Establishment and validation of a nomogram for predicting adjacent vertebral compression fractures after lumbar fusion in elderly patients
Objective:To explore the risk factors for adjacent vertebral compression fractures(AVCF)after lumbar fusion in elderly patients and to construct a nomogram predictive model.Methods:A retrospective analysis was conducted on 297 elderly patients who underwent lumbar fusion surgery at the Hubei Provincial Hospital of Integrated Chinese and Western Medicine from January 2017 to December 2021.Patients were divided into fracture and non-fracture groups based on the development of AVCF.Demographic and clinical data were collected,including age,sex,body mass index,educational level,number of comorbidities,duration of disease,preoperative bone mineral density T score,intraoperative blood loss,number of fusion segments,postoperative blood transfusion volume,postoperative ICU monitoring,and type and duration of external fixation.Univariate and multivariate logistic regression analyses were conducted to identify the risk factors for postoperative AVCF.A nomogram predictive model was constructed using R software and its predictive performance was evaluated.Results:There were 67 cases in the fracture group and 230 cases in the non-fracture group,with a 22.56%incidence rate of AVCF.The risk factors for AVCF included age,educational level,preoperative bone mineral density T score,intraoperative blood loss,postoperative blood transfusion volume,and postoperative ICU monitoring(all P<0.05).Multivariate logistic regression analysis identified age,preoperative bone mineral density T score,intraoperative blood loss,postoperative blood transfusion volume,and postoperative ICU monitoring as independent risk factors for postoperative AVCF in elderly patients(all P<0.05).The area under the receiver operating characteristic curve was 0.769,and the Hosmer-Lemeshow goodness-of-fit test yielded χ2=8.009,P=0.533.The calibration curve slope was close to 1,indicating good consistency.Conclusions:A nomogram predictive model for postoperative AVCF in elderly patients was successfully developed,incorporating age,preoperative bone mineral density,intraoperative blood loss,postoperative blood transfusion volume,and postoperative ICU monitoring.This model has good predictive value for postoperative AVC,enabling targeted interventions to reduce the risk of AVCF after lumbar fusion.
Elderly PatientsLumbar FusionAdjacent Vertebral Compression FractureRisk FactorsNomogram Predictive Model
万方数据
维普
