目的 构建列线图模型分析绝经后骨质疏松性胸腰椎骨折(OTF)患者经皮椎体成形术(PVP)后再次骨折的影响因素.方法 采用回顾性病例对照研究纳入2018年1月至2022年9月于江苏省江阴市中医院接受PVP手术治疗的690例绝经后OTF患者作为研究对象,以简单随机抽样法按照7∶3比例分为建模组(n=483)与验证组(n=207).采用单因素分析建模组患者PVP后再次骨折的独立危险因素并构建列线图,以验证组数据对列线图模型进行外部验证.结果 经Logistic回归分析显示,年龄(OR=1.173,95％CI:1.114～1.236)、骨密度 T 值(OR=0.436,95％CI:0.293～0.647)、多椎体手术(OR=2.146,95％CI:1.332～3.458)、骨水泥渗漏(OR=2.233,95％CI:1.204～4.141)、骨水泥弥散程度(OR=2.600,95％CI:1.505～4.492)、术后规律抗骨质疏松治疗(OR=1.788,95％CI:1.069～2.993)是PVP后再次骨折的影响因素(P＜0.05).基于以上影响因素建立列线图风险模型,绘制受试者工作特征(ROC)曲线,曲线下面积(AUC)为0.782(95％CI:0.711～0.853,P＜0.001),模型预测效能良好.结论 根据绝经后OTF患者PVP后再次骨折的危险因素构建的列线图模型能有效预测PVP后再次骨折的风险.
Construction and verification of nomograph model for the risk of refracture after percutaneous vertebroplasty in postmenopausal patients with osteoporotic thoracolumbar fracture
Objective To construct a nomograph model to analyze the influencing factors of refracture after percutaneous vertebroplasty(PVP)in postmenopausal patients with osteoporotic thoracolumbar fracture(OTF).Methods A retrospective case-control study was conducted on 690 postmenopausal OTF patients who underwent PVP surgery in Jiangyin Hospital of Traditional Chinese Medicine,Jiangsu Province from January 2018 to September 2022.They were randomly divided into modeling group(n=483)and verification group(n=207)by simple random sampling according to the ratio of 7∶3.Single factor analysis was used to analyze the independent risk factors of refracture after PVP in the modeling group,and nomogram was constructed to verify the data of the verification group for external verification of the nomogram model.Results Logistic regression analysis showed that age(OR=1.173,95％CI:1.114-1.236),bone mineral density T value(OR=0.436,95％CI:0.293-0.647),multi-vertebral surgery(OR=2.146,95％CI:1.332-3.458),bone cement leakage(OR=2.233,95％CI:1.204-4.141),bone cement dispersion(OR=2.600,95％CI:1.505-4.492),and regular anti-osteoporosis treatment after operation(OR=1.788,95％CI:1.069-2.993)were independent influencing factors for refractures after PVP(P＜0.05).Based on the above influencing factors,a nomogram risk model was established,and the receiver operating characteristic(ROC)curve was plotted,with an area under curve(AUC)of 0.782(95％CI:0.711-0.853,P＜0.001).The model had good predictive efficiency.Conclusions A nomograph model based on risk factors of refracture after PVP in postmenopausal patients with OTF can effectively predict the risk of refracture after PVP.
万方数据
维普
