A nomogram of the risk of residual pain from vertebroplasty in elderly patients with osteoporotic vertebral compression fractures
Objective To analyze the risk factors for residual pain after vertebroplasty of patients with osteoporotic vertebral compression fractures(OVCF),and construct a nomogram to provide references for residual pain management decision-making after clinical vertebroplasty.Methods 202 OVCF patients who underwent vertebroplasty treatment in our hospital from January 2020 to June 2023 were selected and their clinical data were collected.Using a multivariate logistic regression model to analyze the risk factors of postoperative residual pain.The risk factors were used as predictive indicators to construct a nomogram.Using internal data to validate the performance of nomogram,and using decision curve analysis to evaluate the clinical net benefits of nomogram.Results The incidence of postoperative residual pain in 202 vertebroplasty patients was 17.3%(35/202).The age,smoking proportion,history of low back pain,proportion of posterior fascial edema,proportion of small joint injuries,proportion of bone cement distribution(clump-like),proportion of surgical vertebrae(>2),surgical time,proportion of intravertebral fissure sign,and proportion of bone cement leakage were all higher than those in the postoperative relief group(P<0.05).The bone mineral density(BMD)and the ratio of bone cement to endplate contact were lower in the postoperative relief group(P<0.05).The results of multivariate logistic regression analysis showed that small joint injury(OR:1.560,95%CI:1.085-3.655),bone cement distribution(block-like)(OR:2.730,95%CI:1.785-4.389),vertebral fissure sign(OR:1.497,95%CI:1.523-8.031),and bone cement leakage(OR:1.799,95%CI:1.517-3.066)were independent risk factors for residual pain after vertebroplasty in OVCF patients(P<0.05).The nomogram correction curve showed a C-index of 0.865.When nomogram predicted a residual pain risk threshold of 0.080-0.814 for OVCF patients undergoing vertebroplasty,it provided significant clinical benefits.The Simple model predicted the risk stratification of 1000 patients,and the risk threshold increased.The accuracy of the nomogram prediction gradually approached the actual observation results.Conclusions The nomogram constructed in this study has good performance and can accurately predict and quantify the risk of residual pain of OVCF patients after vertebroplasty,providing a theoretical basis for intervention strategies to prevent residual low back pain after vertebroplasty.
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