Risk factors analysis for Cobb angle increase after short segment internal fixation with trans-injured vertebrae screw place-ment via Wiltse approach for thoracolumbar fracture without neurological symptoms and construction of prediction model
Risk factors analysis for Cobb angle increase after short segment internal fixation with trans-injured vertebrae screw place-ment via Wiltse approach for thoracolumbar fracture without neurological symptoms and construction of prediction model
Objective To analyze the risk factors for Cobb angle increase after short segment internal fixation with trans-injured vertebrae screw placement via Wiltse approach for thoracolumbar fracture without neurological symptoms,and to construct a prediction model.Methods A total of 110 patients with thoracolumbar fractures but without neurological symptoms who underwent short segment internal fixation with trans-injured vertebrae screw placement via Wiltse approach in General Hospital of Huainan Oriental Hospital Group from June 2018 to December 2021 were selected as the research subjects.According to the situation of Cobb angle increase after operation,the subjects were divided into study group and control group.The clinical data,operation related indicators,postoperative follow-up data of the two groups were compared.Multivariate logistic regression analysis was conducted to identify the risk factors for Cobb angle increase after operation,and a prediction model was constructed.Results The patients were followed up for 17-36 months,and 5 patients were lost to follow up.There were 73 patients had Cobb angle increase ≤ 3°(control group)and 32 patients had Cobb angle ≥ 4°(Cobb angle increase group).There were statistically significant differences between the groups in terms of age,vertebral Cobb angle and Cobb angle increase before operation,at 1 week after operation and at the last time of follow-up,preoperative vertebral compression rate,preoperative anterior height ratio of the injured vertebral body,changes in intervertebral space height,re-duction of the injured vertebral body,and postoperative functional exercise(P＜0.05).Multivariate logistic regression analysis found that large vertebral Cobb angle before operation,preoperative vertebral compression rate＞50％,and unreasonable postoperative func-tional exercise were independent risk factors for Cobb angle increase after operation,and well reduction of the injured vertebral body was a protective factor(P＜0.05).The risk prediction model was as fol-low:Log(P)=1.205 × preoperative vertebral Cobb angle+1.859 × preoperative vertebral compression rate-0.064 × reduction of the injured vertebral body+3.765 × unreasonable postoperative functional exercise-72.909.The areas under the ROC curve of pre-operative vertebral Cobb angle and reduction degree of the injured vertebral body for predicting Cobb angle increase were 0.792 and 0.714.Hosmer-Lemeshow test for this model showed no statistically significant difference(x2=1.489,P=0.356),indicating good de-gree of coincidence.Conclusions Preoperative vertebral Cobb angle,OSTA index,preoperative vertebral compression rate,and post-operative functional exercise are risk factors for Cobb angle increase after short segment internal fixation with trans-injured vertebrae screw placement via Wiltse approach for thoracolumbar fracture without neurological symptoms,well reduction of the injured vertebral body was a protective factor.Corresponding improvement measures can be taken to improve the curative effect.
维普
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