Abstract：
Recompression of augmented vertebrae (RCAV) is often seen after percutaneous kyphoplasty (PKP), especially at the thoracolumbar junction. The authors aimed to develop and validate a risk prediction model (nomogram) for RCAV and to evaluate the efficacy of a modified puncture technique for RCAV prevention after PKP for thoracolumbar osteoporotic vertebral fractures (OVFs).
Patients who underwent PKP for single thoracolumbar OVFs (T10-L2) between January 2016 and October 2020 were reviewed and followed up for at least 2 years. All patients were randomly divided into a training group (70%) and a validation group (30%). Relevant potential data affecting recompression were collected. Predictors were screened by using binary logistic regression analysis to construct the nomogram. Calibration and receiver operating characteristic curves were used to evaluate the consistency of the prediction models. Finally, the efficacy of the modified puncture technique for prevention of RCAV in OVF patients with a preoperative intravertebral cleft (IVC) was further demonstrated through binary logistic regression analysis.
Overall, 394 patients were included and 116 of them (29.4%) sustained RCAV. The independent risk factors included decreased bone mineral density, lower level of serum 25-hydroxy vitamin D3, larger C7-S1 sagittal vertical axis (SVA), preoperative IVC, and solid-lump cement distribution. The area under the curve (AUC) of the prediction model was 0.824 in the training group and 0.875 in the validation group patients. The calibration curve indicated the predictive power of this nomogram, with the preoperative IVC having the highest prediction accuracy (AUC 0.705). The modified puncture technique significantly reduced the incidence of RCAV by enhancing bone cement distribution into a sufficiently diffused distribution in OVF patients with preoperative IVC.
The nomogram prediction model had satisfactory accuracy and clinical utility for identification of patients at low and high risk of postoperative RCAV. Patients at high risk of postoperative RCAV might benefit from the target puncture technique and vitamin D supplementation as well as effective antiosteoporotic therapies.
Patients who underwent PKP for single thoracolumbar OVFs (T10-L2) between January 2016 and October 2020 were reviewed and followed up for at least 2 years. All patients were randomly divided into a training group (70%) and a validation group (30%). Relevant potential data affecting recompression were collected. Predictors were screened by using binary logistic regression analysis to construct the nomogram. Calibration and receiver operating characteristic curves were used to evaluate the consistency of the prediction models. Finally, the efficacy of the modified puncture technique for prevention of RCAV in OVF patients with a preoperative intravertebral cleft (IVC) was further demonstrated through binary logistic regression analysis.
Overall, 394 patients were included and 116 of them (29.4%) sustained RCAV. The independent risk factors included decreased bone mineral density, lower level of serum 25-hydroxy vitamin D3, larger C7-S1 sagittal vertical axis (SVA), preoperative IVC, and solid-lump cement distribution. The area under the curve (AUC) of the prediction model was 0.824 in the training group and 0.875 in the validation group patients. The calibration curve indicated the predictive power of this nomogram, with the preoperative IVC having the highest prediction accuracy (AUC 0.705). The modified puncture technique significantly reduced the incidence of RCAV by enhancing bone cement distribution into a sufficiently diffused distribution in OVF patients with preoperative IVC.
The nomogram prediction model had satisfactory accuracy and clinical utility for identification of patients at low and high risk of postoperative RCAV. Patients at high risk of postoperative RCAV might benefit from the target puncture technique and vitamin D supplementation as well as effective antiosteoporotic therapies.
摘要：
目的：经皮椎体后凸成形术（PKP）后，常出现增强椎体再加压（RCAV），尤其是胸腰椎交界处.作者旨在开发和验证RCAV的风险预测模型（列线图），并评估改良穿刺技术在胸腰椎骨质疏松性椎体骨折（OVFs）PKP后预防RCAV的有效性。
方法：对2016年1月至2020年10月因单发胸腰椎OVF（T10-L2）接受PKP治疗的患者进行了回顾，并随访至少2年。将所有患者随机分为训练组(70%)和验证组(30%)。收集影响再压缩的相关潜在数据。通过使用二元逻辑回归分析筛选预测因子以构建列线图。使用校准和接收器工作特性曲线来评估预测模型的一致性。最后,通过二元logistic回归分析,进一步证明了改良穿刺技术预防术前椎间隙(IVC)OVF患者RCAV的疗效.
结果：总体而言，纳入394例患者，其中116例（29.4%）持续RCAV。独立危险因素包括骨密度降低，血清25-羟维生素D3水平较低，C7-S1矢状纵轴（SVA）较大，术前IVC,和固体块水泥分布。预测模型的曲线下面积(AUC)在训练组患者中为0.824,在验证组患者中为0.875。校准曲线显示了这个列线图的预测能力，术前IVC具有最高的预测准确性（AUC0.705）。在术前IVC的OVF患者中，改良的穿刺技术通过将骨水泥分布增强为充分扩散的分布，显着降低了RCAV的发生率。
结论：列线图预测模型对于识别术后RCAV低风险和高风险患者具有令人满意的准确性和临床实用性。术后RCAV高危患者可能受益于靶穿刺技术和补充维生素D以及有效的抗骨质疏松治疗。
方法：对2016年1月至2020年10月因单发胸腰椎OVF（T10-L2）接受PKP治疗的患者进行了回顾，并随访至少2年。将所有患者随机分为训练组(70%)和验证组(30%)。收集影响再压缩的相关潜在数据。通过使用二元逻辑回归分析筛选预测因子以构建列线图。使用校准和接收器工作特性曲线来评估预测模型的一致性。最后,通过二元logistic回归分析,进一步证明了改良穿刺技术预防术前椎间隙(IVC)OVF患者RCAV的疗效.
结果：总体而言，纳入394例患者，其中116例（29.4%）持续RCAV。独立危险因素包括骨密度降低，血清25-羟维生素D3水平较低，C7-S1矢状纵轴（SVA）较大，术前IVC,和固体块水泥分布。预测模型的曲线下面积(AUC)在训练组患者中为0.824,在验证组患者中为0.875。校准曲线显示了这个列线图的预测能力，术前IVC具有最高的预测准确性（AUC0.705）。在术前IVC的OVF患者中，改良的穿刺技术通过将骨水泥分布增强为充分扩散的分布，显着降低了RCAV的发生率。
结论：列线图预测模型对于识别术后RCAV低风险和高风险患者具有令人满意的准确性和临床实用性。术后RCAV高危患者可能受益于靶穿刺技术和补充维生素D以及有效的抗骨质疏松治疗。
