老年骨质疏松性胸腰椎压缩性骨折患者术后残余腰背痛影响因素分析及预测模型的构建

Analysis of influential factors for residual low back pain in older adult patients with osteoporotic thoracolumbar compression fractures after surgery and construction of a predictive model

目的分析老年人骨质疏松性胸腰椎压缩性骨折术后残余腰背痛的相关因素,并通过收集数据构建预测模型以评估其效能。方法回顾性分析西安国际医学中心医院2020年1月至2022年12月收治的接受手术治疗的老年骨质疏松性胸腰椎压缩性骨折患者101例的临床资料,按术后是否有腰背疼痛将患者分为有腰背部疼痛组和无腰背部疼痛组,详细记录术后疼痛状况。以此实施单因素和多因素分析以确定独立影响因素。此外构建预测模型并检验其准确性和预测能力。结果101例骨质疏松性胸腰椎压缩性骨折患者中,腰背部疼痛组43例(42.57%),无腰背部疼痛组58例(57.43%)。单因素分析结果显示,腰背部疼痛组患者的年龄更大[(67.81±3.65)岁比(64.21±3.11)岁,t=5.34],受教育程度更高(专科及以上的比例62.79%比41.38%,χ^(2)=4.52),合并心理疾病的比例更高(39.53%比20.69%,χ^(2)=4.28),吸烟的比例更大(34.88%比13.79%,χ^(2)=6.25),既往有骨折史的比例更大(25.58%比10.34%,χ^(2)=4.09),骨密度水平更低[(3.18±0.48)g/cm^(3)比(3.67±0.43)g/cm^(3),t=-5.38],美国麻醉医师协会(ASA)的分级相对更高(Ⅰ级、Ⅱ级、Ⅲ级、Ⅳ级的比例18.60%、25.58%、32.56%、23.26%比34.48%、37.93%、20.69%、6.90%,χ^(2)=9.51),骨水泥注入量更少[(4.62±0.21)mL比(4.85±0.18)mL,t=-5.91],出现骨水泥渗漏的比例更高(18.60%比1.72%,χ^(2)=6.71),与无腰背部疼痛组患者比较,差异均有统计学意义(均P<0.05)。多因素logistic回归分析显示,年龄和骨水泥渗漏为独立危险因素(OR=1.634、3.379,均P<0.05),而骨密度和骨水泥注入量则是保护因素(OR=0.017、0.003,均P<0.05)。模型验证显示,回归模型具有良好的拟合度(Hosmer-Lemeshow χ^(2)=6.73,P>0.05)。根据筛选的变量构建风险预测模型,C-index为0.792。通过独立变量和P值,构建的受试者工作特征曲线预测患者腰背痛的可能性,曲线下面积(AUC)分别为0.749、0.754、0.754、0.642、0.945。结论老年骨质疏松性胸腰椎骨折患者术后残余腰背痛与年龄、骨密度、骨水泥注入量和骨水泥渗漏等因素相关,采用上述因素建立预测老年人骨质疏松性胸腰椎骨折术后残余腰背痛的列线图模型,能够取得良好的预测效果。

Objective To analyze the factors associated with residual low back pain in older adults with osteoporotic thoracolumbar compression fractures after surgery,and to construct a predictive model based on the collected data and assess its effectiveness.Methods The clinical data of 101 older adult patients with osteoporotic thoracolumbar compression fractures who underwent surgical treatment at Xi'an International Medical Center Hospital from January 2020 to December 2022 were retrospectively analyzed.The patients were divided into two groups based on the presence or absence of low back pain after surgery:those with low back pain and those without.Postoperative pain intensity was recorded in detail.Univariate and multivariate analyses were performed to identify independent influential factors.In addition,a predictive model was constructed and its accuracy and prediction ability were tested.Results Among 101 patients with osteoporotic thoracolumbar compression fractures,43(42.57%)experienced low back pain after surgery,while 58(57.43%)did not.Univariate analysis revealed that patients with low back pain were older compared with those without low back pain[(67.81±3.65)years vs.(64.21±3.11)years,t=5.34].Patients with low back pain had a higher level of education,with 62.79%holding a college degree or higher compared to 41.38%of patients without low back pain(χ^(2)=4.52).The prevalence of psychological disorders was higher in patients with low back pain compared with those without low back pain(39.53%vs.20.69%,χ^(2)=4.28),as was the proportion of patients who smoke(34.88%vs.13.79%,χ^(2)=6.25).Additionally,the proportion of patients with a history of fractures was greater in patients with low back pain compared with those without low back pain(25.58%vs.10.34%,χ^(2)=4.09).The bone density in patients with low back pain was lower than that in patients without low back pain[(3.18±0.48)g/cm³vs.(3.67±0.43)g/cm³,t=-5.38].The American Society of Anesthesiologists(ASA)classification was also higher in patients with low back pain,with proportions of ASAⅠ,Ⅱ,Ⅲ,andⅣbeing 18.60%,25.58%,32.56%,and 23.26%compared with 34.48%,37.93%,20.69%,and 6.90%in patients without low back pain(χ^(2)=9.51).The volume of bone cement injected was lower in patients with low back pain than in those without low back pain[(4.62±0.21)mL vs.(4.85±0.18)mL,t=-5.91].The incidence of cement leakage was higher in patients with low back pain than in those without low back pain(18.60%vs.1.72%,χ^(2)=6.71).All differences were statistically significant(all P<0.05).Multivariate logistic regression analysis indicated that age and cement leakage were independent risk factors for residual low back pain(OR=1.634,3.379,both P<0.05),while bone density and the amount of injected cement were protective factors against residual low back pain(OR=0.017,0.003,both P<0.05).Model validation showed that the regression model had good fit(Hosmer-Lemeshowχ^(2)=6.73,P>0.05).A risk prediction model was constructed based on the selected variables,yielding a C-index of 0.792.Using the independent variables and P values,a receiver operating characteristic curve was generated to predict the likelihood of low back pain in patients,with areas under the curve of 0.749,0.754,0.754,0.642,and 0.945,respectively.Conclusion Residual low back pain after surgery in older adult patients with osteoporotic thoracolumbar compression fractures is associated with age,bone density,volume of bone cement injected,and cement leakage.The constructed nomogram model,based on these factors,demonstrates good predictive capability for residual low back pain in this population.