摘要
目的分析老年骨质疏松性胸腰椎骨折患者椎体强化术后再骨折的危险因素,并构建预测模型。方法纳入2020年1月—2023年3月采用椎体强化术治疗的骨质疏松性胸腰椎骨折老年患者268例,根据术后1年是否发生再骨折分为再骨折组(n=50)和未再骨折组(n=218)。采用单因素、多因素logistic回归分析再骨折的风险因素,建立预测模型,并绘制受试者工作特征(ROC)曲线分析预测模型对椎体强化术后再骨折发生风险的预测价值。结果与未再骨折组比较,再骨折组骨密度(BMD)更低,骨水泥渗漏、使用激素、无延伸至终板的骨折线比例更高,胸腰椎后凸角、矢状面垂直轴(SVA)偏移量、血清β-胶原降解产物(β-CTX)和Ⅰ型胶原氨基端延长肽(PINP)水平更高,差异均有统计学意义(P<0.05)。多因素logistic分析结果显示,BMD降低、骨水泥渗漏、使用激素、SVA偏移量高、血清β-CTX水平升高为老年骨质疏松性胸腰椎骨折患者椎体强化术后再骨折的危险因素。预测模型:logit(P)=-8.047-BMD实测值×0.522+骨水泥渗漏赋值×0.735+使用激素赋值×0.672+SVA偏移量实测值×0.561+血清β-CTX水平实测值×0.724。H-L拟合优度检验显示模型拟合效果较好(χ^(2)=6.524,P=0.619)。按照预测模型绘制预测ROC曲线,结果显示,当logit(P)>7.44时,ROC曲线下面积(AUC)为0.894,灵敏度为86.00%、特异度为80.73%。结论老年骨质疏松性胸腰椎骨折患者椎体强化术后再骨折危险因素为BMD降低、骨水泥渗漏、使用激素、SVA偏移量高、血清β-CTX水平升高,在这些影响因素基础上构建的预测模型具有良好的预测价值。
Objective To analyze the risk factors for re-fracture in elderly patients with osteoporotic thoracolumbar fractures after vertebral augmentation,and to construct a predictive model.Methods From January 2020 to March 2023,268 elderly patients with osteoporotic thoracolumbar fractures treated with vertebral augmentation were included.They were divided into a refracture group(n=50)and a non re-fracture group(n=218)based on whether they experienced a re-fracture at postoperative 1 year.Univariate and multivariate logistic regression analysis were used to to identify risk factors for re-fractures.A predictive model was established,and the receiver operating characteristic(ROC)curve was plotted to analyze the predictive value of the predictive model for the risk of re-fractures after vertebral augmentation.Results Compared with the non re-fractured group,the re-fractured group had lower bone mineral density(BMD),higher proportion of cement leakage,hormone use and fracture lines without extension to the endplate,and higher thoracolumbar kyphosis angle,sagittal vertical axis(SVA)offset,serumβisomer of C-terminal telopeptide of typeⅠcollagen(β-CTX)and procollagen typeⅠN-terminal propeptide(PINP)levels,and the differences were statistically significant(P<0.05).Multivariate logistic analysis showed that decreased BMD,bone cement leakage,hormone use,high SVA offset and elevated serum β-CTX level were risk factors for re-fractures in elderly patients with osteoporotic thoracolumbar fractures after vertebral augmentation.Prediction model:logit(P)=-8.047-measured value of BMD×0.522+assigned value of bone cement leakage×0.735+assigned value of hormone use×0.672+measured value of SVA offset×0.561+measured value of serum β-CTX level×0.724.The H-L goodness of fit test showed that the model had a good fitting effect(χ^(2)=6.524,P=0.619).According to the prediction model,the ROC curve was plotted,and the results showed that when logit(P)>7.44,the area under the ROC curve(AUC)was 0.894,the sensitivity 86.00%,and the specificity 80.73%.Conclusions The risk factors for re-fractures in elderly patients with osteoporotic thoracolumbar fractures after vertebral augmentation are decreased BMD,cement leakage,hormone use,high SVA offset and elevated serumβ-CTX level.The predictive model constructed based on these influencing factors has good predictive value.
作者
贺元
关炳瑜
吴世萍
He Yuan;Guan Bingyu;Wu Shiping(Department of Orthopaedics,Xining First People’s Hospital,Xining 810000,Qinghai,China)
出处
《脊柱外科杂志》
2025年第4期250-254,共5页
Journal of Spinal Surgery
关键词
胸椎
腰椎
骨折
压缩性
骨质疏松
椎体成形术
椎体后凸成形术
Thoracic vertebrae
Lumbar vertebrae
Fractures,compression
Osteoporosis
Vertebroplasty
Kyphoplasty
