| 陈思,霍理,王伯鑫,等.经皮椎体成形术治疗单节段骨质疏松性椎体压缩骨折术后残余疼痛的列线图模型构建.骨科,2024,15(6): 507-512,518. |
| 经皮椎体成形术治疗单节段骨质疏松性椎体压缩骨折术后残余疼痛的列线图模型构建 |
| Construction of a Nomogram of Postoperative Residual Pain after Percutaneous Vertebroplasty for Single-segment Osteoporotic Vertebral Compression Fractures |
| 投稿时间：2024-06-16 |
| DOI：10.3969/j.issn.1674-8573.2024.06.005 |
| 中文关键词: 残余疼痛 单节段 经皮椎体成形术 骨质疏松性椎体压缩骨折 列线图 |
| 英文关键词: Residual pain Single-segment Percutaneous vertebroplasty Osteoporotic vertebral compressive fractures Nomogram |
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| 中文摘要: |
| 目的 分析经皮椎体成形术（percutaneous vertebroplasty，PVP）治疗单节段骨质疏松性椎体压缩骨折（osteoporotic vertebral compressive fractures，OVCFs）术后残余疼痛的独立危险因素，并以此构建列线图预测模型。方法 纳入2021年1月至2023年6月期间在我院接受PVP治疗的单节段OVCFs病人，根据病人术后3天和1个月疼痛视觉模拟量表（VAS）评分是否均大于等于4分，分为疼痛缓解组和残余疼痛组。采用lasso回归筛选出PVP治疗单节段OVCFs术后残余疼痛的独立预测因子，以此构建一个列线图模型，并将其转换为在线计算器。通过受试者工作特征（ROC）曲线下面积（AUC）、校准曲线分析和决策曲线分析（DCA）对模型的区分度、校准性和临床适用性进行评估。最后在验证队列中对模型进行外部验证，并使用自举法（Bootstrap）对模型进行内部验证。结果 本研究纳入了309例病人，其中男74例，女235例，年龄（75.77±8.30）岁，包括疼痛缓解组280例，残余疼痛组29例。骨折程度、椎体真空裂隙征、腰背肌筋膜炎、骨水泥分布类型、关节突关节侵扰被筛选为独立预测因子。模型的AUC为0.851，95% CI（0.802，0.900）；外部验证值为0.836，95% CI（0.787，0.885）。同时，校准曲线和DCA也验证了该模型具有令人满意的实际一致性和临床适用性。结论 骨折程度、椎体真空裂隙征、腰背肌筋膜炎、骨水泥分布类型、关节突关节侵扰与PVP治疗单节段OVCFs术后残余疼痛有关，基于此建立的模型具有良好的预测效能，可为OVCFs病人的临床决策提供一定的依据。 |
| 英文摘要: |
| Objective To analyze the independent risk factors for residual pain after percutaneous vertebroplasty (PVP) for single-segment osteoporotic vertebral compression fractures (OVCFs) and to construct a nomogram prediction model with these factors. Methods Patients with single-segment OVCFs treated with PVP at our Hospital between January 2021 and June 2023 were included, and patients were divided into remission group and residual pain groups based on whether the visual analogue scale (VAS) score ≥ 4 at 3rd day and 1st month postoperatively. Lasso regression was used to screen independent predictors of residual pain after PVP for single-segment OVCFs, from which a nomogram model was constructed and converted into an online calculator. The model was evaluated for discrimination, calibration, and clinical applicability by means of area under the curve (AUC) of receiver operating characteristic (ROC), calibration curve analysis, and decision curve analysis (DCA). Finally, the model was externally validated in a validation cohort and internally validated using Bootstrap. Results A total of 309 patients were enrolled in this study, 74 males and 235 females, aged (75.77±8.30) years, including 280 in the remission group and 29 in the residual pain group. Degree of fracture, intervertebral vacuum cleft, lumbodorsal fasciitis, bone cement distribution, and facet joint violation were screened as independent predictors. The AUC of the model was 0.851, 95% CI (0.802, 0.900) and the external validation result was 0.836, 95% CI (0.787, 0.885). Also, the calibration curves and DCA verified that the model had satisfactory practical consistency and clinical applicability. Conclusion Degree of fracture, intervertebral vacuum cleft, lumbodorsal fasciitis, bone cement distribution, and facet joint violation were associated with residual pain after PVP treatment of single-segment OVCFs, and the model based on this has good predictive efficacy, which can provide some basis for clinical decision-making in patients with OVCFs. |
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