骨质疏松性椎体压缩骨折患者椎体成形术后再发骨折风险预测模型的建立

Establishment of risk predictive model of fracture recurrence after vertebroplastyin patients with osteoporotic vertebral compression fractures

目的 探讨骨质疏松性椎体压缩骨折(OVCF)患者经皮椎体成形术(PVP)术后再发骨折的相关因素,并以此构建风险预测模型。方法 回顾性分析2017年1月至2020年11月在该院接受治疗的345例OVCF患者,所选患者均接受PVP治疗,对患者随访至少2年,根据患者术后再发骨折情况将患者分为未骨折组289例和再骨折组56例。收集并比较两组患者的相关指标,包括年龄、性别、体质量指数(BMI)、骨折节段、糖尿病史、骨密度、手术情况和术后抗骨质疏松治疗情况,采用多因素Logistic回归分析OVCF患者PVP术后再发骨折的独立影响因素,并以此构建风险预测模型。采用受试者工作特征(ROC)曲线检验风险预测模型对OVCF患者PVP术后再发骨折的预测效果,采用Hosmer-Lemeshow检验判断模型的拟合优度。结果 两组患者年龄、骨密度值、骨水泥渗漏情况、初次骨折椎体数、服用双膦酸盐药物情况比较,差异均有统计学意义(P<0.05),而两组性别、BMI、骨折节段、糖尿病史、Cobb角、穿刺方式、初次接受PVP情况及骨水泥注入量比较,差异均无统计学意义(P>0.05)。多因素Logistic回归分析显示,骨密度值、骨水泥渗漏、初次骨折椎体数、服用双膦酸盐药物均是OVCF患者PVP术后再发骨折的独立影响因素(P<0.05);风险预测模型:Logit(P)=-21.635+2.697×X骨密度值+0.948×X骨水泥渗漏+2.419×X初次骨折椎体数+1.156×X服用双膦酸盐药物。风险预警模型预测OVCF患者PVP术后再发骨折的曲线下面积(AUC)为0.921(95%CI:0.874~0.967),灵敏度为76.80%,特异度为94.80%,Hosmer-Lemeshow检验显示,χ^(2)=7.157,P=0.520,模型拟合效度好,预测价值高。结论 骨密度值、骨水泥渗漏、初次骨折椎体数、服用双膦酸盐药物均是OVCF患者PVP术后再发骨折的独立影响因素,构建的OVCF患者PVP术后再发骨折的风险预测模型具有较好的预测效能,可对OVCF患者PVP术后再发骨折的风险进行评估,为临床制订术后再发骨折的干预措施提供依据。

Objective To explore the related factors of fracture recurrence after percutaneous vertebroplasty(PVP)in the patients with osteoporotic vertebral compression fracture(OVCF),and to construct a risk predictive model.Methods A retrospective analysis was conducted on 345 cases of OVCF received the treatment in this hospital from January 2017 to November 2020.All selected patients underwent the PVP treatment and were followed up for at least 2 years.The patients were divided into the non-fracture group(289 cases)and re-fracture group(56 cases)according to the postoperative fracture recurrence.The related indicators were collected and compared between the two groups,including age,gender,body mass index(BMI),fracture segment,history of diabetes,bone mineral density,surgical conditions and postoperative anti-osteoporosis treatment situation.The multivariate Logistic regression was adopted to analyze the independent influencing factors for the recurrent fracture occurrence after PVP in the patients with OVCF and the risk predictive model was constructed on this basis.The receiver operating characteristic(ROC)curve was used to test the predictive effect of the risk predictive model on recurrent fractures after PVP treatment in OVCF patients,and the Hosmer-Lemeshow test was used to judge the goodness of fit of the model.Results There were statistically significant differences in the age,bone mineral density,bone cement leakage,number of vertebral bodies in initial fracture and bisphosphonates medication between the two groups(P<0.05),while there were no statistically significant differences in the gender,BMI,fracture segment,history of diabetes,Cobb angle,puncture mode,PVP for the first time and the amount of bone cement injection between the two groups(P>0.05).The multivariate Logistic regression analysis showed that the bone mineral density value,cement leakage,number of first fractured vertebrae and administration of bisphosphonates were the independent influencing factors for postoperative fracture recurrence of the patients(P<0.05);the risk predictive model:Logit(P)=-21.635+2.697×X bone density+0.948×X leakage of bone cement+2.419×X number of vertebral bodies in initial fracture+1.156×X bisphosphate medication.The area under the curve(AUC)of the risk predictive model for predicting recurrent fracture after PVP in OVCF patients was 0.921(95%CI:0.874-0.967),with a sensitivity of 76.80%and a specificity of 94.80%.The Hosmer-Lemeshow test showed thatχ^(2)=7.157,P=0.520,the model had the good fitting validity and high predictive value.Conclusion The BMD value,bone cement leakage,number of vertebra in primary fracture and bisphosphonates medication all are the independent influencing factors for the recurrence of fractures after PVP in OVCF patients.The constructed risk predictive model for postoperative recurrence fracture after PVP in OVCF patients has good predictive efficacy,which can evaluate the risk of postoperative recurrence fracture recurrence after PVP in OVCF patients,could be used to evaluate the fracture recurrence risk after PVP in OVCF patients and provide the guidance for clinically formulating the interventional measures in postoperative fracture recurrence.