Abstract：
OBJECTIVE: To construct percutaneous vertebroplasty for predicting osteoporotic vertebral compression fractures (OVCFs) nomogram of residual back pain (RBP) after percutaneous vertebroplasty(PVP).
METHODS: Clinical data of 245 OVCFs patients who were performed PVP from January 2020 to December 2022 were retrospectively analyzed, including 47 males and 198 females, aged from 65 to 77 years old with an average of (71.47±9.03) years old, and were divided into RBP group and non-RBP group according to whether RBP occurred. Gender, age, comorbidities, fracture stage, body mass index (BMI), bone mineral density (BMD), visual analogue scale (VAS), Oswestry disability index (ODI) and other general information were collected; anterior vertebral height (AVH), anterior vertebral height ratio (AVH), anterior vertebral height ratio(AVHR), Cobb angle, intravertebral vacuum cleft (IVC), thoracolumbar fascia (TLF) injury, paravertebral muscle steatosis, injection volume and leakage of bone cement, bone cement dispersion pattern, anterior vertebral height recovery ratio (AVHRR), Cobb angle changes, etc. imaging parameters before operation and 24 h after operation were collected. Univariate analysis was performed to analysis above factors, and multivariate Logistic regression model was used to investigate independent risk factors for postoperative RBP, and Nomogram model was constructed and verified;receiver operating characteristic(ROC) curve and calibration curve were used to determine predictive performance and accuracy of the model, and Hosmer-Lemeshow (H-L) test was used for evaluation. The area under curve (AUC) of ROC was calculated, and Harrell consistency index (C index) was used to evaluate the predictive efficiency of model;decision curve analysis (DCA) was used to evaluate clinical practicability of model.
RESULTS: There were 34 patients in RBP group and 211 patients in non-RBP group. There were no significant differences in gender, age, comorbidities, fracture stage, BMI, BMD, VAS, ODI, AVH, AVHR and Cobb angle between two groups (P>0.05). Univariate analysis showed 6 patients occurred IVC in RBP group and 13 patients in non-RBP, the number of IVC in RBP group was higher than that in non-RBP group (χ2=5.400, P=0.020);6 patients occuured TLF injury in RBP group and 11 patients in non-RBP group, the number of TLF injury in RBP group was higher than that in non-RBP group (χ2=7.011, P=0.008);In RBP group, 18 patients with grade 3 to 4 paraptebral steatosis and 41 patients in non-RBP group, RBP group was higher than non-RBP group (χ2=21.618, P<0.001), and the proportion of bone cement mass in RBP group was higher than non-RBP group (χ2=6.836, P=0.009). Multivariate Logistic regression analysis showed IVC (χ2=4.974, P=0.025), TLF injury (χ2=5.231, P=0.023), Goutallier grade of paravertebral steatosis >2 (χ2=15.124, P<0.001) and proportion of bone cement (χ2=4.168, P=0.038) were independent risk factors for RBP after PVP. ROC curve of model showed AUC of original model was 0.816[OR=2.862, 95%CI (0.776, 0.894), P<0.001]. The internal verification of model through 200 bootstrap samples showed the value of C index was 0.936, and calibration curve showed predicted probability curve was close to actual probability curve. H-L goodness of fit test results were χ2=5.796, P=0.670. DCA analysis results showed the decision curve was above None line and All line when the threshold value ranged from 6% to 71%.
CONCLUSIONS: IVC, TLF combined injury, paravertebral muscle steatosis with Goutallier grade> 2, and bone cement diffusion with mass type are independent risk factors for RBP after PVP. The risk prediction model for RBP after PVP established has good predictive performance and good clinical practicability.
METHODS: Clinical data of 245 OVCFs patients who were performed PVP from January 2020 to December 2022 were retrospectively analyzed, including 47 males and 198 females, aged from 65 to 77 years old with an average of (71.47±9.03) years old, and were divided into RBP group and non-RBP group according to whether RBP occurred. Gender, age, comorbidities, fracture stage, body mass index (BMI), bone mineral density (BMD), visual analogue scale (VAS), Oswestry disability index (ODI) and other general information were collected; anterior vertebral height (AVH), anterior vertebral height ratio (AVH), anterior vertebral height ratio(AVHR), Cobb angle, intravertebral vacuum cleft (IVC), thoracolumbar fascia (TLF) injury, paravertebral muscle steatosis, injection volume and leakage of bone cement, bone cement dispersion pattern, anterior vertebral height recovery ratio (AVHRR), Cobb angle changes, etc. imaging parameters before operation and 24 h after operation were collected. Univariate analysis was performed to analysis above factors, and multivariate Logistic regression model was used to investigate independent risk factors for postoperative RBP, and Nomogram model was constructed and verified;receiver operating characteristic(ROC) curve and calibration curve were used to determine predictive performance and accuracy of the model, and Hosmer-Lemeshow (H-L) test was used for evaluation. The area under curve (AUC) of ROC was calculated, and Harrell consistency index (C index) was used to evaluate the predictive efficiency of model;decision curve analysis (DCA) was used to evaluate clinical practicability of model.
RESULTS: There were 34 patients in RBP group and 211 patients in non-RBP group. There were no significant differences in gender, age, comorbidities, fracture stage, BMI, BMD, VAS, ODI, AVH, AVHR and Cobb angle between two groups (P>0.05). Univariate analysis showed 6 patients occurred IVC in RBP group and 13 patients in non-RBP, the number of IVC in RBP group was higher than that in non-RBP group (χ2=5.400, P=0.020);6 patients occuured TLF injury in RBP group and 11 patients in non-RBP group, the number of TLF injury in RBP group was higher than that in non-RBP group (χ2=7.011, P=0.008);In RBP group, 18 patients with grade 3 to 4 paraptebral steatosis and 41 patients in non-RBP group, RBP group was higher than non-RBP group (χ2=21.618, P<0.001), and the proportion of bone cement mass in RBP group was higher than non-RBP group (χ2=6.836, P=0.009). Multivariate Logistic regression analysis showed IVC (χ2=4.974, P=0.025), TLF injury (χ2=5.231, P=0.023), Goutallier grade of paravertebral steatosis >2 (χ2=15.124, P<0.001) and proportion of bone cement (χ2=4.168, P=0.038) were independent risk factors for RBP after PVP. ROC curve of model showed AUC of original model was 0.816[OR=2.862, 95%CI (0.776, 0.894), P<0.001]. The internal verification of model through 200 bootstrap samples showed the value of C index was 0.936, and calibration curve showed predicted probability curve was close to actual probability curve. H-L goodness of fit test results were χ2=5.796, P=0.670. DCA analysis results showed the decision curve was above None line and All line when the threshold value ranged from 6% to 71%.
CONCLUSIONS: IVC, TLF combined injury, paravertebral muscle steatosis with Goutallier grade> 2, and bone cement diffusion with mass type are independent risk factors for RBP after PVP. The risk prediction model for RBP after PVP established has good predictive performance and good clinical practicability.
摘要：
目的：构建经皮椎体成形术预测骨质疏松性椎体压缩性骨折(OVCFs)经皮椎体成形术(PVP)后残余背痛(RBP)的列线图。
方法：回顾性分析2020年1月至2022年12月进行PVP的245例OVCFs患者的临床资料，包括47名男性和198名女性，年龄在65至77岁之间，平均（71.47±9.03）岁，根据是否发生RBP分为RBP组和非RBP组。性别,年龄,合并症,断裂阶段,体重指数（BMI），骨矿物质密度（BMD），视觉模拟量表（VAS），收集Oswestry残疾指数（ODI）和其他一般信息；椎体前高度（AVH），前椎体高度比（AVH），前椎体高度比（AVHR），Cobb角,椎管内真空裂隙(IVC),胸腰椎筋膜（TLF）损伤，椎旁肌肉脂肪变性,注射量和骨水泥渗漏，骨水泥分散模式，椎体前高度恢复率（AVHRR），Cobb角改变,等。采集术前、术后24h的影像学参数。对上述因素进行单因素分析，采用多因素Logistic回归模型探讨术后RBP的独立危险因素,建立并验证了该模型;利用受试者工作特性(ROC)曲线和校正曲线,采用Hosmer-Lemeshow(H-L)试验进行评价。计算ROC曲线下面积(AUC),采用Harrell一致性指数(C指数)评价模型的预测效率;采用决策曲线分析(DCA)评价模型的临床实用性。
结果：RBP组34例，非RBP组211例。性别差异不显著,年龄,合并症,断裂阶段,BMI,BMD,VAS,ODI,AVH,两组AVHR和Cobb角比较(P>0.05)。单因素分析显示,RBP组发生IVC6例,非RBP组发生IVC13例,RBP组IVC数高于非RBP组(χ2=5.400,P=0.020);RBP组发生TLF损伤6例,非RBP组发生TLF损伤11例,RBP组TLF损伤数高于非RBP组(χ2=7.011,P=0.008);18例3至4级椎旁脂肪变性患者和41例非RBP患者，RBP组高于非RBP组(χ2=21.618,P<0.001),RBP组骨水泥质量所占比例高于非RBP组(χ2=6.836,P=0.009)。多因素Logistic回归分析显示IVC(χ2=4.974,P=0.025),TLF损伤(χ2=5.231,P=0.023),椎旁脂肪变性Goutallier分级>2（χ2=15.124，P<0.001）和骨水泥比例（χ2=4.168，P=0.038）是PVP术后RBP的独立危险因素。模型的ROC曲线显示原始模型的AUC为0.816[OR=2.862，95CI（0.776，0.894），P<0.001]。通过200个bootstrap样本对模型进行内部验证，C指数为0.936，校准曲线显示预测概率曲线与实际概率曲线接近。H-L拟合优度检验结果χ2=5.796,P=0.670。DCA分析结果表明，当阈值范围为6％至71％时，决策曲线高于None线和All线。
结论：IVC，TLF合并损伤,Goutallier等级>2级的椎旁肌脂肪变性和骨水泥弥散与肿块类型是PVP术后RBP的独立危险因素。建立的PVP后RBP风险预测模型具有良好的预测性能和良好的临床实用性。
方法：回顾性分析2020年1月至2022年12月进行PVP的245例OVCFs患者的临床资料，包括47名男性和198名女性，年龄在65至77岁之间，平均（71.47±9.03）岁，根据是否发生RBP分为RBP组和非RBP组。性别,年龄,合并症,断裂阶段,体重指数（BMI），骨矿物质密度（BMD），视觉模拟量表（VAS），收集Oswestry残疾指数（ODI）和其他一般信息；椎体前高度（AVH），前椎体高度比（AVH），前椎体高度比（AVHR），Cobb角,椎管内真空裂隙(IVC),胸腰椎筋膜（TLF）损伤，椎旁肌肉脂肪变性,注射量和骨水泥渗漏，骨水泥分散模式，椎体前高度恢复率（AVHRR），Cobb角改变,等。采集术前、术后24h的影像学参数。对上述因素进行单因素分析，采用多因素Logistic回归模型探讨术后RBP的独立危险因素,建立并验证了该模型;利用受试者工作特性(ROC)曲线和校正曲线,采用Hosmer-Lemeshow(H-L)试验进行评价。计算ROC曲线下面积(AUC),采用Harrell一致性指数(C指数)评价模型的预测效率;采用决策曲线分析(DCA)评价模型的临床实用性。
结果：RBP组34例，非RBP组211例。性别差异不显著,年龄,合并症,断裂阶段,BMI,BMD,VAS,ODI,AVH,两组AVHR和Cobb角比较(P>0.05)。单因素分析显示,RBP组发生IVC6例,非RBP组发生IVC13例,RBP组IVC数高于非RBP组(χ2=5.400,P=0.020);RBP组发生TLF损伤6例,非RBP组发生TLF损伤11例,RBP组TLF损伤数高于非RBP组(χ2=7.011,P=0.008);18例3至4级椎旁脂肪变性患者和41例非RBP患者，RBP组高于非RBP组(χ2=21.618,P<0.001),RBP组骨水泥质量所占比例高于非RBP组(χ2=6.836,P=0.009)。多因素Logistic回归分析显示IVC(χ2=4.974,P=0.025),TLF损伤(χ2=5.231,P=0.023),椎旁脂肪变性Goutallier分级>2（χ2=15.124，P<0.001）和骨水泥比例（χ2=4.168，P=0.038）是PVP术后RBP的独立危险因素。模型的ROC曲线显示原始模型的AUC为0.816[OR=2.862，95CI（0.776，0.894），P<0.001]。通过200个bootstrap样本对模型进行内部验证，C指数为0.936，校准曲线显示预测概率曲线与实际概率曲线接近。H-L拟合优度检验结果χ2=5.796,P=0.670。DCA分析结果表明，当阈值范围为6％至71％时，决策曲线高于None线和All线。
结论：IVC，TLF合并损伤,Goutallier等级>2级的椎旁肌脂肪变性和骨水泥弥散与肿块类型是PVP术后RBP的独立危险因素。建立的PVP后RBP风险预测模型具有良好的预测性能和良好的临床实用性。
