中国组织工程研究

中国组织工程研究 ›› 2023, Vol. 27 ›› Issue (23): 3700-3706.doi: 10.12307/2023.491

• 组织构建实验造模 experimental modeling in tissue construction • 上一篇    下一篇

椎体后凸成形治疗骨质疏松性椎体压缩骨折后新发骨折危险因素预测模型的建立

马一鸣1，2，王子豪1，2，蔡大钊1，2，鹿  麒1，2，袁  峰1，2，陈宏亮1，2   

  1. 1徐州医科大学第一临床医学院，江苏省徐州市  221001；2徐州医科大学附属医院脊柱外科，江苏省徐州市  221006
  • 收稿日期:2022-06-10 接受日期:2022-07-25 出版日期:2023-08-18 发布日期:2023-01-16
  • 通讯作者: 陈宏亮，博士，主任医师，硕士生导师，徐州医科大学第一临床医学院，江苏省徐州市 221001；徐州医科大学附属医院脊柱外科，江苏省徐州市 221006
  • 作者简介:马一鸣，男，1996年生，徐州医科大学在读硕士，主要从事脊柱外科疾病相关研究。
  • 基金资助:
    江苏省卫生健康委员会项目(Z2021070)，项目负责人：陈宏亮

A prediction model for new fracture risk factors after percutaneous kyphoplasty for osteoporotic vertebral compression fractures

Ma Yiming1, 2, Wang Zihao1, 2, Cai Dazhao1, 2, Lu Qi1, 2, Yuan Feng1, 2, Chen Hongliang1, 2   

  1. 1First Clinical Medical College, Xuzhou Medical University, Xuzhou 221001, Jiangsu Province, China; 2Department of Spine Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou 221006, Jiangsu Province, China
  • Received:2022-06-10 Accepted:2022-07-25 Online:2023-08-18 Published:2023-01-16
  • Contact: Chen Hongliang, MD, Chief physician, Master’s supervisor, First Clinical Medical College, Xuzhou Medical University, Xuzhou 221001, Jiangsu Province, China; Department of Spine Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou 221006, Jiangsu Province, China
  • About author:Ma Yiming, Master candidate, First Clinical Medical College, Xuzhou Medical University, Xuzhou 221001, Jiangsu Province, China; Department of Spine Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou 221006, Jiangsu Province, China
  • Supported by:
    Project of Jiangsu Provincial Health Commission, No. Z2021070 (to CHL)

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摘要：

文题释义：

经皮椎体后凸成形：是一种在X射线透视下对骨折椎体定位并进行穿刺注射骨水泥的微创手术，具有创伤小、术后快速恢复等优势，是近年来治疗骨质疏松性椎体压缩骨折的首选手术方式。
预测模型：该文应用基于回归分析结果的列线图作为预测模型，其原理是根据纳入模型的各个变量对结局变量的影响程度进行量化并赋值，最后将各个危险因素的值总和成最终分值，可视化最终分值对应的结局概率。将该模型制作成网页，为医患提供了用户友好的交互式计算器。这种方法使统计结果可视化，带给了临床工作极大便利。

背景：目前对于椎体后凸成形治疗后新发骨折的研究较多，但是如何将其风险直观地呈现以便于临床应用，这类研究尚少。
目的：探究椎体后凸成形治疗骨质疏松性椎体压缩骨折后新发椎体骨折的危险因素，并建立预测术后再骨折发生的列线图。
方法：选择2017年12月至2020年6月徐州医科大学附属医院收治的骨质疏松性椎体压缩骨折患者439例，男107例，女332例，年龄(71.38±9.73)岁，根据椎体后凸成形治疗后1年内有无新发骨折分为新发骨折组(n=57)和无新发骨折组(n=382)。采用单因素和多因素分析确定术后发生新骨折的危险因素。使用KNN法对缺失值进行多重插补，并用SMOTE方法对样本过采样均衡。将数据随机分为训练集(75%)和测试集(25%)，根据多因素分析结果建立了预测再骨折发生风险的列线图，并使用受试者工作特征曲线(ROC)、校准曲线和决策曲线分析来评估其性能，制作网络计算器给临床医生带来更便捷的交互体验。

结果与结论：①单因素分析显示，两组间骨密度T值、既往骨折史、脑血管疾病、受伤时间及术后椎体Cobb角比较差异有显著性意义(P < 0.05)；多因素分析显示，脑血管疾病[OR=35.742，95%CI(9.377，136.236)，P=0.000]、骨折史[OR=11.546，95%CI(5.420，24.595)，P=0.000]、骨水泥椎间隙渗漏[OR=2.817，95%CI(1.109，7.158)，P=0.029]是与新发骨折呈正相关的独立危险因素，骨密度T值[OR=0.019，95%CI(0.005，0.076)，P=0.000]、受伤时间[OR=0.981，95%CI(0.963，0.999)，P=0.041]与术后新发骨折呈负相关；②在训练集和测试集中，列线图的曲线下面积值分别为0.927[95%CI(0.864，0.989)]和0.807[95%CI(0.707，0.906)]，校准曲线显示预测和实际状态之间的一致性较高，决策曲线下面积分别为0.044和0.062；③结果表明，低骨密度、脑血管疾病、骨折史、骨水泥椎间隙渗漏及受伤时间较短是椎体后凸成形治疗后发生新骨折的危险因素。

https://orcid.org/0000-0003-1993-3014(马一鸣)

中国组织工程研究杂志出版内容重点：组织构建；骨细胞；软骨细胞；细胞培养；成纤维细胞；血管内皮细胞；骨质疏松；组织工程

关键词: 骨质疏松, 椎体后凸成形, 椎体压缩性骨折, 列线图, 预测模型

Abstract: BACKGROUND: There are many studies on new fractures after percutaneous kyphoplasty, but less is reported on how to visualize the risk for clinical application.
OBJECTIVE: To investigate the risk factors for new vertebral compression fractures after percutaneous kyphoplasty for osteoporotic vertebral compression fractures and to establish a nomogram to predict the occurrence of postoperative new fractures.
METHODS: Totally 439 patients treated with percutaneous kyphoplasty for osteoporotic vertebral compression fractures admitted at the Affiliated Hospital of Xuzhou Medical University from December 2017 to June 2020 were enrolled, including 107 males and 332 females, aged (71.38±9.73) years. All patients were divided into a new fracture group and a non-fracture group according to the presence of new fractures within 1 year after surgery. Univariate and multivariate analyses were used to determine the risk factors for the occurrence of new fracture after surgery. Multiple interpolation of missing values was performed using the KNN method, and the samples were oversampled and equalized using the SMOTE method. The data were randomly divided into a training set (75%) and a testing set (25%). A nomogram predicting the risk of new fracture occurrence was created based on the results of multivariate analysis, and its performance was evaluated using receiver operating characteristic curve, calibration curve, and decision curve analysis. A web calculator was created to facilitate a more convenient interactive experience for clinicians.
RESULTS AND CONCLUSION: Univariate analysis showed significant differences (P < 0.05) between the two groups in T value, fracture history, cerebrovascular disease, injury time, and postoperative Cobb angle. Multivariate analysis showed that cerebrovascular disease [odds ratio (OR)=35.742, 95% confidence interval (CI) (9.377, 136.236),P=0.000], history of fracture [OR=11.546, 95% CI (5.420, 24.595), P=0.000], cemented intervertebral leakage [OR=2.817, 95% CI (1.109, 7.158), P=0.029] were the independent risk factors positively associated with new fractures. T value [OR=0.019, 95% CI (0.005, 0.076), P=0.000], and time to injury [OR=0.981, 95% CI (0.963, 0.999), P=0.041] were negatively associated with new fractures postoperatively. The area under the curve values of the nomogram were 0.927 [95% CI (0.864-0.989)] and 0.807 [95% CI (0.707-0.906)] in the training and test sets, respectively, and the calibration curves showed a high agreement between predicted and actual status with an area under the decision curve of 0.044 and 0.062, respectively. To conclude, low bone mineral density, cerebrovascular disease, fracture history, cemented intervertebral leakage, and short duration of injury are risk factors for new fractures after percutaneous kyphoplasty. 

Key words: osteoporosis, percutaneous kyphoplasty, vertebral compression fracture, nomogram, prediction model

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