摘要
目的分析骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fractures,OVCF)患者椎体成形术后发生残余疼痛风险的危险因素并构建列线图,为临床椎体成形术后残余疼痛管理决策提供参考。方法选取2020年1月至2023年6月在我院行椎体成形术治疗的202例OVCF患者,收集患者临床资料。采用多因素Logistic回归模型分析术后残余疼痛的危险因素,将危险因素作为构建列线图的预测指标。采用内部数据验证列线图性能,采用决策曲线分析评估列线图临床净收益。结果202例椎体成形术患者的术后残余疼痛发生率为17.3%(35/202),术后残余疼痛患者年龄、吸烟比例、腰痛史比例、后筋膜水肿比例、小关节损伤比例、骨水泥分布(团块状)比例、手术椎骨数量(>2)比例、手术时间、椎体内裂隙征比例和骨水泥渗漏比例均高于术后缓解组(P<0.05),骨密度(bone mineral density,BMD)和骨水泥与终板接触比例低于术后缓解组(P<0.05)。多因素Logistic回归分析结果显示:小关节损伤(OR:1.560,95%CI:1.085~3.655)、骨水泥分布(团块状)(OR:2.730,95%CI:1.785~4.389)、椎体内裂隙征(OR:1.497,95%CI:1.523~8.031)和骨水泥渗漏(OR:1.799,95%CI:1.517~3.066)为OVCF患者椎体成形术后残余疼痛独立危险因素(P<0.05)。列线图校正曲线显示C-index为0.865,当列线图预测OVCF患者行椎体成形术后发生残余疼痛风险阈值为0.080~0.814时,提供了显著临床收益。Simple模型预测1000例患者风险分层显示,风险阈值增高,列线图预测准确性逐渐接近实际观察结果。结论本研究所构建的列线图有较好的性能,可以精准预测和量化OVCF患者椎体成形术后残余疼痛的风险,为预防椎体成形术后残余腰痛的干预策略提供理论依据。
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.
作者
吴晶晶
李思炜
朱爱朝
罗刚
WU Jing-jing;LI Si-wei;ZHU Ai-chao;LUO Gang(Operating Theatre,Anhui Chizhou People’s Hospital,Chizhou,Anhui,247000,China)
出处
《中国骨与关节杂志》
CAS
2024年第9期743-748,共6页
Chinese Journal of Bone and Joint
