摘要
目的 构建个体化预测经皮椎体后凸成形术(PKP)患者术后残余疼痛风险的列线图模型,以期为PKP患者术后疼痛的预防和干预提供参考。方法 选取2021年6月—2023年8月在南京医科大学附属南京医院接受PKP治疗的210例骨质疏松性椎体压缩骨折(OVCF)患者,根据术后半年内是否存在残余疼痛分为残余疼痛组(n=41)和非残余疼痛组(n=169)。采用多因素logistic逐步回归分析探讨PKP患者术后残余疼痛的影响因素,并以此构建列线图模型;采用受试者工作特征(ROC)曲线评估列线图模型对PKP患者术后残余疼痛的预测价值。结果 残余疼痛组患者的年龄、身体质量指数均大于非残余疼痛组,骨折椎体数量≥2个、腰背筋膜损伤、椎体内裂隙征、骨水泥团块状分布所占比例均高于非残余疼痛组,骨密度、单个椎体骨水泥注入量均小于非残余疼痛组,差异均有统计学意义(P<0.05)。多因素logistic逐步回归分析结果显示,骨密度(OR=2.450,95%CI:1.630~3.683)、腰背筋膜损伤(OR=2.113,95%CI:1.479~3.018)、椎体内裂隙征(OR=2.843,95%CI:1.844~4.385)、单个椎体骨水泥注入量(OR=2.368,95%CI:1.587~3.532)、骨水泥分布(OR=3.149,95%CI:1.983~5.001)是PKP患者术后残余疼痛的独立影响因素(P<0.05)。构建的PKP患者术后残余疼痛的列线图预测模型分析结果显示,一致性指数(C-index)为0.881(95%CI:0.823~0.934)。列线图模型预测PKP患者术后残余疼痛的曲线下面积(AUC)为0.874(95%CI:821~0.927),特异度为68.16%,灵敏度为91.47%。结论PKP患者术后残余疼痛的影响因素包括骨密度、腰背筋膜损伤、椎体内裂隙征、单个椎体骨水泥注入量、骨水泥分布,据此构建的列线图模型对P K P患者术后残余疼痛预测具有较高价值。
Objective To develop a nomogram model for individualized prediction of residual pain risk in patients after percutaneous kyphoplasty(PKP),providing references for prevention and intervention of this population.Methods A total of 210 osteoporotic vertebral compression fracture(OVCF)patients undergoing PKP(June 2021-August 2023)were allocated to residual pain(n=41)and non-residual pain(n=169)groups based on the absence or presence of pain status within six months postoperatively.Multivariate logistic stepwise regression analysis was employed to identify influencing factors,and a nomogram was constructed.Receiver operating characteristic(ROC)curves were used to evaluate the predictive performance of this model.Results The residual pain group had higher age,body mass index;higher proportions of≥2 fractured vertebrae,thoracolumbar fascia injury,intravertebral cleft sign,and clustered bone cement distribution;but lower bone mineral density and bone cement volume per vertebra than the non-residual pain group,with statistically significant differences(P<0.05).Multivariate logistic stepwise regression analysis identified bone mineral density(OR=2.450,95%CI:1.630-3.683),thoracolumbar fascia injury(OR=2.113,95%CI:1.479-3.018),intravertebral cleft sign(OR=2.843,95%CI:1.844-4.385),bone cement volume per vertebra(OR=2.368,95%CI:1.587-3.532),and bone cement distribution(OR=3.149,95%CI:1.983-5.001)as independent influencing factors(P<0.05).The nomogram model for individualized prediction of residual pain risk in patients after PKP achieved a C-index of 0.881(95%CI:0.823-0.934).The area under the curve(AUC)of the nomogram for predicting residual pain was 0.874(95%CI:0.821-0.927),with 68.16%specificity and 91.47%sensitivity.Conclusion Bone mineral density,thoracolumbar fascia injury,intravertebral cleft sign,bone cement volume per vertebra,and bone cement distribution are independent factors influencing residual pain after PKP.The constructed nomogram established based on the above factors demonstrates high predictive value.
作者
潘代梅
吴志浩
黄凯华
俞静
孔静静
汤云云
孙强
王红玉
Pan Daimei;Wu Zhihao;Huang Kaihua;Yu Jing;Kong Jingjing;Tang Yunyun;Sun Qiang;Wang Hongyu(Department of Orthopedics,Nanjing Hospital Affiliated to Nanjing Medical University/Nanjing First Hospital,Nanjing 210006,China)
出处
《保健医学研究与实践》
2025年第8期71-76,共6页
Health Medicine Research and Practice
基金
江苏省卫生健康委员会老年健康科研项目(LK2021031)。
