老年骨质疏松性椎体压缩骨折患者经皮椎体后凸成形术治疗后再骨折风险分析及列线图预测模型的构建

Analysis of risk factors for re-fracture in elderly patients with OVCF after PKP and construction of a nomogram prediction model

中文关键词: 老年  骨质疏松性椎体压缩骨折  经皮椎体后凸成形术  术后  再骨折  列线图

英文关键词: elderly  osteoporotic vertebral compression fractures  percutaneous kyphoplasty  postoperation  re-fracture  nomogram

中文摘要:

      目的 分析老年骨质疏松性椎体压缩骨折(OVCF)患者经皮椎体后凸成形术(PKP)治疗后再骨折风险因素,并构建列线图预测模型.方法 收集2019年1月—2023年12月武汉市中医医院收治的行PKP治疗的205例老年OVCF患者临床资料,根据术后12个月再骨折发生情况分为再发组(n=31)与非再发组(n=174).比较2组围术期资料,使用多因素Logistic回归分析评估老年OVCF患者术后12个月再骨折的影响因素,利用列线图构建老年OVCF患者术后再骨折的预测模型,利用Bootstrap法重复抽样对列线图预测模型进行内部验证.结果 205例老年OVCF患者术后12个月再骨折发生率为15.12％(31/205),再发组与非再发组年龄及骨密度(BMD)、椎旁肌质量、骨水泥渗漏率比较,差异均有统计学意义(P＜0.05).多因素Logistic回归分析显示,年龄[OR=1.303,95％CI(1.110～1.529),P＜0.05]、骨水泥渗漏[OR=8.627,95％CI(1.514～49.173),P＜0.05]均为老年OVCF患者术后再骨折的独立危险因素,BMD[OR=0.029,95％CI(0.005～0.176),P＜0.05]、椎旁肌质量[OR=0.955,95％CI(0.933～0.978),P＜0.05]则为其独立保护因素.以上述4项独立影响因素构建老年OVCF患者术后再骨折的风险列线图预警模型,内部验证显示预测准确性良好、区分度良好.结论 年龄及骨水泥渗漏可能是老年OVCF患者术后12个月再骨折的危险因素,BMD及椎旁肌质量是其保护因素,以上述4项影响因素构建的列线图预警模型可预测再骨折风险.

英文摘要:

      Objective To analyze the risk factors for re-fracture in elderly patients with osteoporotic vertebral compres-sion fractures(OVCF)after percutaneous kyphoplasty(PKP),and construct a nomogram prediction model.Methods The clinical data from 205 elderly OVCF patients treated with PKP in Traditional Chinese Medicine Hospital of Wuhan City between January 2019 and December 2023 were collected.They were divided into re-fracture group(n=31)and non-re-fracture group(n=174)according to the occurrence of re-fracture within 12 months after surgery.The perioperative data were compared be-tween the two groups.Multivariate Logistic regression analysis was used to evaluate the influencing factors for re-fracture within 12 months postoperatively.The nomogram was used to construct a prediction model for postoperative re-fracture in elderly OVCF patients.The internal validation of the nomogram prediction model was carried out by repeated sampling with Bootstrap method.Results The incidence of re-fracture within 12 months postoperatively was 15.12％(31/205).Significant differ-ences were observed between the re-fracture and non-re-fracture groups in age,bone mineral density(BMD),paraspinal mus-cle mass,and bone cement leakage rate(P＜0.05).Multivariate Logistic regression analysis showed that age[OR=1.303,95％CI(1.110-1.529),P＜0.05]and bone cement leakage[OR=8.627,95％CI(1.514-49.173),P＜0.05]were the independent risk factors for re-fracture in elderly OVCF patients,while BMD[OR=0.029,95％CI(0.005-0.176),P＜0.05]and paraspinal muscle mass[OR=0.955,95％CI(0.933-0.978),P＜0.05]were independent protective factors.Based on the above four independent influencing factors,a nomogram prediction model was constructed.Internal validation demonstrated good predictive accuracy and discrimination.Conclusion Age and bone cement leakage may be risk factors for re-fracture within 12 months postoperatively in elderly OVCF patients,while BMD and paraspinal muscle mass may be protective factors.The nomogram model constructed based on the above four influencing factors can predict the risk of re-fractures.