BACKGROUND Although percutaneous vertebral augmentation(PVA)is a commonly used procedure for treating vertebral compression fracture(VCF),the risk of vertebral refracture should be considered.Chronic kidney disease-mi...BACKGROUND Although percutaneous vertebral augmentation(PVA)is a commonly used procedure for treating vertebral compression fracture(VCF),the risk of vertebral refracture should be considered.Chronic kidney disease-mineral and bone disorder(CKD-MBD)is a systemic disease of mineral and bone metabolism.It is associated with an increased risk of fracture.Few studies have reported the use of PVA in patients with CKD-MBD.We herein report a rare case wherein the cemented vertebra and the adjacent vertebra refractured simultaneously in a CKD-MBD patient after PVA.CASE SUMMARY A 74-year-old man suffered from low back pain after taking a fall about 3 wk ago.According to physical examination,imaging and laboratory findings,diagnoses of T12 VCF,CKD-MBD,and chronic kidney disease stage 5 were established.He then received percutaneous vertebroplasty at T12 vertebra.Fourteen weeks later,he presented with T12 and L1 vertebral refractures caused by lumbar sprain.Once again,he was given PVA which was optimized for the refractured vertebrae.Although the short-term postoperative effect was satisfactory,he reported chronic low back pain again at the 3-month follow-up.CONCLUSION It is necessary that patients with CKD-MBD who have received PVA are aware of the adverse effects of CKD-MBD.It may increase the risk of vertebral refracture.Furthermore,the PVA surgical technique needs to be optimized according to the condition of the patient.The medium-and long-term effects of PVA remain uncertain in patients with CKD-MBD.展开更多
To enhance the fusion of graft bone in thoracolumbar vertebrae and minimize the postoperative loss of correction, short-segment pedicle screw fixation was reinforced with posterior moselizee bone grafting in vertebrae...To enhance the fusion of graft bone in thoracolumbar vertebrae and minimize the postoperative loss of correction, short-segment pedicle screw fixation was reinforced with posterior moselizee bone grafting in vertebrae for spinal fusion in patients with thoracrolumbar vertebrate fractures. Seventy patients with thoracrolumbar vertebrate fractures were treated by short-segment pedicle screw fixation and were randomly divided into two groups. Fractures in group A （n=20） were rein-forced with posterior morselized bone grafting in vertebrae for spinal fusion, while patients group B （n=50） did not receive the morselized bone grafting for bone fusion. The two groups were compared in terms of kyphotic deformity, anterior vertebral height, instrument failure and neurological functions after the treatment. Frankel grading system was used for the evaluation of neurological evaluation and Denis scoring scale was employed for pain assessment. The results showed that the kyphosis correction was achieved in both group A and group B （group A： 6.4 degree; group B： 5.4 degree）/At the end of follow-up, kyphosis correction was maintained in group A but lost in group B （P=0.0001）. Postoperatively, greater anterior height was achieved in group A than in group B （P〈0.01）. During follow-up study, anterior vertebral height was maintained only in Group A （P〈0.001）. Both group A and group B showed good Denis pain scores （P1 and P2） but group A outdid group B in terms of control of severe and constant pain （P4 and P5）. By Frankel criteria, the changes in neurological functions in group A was better than those of group B （P〈0.001）. It is concluded that reinforcement of short-segment pedicle fixation with morselized bone grafting for the treatment of patients with thoracolumbar vertebrae fracture could achieve and maintain kyphosis correction, and it may also increase and maintain anterior vertebral height. Morselized bone grafting in vertebrae offers immediate spinal stability in patients with thoracolumbar vertebrate fractures, decreases the instrument failure and provides better postoperative pain control than without the morselized bone grafting.展开更多
AIM:To evaluate the methods and results of the AXIS lateral mass screw plate system in the treating of lower cervical spine injury.METHODS:29 cases of lower cervical vertebrae injury were fixed with AXIS system.All of...AIM:To evaluate the methods and results of the AXIS lateral mass screw plate system in the treating of lower cervical spine injury.METHODS:29 cases of lower cervical vertebrae injury were fixed with AXIS system.All of them were followed up for more than 1 year.RESULTS:All cases had a good bone union without malformation.We found no complication of the injury to the vertebral arteries or nerves.There was no loosening of the plate and screw. CONCLUSION:AXIS lateral mass screw plate system has the characteristic of stable,simple and safe and is suitable for the treatment of lower cervical spine injury.展开更多
Osteoporosis is a common metabolic skeletal disorder characterized by decreased bone mass and deteriorated bone structure, leading to increased susceptibility to fractures. With aging population, osteoporotic fracture...Osteoporosis is a common metabolic skeletal disorder characterized by decreased bone mass and deteriorated bone structure, leading to increased susceptibility to fractures. With aging population, osteoporotic fractures are of global health and socioeconomic importance. The three-dimensional microstructural information of the common osteoporosis-related fracture sites, including vertebra, femoral neck and distal radius, is a key for fully understanding osteoporosis pathogenesis and predicting the fracture risk. Low vertebral bone mineral density(BMD) is correlated with increased fracture of the spine. Vertebral BMD decreases from cervical to lumbar spine, with the lowest BMD at the third lumbar vertebra. Trabecular bone mass of the vertebrae is much lower than that of the peripheral bone. Cancellous bone of the vertebral body has a complex heterogeneous three-dimensional microstructure, with lower bone volume in the central and anterior superior regions. Trabecular bone quality is a key element to maintain the vertebral strength. The increased fragility of osteoporotic femoral neck is attributed to low cancellous bone volume and high compact porosity. Compared with age-matched controls, increased cortical porosity is observed at the femoral neck in osteoporoticfracture patients. Distal radius demonstrates spatial inhomogeneous characteristic in cortical microstructure. The medial region of the distal radius displays the highest cortical porosity compared with the lateral, anterior and posterior regions. Bone strength of the distal radius is mainly determined by cortical porosity, which deteriorates with advancing age.展开更多
Objective To review imaging use in the diagnosis of thoracolumbar burst fractures and to determine the diagnostic va-lue of different imaging methods. Methods One hundred and fourteen patients with 120 thoracolumbar b...Objective To review imaging use in the diagnosis of thoracolumbar burst fractures and to determine the diagnostic va-lue of different imaging methods. Methods One hundred and fourteen patients with 120 thoracolumbar burst fractures were retrospectively reviewed. Pl-ain radiographs were available in all cases; CT scans and MRI were obtained in 96 and 74 cases, respectively. Results A total of 27 burst fractures were misdiagnosed as other types of fractures on radiographs alone, and accounted for 22.5% of all fractures. The results indicated that plain radiographs often fail to delineate the pathological features of thor-acolumbar burst fractures, leading to delay in diagnosis. Conclusion In regard to thoracolumbar injury diagnosis, burst fractures should be differentiated from compression frac-tures. CT should be routinely indicated and MRI examination, when necessary, may be simultaneously considered.展开更多
Objective:To investigate the relationship between morphological abnormalities and spinal cord deficit in thoracolumbar burst fractures. Methods: Seventy-eight patients with thoracolumbar burst fractures were retrospec...Objective:To investigate the relationship between morphological abnormalities and spinal cord deficit in thoracolumbar burst fractures. Methods: Seventy-eight patients with thoracolumbar burst fractures were retrospectively reviewed to calculate the stenotic ratio of spinal canal based on the midsagittal diameters and the hyphosis angle according to Cobb. The ASIA scoring of motor function of lower extremities was recorded . Results: The differences (P > 0.05) of the stenotic ratio of spinal canal and the kyphosis angle were not significant between patients without neurological deficit, with incomplete and complete lesions. No significant correlation(P > 0.05) between the stenotic ratio of spinal canal and the kyphosis angle, and ASIA scoring was noted. Conclusion:The severity of spinal cord injuries in thoracolumbar burst fractures is not predicted according to the percentage of canal stenosis or the degree of kyphesis induced by thoracolumbar burst fractures.展开更多
BACKGROUND As one of the most common complications of osteoporosis,osteoporotic vertebral compression fracture(OVCF)increases the risk of disability and mortality in elderly patients.Percutaneous vertebroplasty(PVP)is...BACKGROUND As one of the most common complications of osteoporosis,osteoporotic vertebral compression fracture(OVCF)increases the risk of disability and mortality in elderly patients.Percutaneous vertebroplasty(PVP)is considered to be an effective,safe,and minimally invasive treatment for OVCFs.The recollapse of cemented vertebrae is one of the serious complications of PVP.However,the risk factors associated with recollapse after PVP remain controversial.AIM To identify risk factors for the recollapse of cemented vertebrae after PVP in patients with OVCFs.METHODS A systematic search in EMBASE,MEDLINE,the Cochrane Library,and PubMed was conducted for relevant studies from inception until March 2020.Studies investigating risk factors for the recollapse of cemented vertebrae after PVP without additional trauma were selected for analysis.Odds ratios(ORs)or standardized mean differences with 95%confidence interval(CI)were calculated and heterogeneity was assessed by both the chi-squared test and the I-squared test.The methodological quality of the included studies was assessed according to the Newcastle-Ottawa Scale.RESULTS A total of nine case-control studies were included in our meta-analysis comprising 300 cases and 2674 controls.The significant risk factors for the recollapse of cemented vertebrae after PVP in OVCF patients were fractures located at the thoracolumbar junction(OR=2.09;95%CI:1.30 to 3.38;P=0.002),preoperative intravertebral cleft(OR=2.97;95%CI:1.93 to 4.57;P<0.00001),and solid lump distribution pattern of the cement (OR = 3.11;95%CI: 1.91 to 5.07;P < 0.00001).The analysis did not support that age, gender, lumbar bone mineral density,preoperative visual analogue scale score, injected cement volume, intradiscalcement leakage, or vertebral height restoration could increase the risk forcemented vertebra recollapse after PVP in OVCFs.CONCLUSIONThis meta-analysis suggests that thoracolumbar junction fractures, preoperativeintravertebral cleft, and solid lump cement distribution pattern are associatedwith the recollapse of cemented vertebrae after PVP in OVCF patients.展开更多
目的:分析胸腰椎爆裂骨折患者内固定术后并发脊柱后凸畸形的危险因素,并建立风险预测模型。方法:以2017年3月至2020年3月,在郑州市骨科医院接受椎弓根螺钉内固定术或椎弓根螺钉内固定术联合仿生骨柱植骨术治疗的患者为研究对象,根据术后...目的:分析胸腰椎爆裂骨折患者内固定术后并发脊柱后凸畸形的危险因素,并建立风险预测模型。方法:以2017年3月至2020年3月,在郑州市骨科医院接受椎弓根螺钉内固定术或椎弓根螺钉内固定术联合仿生骨柱植骨术治疗的患者为研究对象,根据术后2年内是否并发脊柱后凸畸形分为2组。收集2组患者性别、年龄、体质量指数、是否合并内科疾病、骨折节段、骨折原因等一般资料和是否合并椎间盘损伤、骨折爆裂程度、胸腰椎AO脊柱损伤评分(thoracolumbar AO Spine injury score,TLAOSIS)等损伤情况评价指标,以及手术入路、固定节段长短等手术情况。测量术前影像学参数,在术前X线侧位片上测量椎体楔形角、骨折节段Cobb角和椎体前缘高度(计算椎体前缘高度比值),在术前X线正位片上测量上位椎间盘角和下位椎间盘角。比较2组患者的一般资料、损伤情况评价指标、手术情况和影像学参数,进行单因素分析。根据单因素分析结果,采用Logistic回归分析胸腰椎爆裂骨折患者内固定术后并发脊柱后凸畸形的危险因素。依据危险因素分析结果建立胸腰椎爆裂骨折患者内固定术后并发脊柱后凸畸形的风险预测列线图模型,并对模型进行评价。结果:共纳入176例患者,并发畸形组30例,未并发畸形组146例。单因素分析结果显示,2组患者合并椎间盘损伤情况、骨折爆裂程度、TLAOSIS,以及术前椎体前缘高度比值、骨折节段Cobb角、上位椎间盘角、下位椎间盘角的组间差异,均有统计学意义。Logistic回归分析结果显示,合并椎间盘损伤、TLAOSIS>8分、完全爆裂骨折、术前椎体前缘高度比值<50%、术前上位椎间盘角≤3.5°是胸腰椎爆裂骨折患者内固定术后并发脊柱后凸畸形的危险因素[OR=2.965,95%CI(1.682,4.534),P=0.003;OR=2.707,95%CI(1.364,4.216),P=0.009;OR=1.921,95%CI(0.716,3.357),P=0.022;OR=2.221,95%CI(0.986,3.627),P=0.013;OR=3.654,95%CI(1.867,4.853),P=0.000]。列线图模型预测结果显示,上述5个因素对应的胸腰椎爆裂骨折患者内固定术后并发脊柱后凸畸形的风险预测值分别为44.0分、42.5分、33.0分、39.0分、51.5分,并发脊柱后凸畸形的概率为0.10~0.56。受试者操作特征曲线分析结果显示,该模型预测胸腰椎爆裂骨折患者内固定术后并发脊柱后凸畸形的曲线下面积为0.921(P=0.000),灵敏度为78.43%,特异度为85.52%;模型验证C-index值为0.823,校正曲线和标准曲线拟合度较好,模型校准度良好。决策曲线分析结果显示,根据该模型对胸腰椎爆裂骨折患者内固定术后并发脊柱后凸畸形的风险进行预测,可获得较好的净收益,阈值概率为0.02~0.95。结论:合并椎间盘损伤、TLAOSIS>8分、完全爆裂骨折、术前椎体前缘高度比值<50%、术前上位椎间盘角≤3.5°均为胸腰椎爆裂骨折患者内固定术后并发脊柱后凸畸形的危险因素;基于这些因素构建的风险预测列线图模型,对于胸腰椎爆裂骨折患者内固定术后并发脊柱后凸畸形具有一定的预测价值。展开更多
文摘BACKGROUND Although percutaneous vertebral augmentation(PVA)is a commonly used procedure for treating vertebral compression fracture(VCF),the risk of vertebral refracture should be considered.Chronic kidney disease-mineral and bone disorder(CKD-MBD)is a systemic disease of mineral and bone metabolism.It is associated with an increased risk of fracture.Few studies have reported the use of PVA in patients with CKD-MBD.We herein report a rare case wherein the cemented vertebra and the adjacent vertebra refractured simultaneously in a CKD-MBD patient after PVA.CASE SUMMARY A 74-year-old man suffered from low back pain after taking a fall about 3 wk ago.According to physical examination,imaging and laboratory findings,diagnoses of T12 VCF,CKD-MBD,and chronic kidney disease stage 5 were established.He then received percutaneous vertebroplasty at T12 vertebra.Fourteen weeks later,he presented with T12 and L1 vertebral refractures caused by lumbar sprain.Once again,he was given PVA which was optimized for the refractured vertebrae.Although the short-term postoperative effect was satisfactory,he reported chronic low back pain again at the 3-month follow-up.CONCLUSION It is necessary that patients with CKD-MBD who have received PVA are aware of the adverse effects of CKD-MBD.It may increase the risk of vertebral refracture.Furthermore,the PVA surgical technique needs to be optimized according to the condition of the patient.The medium-and long-term effects of PVA remain uncertain in patients with CKD-MBD.
文摘To enhance the fusion of graft bone in thoracolumbar vertebrae and minimize the postoperative loss of correction, short-segment pedicle screw fixation was reinforced with posterior moselizee bone grafting in vertebrae for spinal fusion in patients with thoracrolumbar vertebrate fractures. Seventy patients with thoracrolumbar vertebrate fractures were treated by short-segment pedicle screw fixation and were randomly divided into two groups. Fractures in group A （n=20） were rein-forced with posterior morselized bone grafting in vertebrae for spinal fusion, while patients group B （n=50） did not receive the morselized bone grafting for bone fusion. The two groups were compared in terms of kyphotic deformity, anterior vertebral height, instrument failure and neurological functions after the treatment. Frankel grading system was used for the evaluation of neurological evaluation and Denis scoring scale was employed for pain assessment. The results showed that the kyphosis correction was achieved in both group A and group B （group A： 6.4 degree; group B： 5.4 degree）/At the end of follow-up, kyphosis correction was maintained in group A but lost in group B （P=0.0001）. Postoperatively, greater anterior height was achieved in group A than in group B （P〈0.01）. During follow-up study, anterior vertebral height was maintained only in Group A （P〈0.001）. Both group A and group B showed good Denis pain scores （P1 and P2） but group A outdid group B in terms of control of severe and constant pain （P4 and P5）. By Frankel criteria, the changes in neurological functions in group A was better than those of group B （P〈0.001）. It is concluded that reinforcement of short-segment pedicle fixation with morselized bone grafting for the treatment of patients with thoracolumbar vertebrae fracture could achieve and maintain kyphosis correction, and it may also increase and maintain anterior vertebral height. Morselized bone grafting in vertebrae offers immediate spinal stability in patients with thoracolumbar vertebrate fractures, decreases the instrument failure and provides better postoperative pain control than without the morselized bone grafting.
文摘AIM:To evaluate the methods and results of the AXIS lateral mass screw plate system in the treating of lower cervical spine injury.METHODS:29 cases of lower cervical vertebrae injury were fixed with AXIS system.All of them were followed up for more than 1 year.RESULTS:All cases had a good bone union without malformation.We found no complication of the injury to the vertebral arteries or nerves.There was no loosening of the plate and screw. CONCLUSION:AXIS lateral mass screw plate system has the characteristic of stable,simple and safe and is suitable for the treatment of lower cervical spine injury.
文摘Osteoporosis is a common metabolic skeletal disorder characterized by decreased bone mass and deteriorated bone structure, leading to increased susceptibility to fractures. With aging population, osteoporotic fractures are of global health and socioeconomic importance. The three-dimensional microstructural information of the common osteoporosis-related fracture sites, including vertebra, femoral neck and distal radius, is a key for fully understanding osteoporosis pathogenesis and predicting the fracture risk. Low vertebral bone mineral density(BMD) is correlated with increased fracture of the spine. Vertebral BMD decreases from cervical to lumbar spine, with the lowest BMD at the third lumbar vertebra. Trabecular bone mass of the vertebrae is much lower than that of the peripheral bone. Cancellous bone of the vertebral body has a complex heterogeneous three-dimensional microstructure, with lower bone volume in the central and anterior superior regions. Trabecular bone quality is a key element to maintain the vertebral strength. The increased fragility of osteoporotic femoral neck is attributed to low cancellous bone volume and high compact porosity. Compared with age-matched controls, increased cortical porosity is observed at the femoral neck in osteoporoticfracture patients. Distal radius demonstrates spatial inhomogeneous characteristic in cortical microstructure. The medial region of the distal radius displays the highest cortical porosity compared with the lateral, anterior and posterior regions. Bone strength of the distal radius is mainly determined by cortical porosity, which deteriorates with advancing age.
文摘Objective To review imaging use in the diagnosis of thoracolumbar burst fractures and to determine the diagnostic va-lue of different imaging methods. Methods One hundred and fourteen patients with 120 thoracolumbar burst fractures were retrospectively reviewed. Pl-ain radiographs were available in all cases; CT scans and MRI were obtained in 96 and 74 cases, respectively. Results A total of 27 burst fractures were misdiagnosed as other types of fractures on radiographs alone, and accounted for 22.5% of all fractures. The results indicated that plain radiographs often fail to delineate the pathological features of thor-acolumbar burst fractures, leading to delay in diagnosis. Conclusion In regard to thoracolumbar injury diagnosis, burst fractures should be differentiated from compression frac-tures. CT should be routinely indicated and MRI examination, when necessary, may be simultaneously considered.
文摘Objective:To investigate the relationship between morphological abnormalities and spinal cord deficit in thoracolumbar burst fractures. Methods: Seventy-eight patients with thoracolumbar burst fractures were retrospectively reviewed to calculate the stenotic ratio of spinal canal based on the midsagittal diameters and the hyphosis angle according to Cobb. The ASIA scoring of motor function of lower extremities was recorded . Results: The differences (P > 0.05) of the stenotic ratio of spinal canal and the kyphosis angle were not significant between patients without neurological deficit, with incomplete and complete lesions. No significant correlation(P > 0.05) between the stenotic ratio of spinal canal and the kyphosis angle, and ASIA scoring was noted. Conclusion:The severity of spinal cord injuries in thoracolumbar burst fractures is not predicted according to the percentage of canal stenosis or the degree of kyphesis induced by thoracolumbar burst fractures.
文摘BACKGROUND As one of the most common complications of osteoporosis,osteoporotic vertebral compression fracture(OVCF)increases the risk of disability and mortality in elderly patients.Percutaneous vertebroplasty(PVP)is considered to be an effective,safe,and minimally invasive treatment for OVCFs.The recollapse of cemented vertebrae is one of the serious complications of PVP.However,the risk factors associated with recollapse after PVP remain controversial.AIM To identify risk factors for the recollapse of cemented vertebrae after PVP in patients with OVCFs.METHODS A systematic search in EMBASE,MEDLINE,the Cochrane Library,and PubMed was conducted for relevant studies from inception until March 2020.Studies investigating risk factors for the recollapse of cemented vertebrae after PVP without additional trauma were selected for analysis.Odds ratios(ORs)or standardized mean differences with 95%confidence interval(CI)were calculated and heterogeneity was assessed by both the chi-squared test and the I-squared test.The methodological quality of the included studies was assessed according to the Newcastle-Ottawa Scale.RESULTS A total of nine case-control studies were included in our meta-analysis comprising 300 cases and 2674 controls.The significant risk factors for the recollapse of cemented vertebrae after PVP in OVCF patients were fractures located at the thoracolumbar junction(OR=2.09;95%CI:1.30 to 3.38;P=0.002),preoperative intravertebral cleft(OR=2.97;95%CI:1.93 to 4.57;P<0.00001),and solid lump distribution pattern of the cement (OR = 3.11;95%CI: 1.91 to 5.07;P < 0.00001).The analysis did not support that age, gender, lumbar bone mineral density,preoperative visual analogue scale score, injected cement volume, intradiscalcement leakage, or vertebral height restoration could increase the risk forcemented vertebra recollapse after PVP in OVCFs.CONCLUSIONThis meta-analysis suggests that thoracolumbar junction fractures, preoperativeintravertebral cleft, and solid lump cement distribution pattern are associatedwith the recollapse of cemented vertebrae after PVP in OVCF patients.
文摘目的:分析胸腰椎爆裂骨折患者内固定术后并发脊柱后凸畸形的危险因素,并建立风险预测模型。方法:以2017年3月至2020年3月,在郑州市骨科医院接受椎弓根螺钉内固定术或椎弓根螺钉内固定术联合仿生骨柱植骨术治疗的患者为研究对象,根据术后2年内是否并发脊柱后凸畸形分为2组。收集2组患者性别、年龄、体质量指数、是否合并内科疾病、骨折节段、骨折原因等一般资料和是否合并椎间盘损伤、骨折爆裂程度、胸腰椎AO脊柱损伤评分(thoracolumbar AO Spine injury score,TLAOSIS)等损伤情况评价指标,以及手术入路、固定节段长短等手术情况。测量术前影像学参数,在术前X线侧位片上测量椎体楔形角、骨折节段Cobb角和椎体前缘高度(计算椎体前缘高度比值),在术前X线正位片上测量上位椎间盘角和下位椎间盘角。比较2组患者的一般资料、损伤情况评价指标、手术情况和影像学参数,进行单因素分析。根据单因素分析结果,采用Logistic回归分析胸腰椎爆裂骨折患者内固定术后并发脊柱后凸畸形的危险因素。依据危险因素分析结果建立胸腰椎爆裂骨折患者内固定术后并发脊柱后凸畸形的风险预测列线图模型,并对模型进行评价。结果:共纳入176例患者,并发畸形组30例,未并发畸形组146例。单因素分析结果显示,2组患者合并椎间盘损伤情况、骨折爆裂程度、TLAOSIS,以及术前椎体前缘高度比值、骨折节段Cobb角、上位椎间盘角、下位椎间盘角的组间差异,均有统计学意义。Logistic回归分析结果显示,合并椎间盘损伤、TLAOSIS>8分、完全爆裂骨折、术前椎体前缘高度比值<50%、术前上位椎间盘角≤3.5°是胸腰椎爆裂骨折患者内固定术后并发脊柱后凸畸形的危险因素[OR=2.965,95%CI(1.682,4.534),P=0.003;OR=2.707,95%CI(1.364,4.216),P=0.009;OR=1.921,95%CI(0.716,3.357),P=0.022;OR=2.221,95%CI(0.986,3.627),P=0.013;OR=3.654,95%CI(1.867,4.853),P=0.000]。列线图模型预测结果显示,上述5个因素对应的胸腰椎爆裂骨折患者内固定术后并发脊柱后凸畸形的风险预测值分别为44.0分、42.5分、33.0分、39.0分、51.5分,并发脊柱后凸畸形的概率为0.10~0.56。受试者操作特征曲线分析结果显示,该模型预测胸腰椎爆裂骨折患者内固定术后并发脊柱后凸畸形的曲线下面积为0.921(P=0.000),灵敏度为78.43%,特异度为85.52%;模型验证C-index值为0.823,校正曲线和标准曲线拟合度较好,模型校准度良好。决策曲线分析结果显示,根据该模型对胸腰椎爆裂骨折患者内固定术后并发脊柱后凸畸形的风险进行预测,可获得较好的净收益,阈值概率为0.02~0.95。结论:合并椎间盘损伤、TLAOSIS>8分、完全爆裂骨折、术前椎体前缘高度比值<50%、术前上位椎间盘角≤3.5°均为胸腰椎爆裂骨折患者内固定术后并发脊柱后凸畸形的危险因素;基于这些因素构建的风险预测列线图模型,对于胸腰椎爆裂骨折患者内固定术后并发脊柱后凸畸形具有一定的预测价值。
