BCL 222例。高体重指数、低骨密度、多发性椎体骨折、术后未接受抗骨质疏松治疗和类固醇的使用是PVP后NVCF的独立危险因素(P<0.05);骨水泥量、手术时间和多发性椎体骨折是PVP后BCL的危险因素(P<0.05)。校准曲线显示列线图的预测值与观测值间一致性良好;十折交叉验证显示列线图预测性能较高;DCA和临床影响曲线显示列线图的临床效用价值较高。结论 构建的列线图可有效预测PVP后NVCF和BCL的发生风险。

Objective To investigate the risk factors for new vertebral compression fractures(NVCF)and bone cement leakage(BCL)after percutaneous vertebroplasty(PVP)in patients with osteoporotic vertebral compression fractures(OVCF)and to develop and validate a nomogram prediction model.Methods Patients with OVCF treated with PVP at the First Affiliated Hospital of Hainan Medical College from January 2019 to January 2021 were involved in this retrospective study.Relevant data affecting NVCF and BCL were collected.Predictors were screened using univariate and multi-factor logistic analysis to construct nomogram.The consistency of the prediction models was assessed using calibration plots,and their predictive power was assessed by tenfold cross-validation.Clinical value was assessed using DCA and clinical impact plots.Results A total of 295 patients were enrolled,with 48 cases of NVCF occurring after PVP and 247 cases of non NVCF;There were 73 cases of postoperative BCL and 22 cases of non BCL.Higher BMI,lower BMD,multiple vertebral fractures,no anti-osteoporosis treatment,and steroid use were independent risk factors for NVCF(P<0.05).Cement injection volume,time to surgery,and multiple vertebral fractures were risk factors for NCL after PVP(P<0.05).The calibration curve demonstrated the good agreement between the predicted and observed actual results.Ten fold cross validation demonstrated that the good predictive ability of nomogram.DCA and clinical impact curve demonstrated the good clinical value of nomogram.Conclusion The established nomogram can effectively predict the occurrence of BCL and new OVCF after PVP.