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[1]裴孝鵬,楊勇,孫宜保,等.胸腰椎爆裂骨折患者內(nèi)固定術(shù)后并發(fā)脊柱后凸畸形的危險(xiǎn)因素分析及風(fēng)險(xiǎn)預(yù)測(cè)模型建立[J].中醫(yī)正骨,2024,36(12):8-13,19.
 PEI Xiaopeng,YANG Yong,SUN Yibao,et al.Risk factors and a risk forecasting model for spinal kyphosis deformity after internal fixation in patients with thoracolumbar burst fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2024,36(12):8-13,19.
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胸腰椎爆裂骨折患者內(nèi)固定術(shù)后并發(fā)脊柱后凸畸形的危險(xiǎn)因素分析及風(fēng)險(xiǎn)預(yù)測(cè)模型建立()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第36卷
期數(shù):
2024年12期
頁(yè)碼:
8-13,19
欄目:
臨床研究
出版日期:
2024-12-20

文章信息/Info

Title:
Risk factors and a risk forecasting model for spinal kyphosis deformity after internal fixation in patients with thoracolumbar burst fractures
作者:
裴孝鵬楊勇孫宜保陳爽范富有代耀軍李毅力
鄭州市骨科醫(yī)院,河南 鄭州 450052
Author(s):
PEI XiaopengYANG YongSUN YibaoCHEN ShuangFAN FuyouDAI YaojunLI Yili
Zhengzhou Orthopaedic Hospital,Zhengzhou 450052,Henan,China
關(guān)鍵詞:
脊柱骨折 胸椎 腰椎 骨折固定術(shù)內(nèi) 手術(shù)后并發(fā)癥 脊柱后凸 危險(xiǎn)因素 風(fēng)險(xiǎn) 預(yù)測(cè)
Keywords:
spinal fractures thoracic vertebrae lumbar vertebrae fracture fixationinternal postoperative complications kyphosis risk factors risk forecasting
摘要:
目的:分析胸腰椎爆裂骨折患者內(nèi)固定術(shù)后并發(fā)脊柱后凸畸形的危險(xiǎn)因素,并建立風(fēng)險(xiǎn)預(yù)測(cè)模型。方法:以2017年3月至2020年3月,在鄭州市骨科醫(yī)院接受椎弓根螺釘內(nèi)固定術(shù)或椎弓根螺釘內(nèi)固定術(shù)聯(lián)合仿生骨柱植骨術(shù)治療的患者為研究對(duì)象,根據(jù)術(shù)后2年內(nèi)是否并發(fā)脊柱后凸畸形分為2組。收集2組患者性別、年齡、體質(zhì)量指數(shù)、是否合并內(nèi)科疾病、骨折節(jié)段、骨折原因等一般資料和是否合并椎間盤損傷、骨折爆裂程度、胸腰椎A(chǔ)O脊柱損傷評(píng)分(thoracolumbar AO Spine injury score,TLAOSIS)等損傷情況評(píng)價(jià)指標(biāo),以及手術(shù)入路、固定節(jié)段長(zhǎng)短等手術(shù)情況。測(cè)量術(shù)前影像學(xué)參數(shù),在術(shù)前X線側(cè)位片上測(cè)量椎體楔形角、骨折節(jié)段Cobb角和椎體前緣高度(計(jì)算椎體前緣高度比值),在術(shù)前X線正位片上測(cè)量上位椎間盤角和下位椎間盤角。比較 2組患者的一般資料、損傷情況評(píng)價(jià)指標(biāo)、手術(shù)情況和影像學(xué)參數(shù),進(jìn)行單因素分析。根據(jù)單因素分析結(jié)果,采用Logistic回歸分析胸腰椎爆裂骨折患者內(nèi)固定術(shù)后并發(fā)脊柱后凸畸形的危險(xiǎn)因素。依據(jù)危險(xiǎn)因素分析結(jié)果建立胸腰椎爆裂骨折患者內(nèi)固定術(shù)后并發(fā)脊柱后凸畸形的風(fēng)險(xiǎn)預(yù)測(cè)列線圖模型,并對(duì)模型進(jìn)行評(píng)價(jià)。結(jié)果:共納入176例患者,并發(fā)畸形組30例,未并發(fā)畸形組 146例。單因素分析結(jié)果顯示,2組患者合并椎間盤損傷情況、骨折爆裂程度、TLAOSIS,以及術(shù)前椎體前緣高度比值、骨折節(jié)段Cobb角、上位椎間盤角、下位椎間盤角的組間差異,均有統(tǒng)計(jì)學(xué)意義。Logistic回歸分析結(jié)果顯示,合并椎間盤損傷、TLAOSIS>8分、完全爆裂骨折、術(shù)前椎體前緣高度比值<50%、術(shù)前上位椎間盤角≤3.5°是胸腰椎爆裂骨折患者內(nèi)固定術(shù)后并發(fā)脊柱后凸畸形的危險(xiǎn)因素[OR=2.965,95%CI(1.682,4.534),P=0.003; OR=2.707,95%CI(1.364,4.216),P=0.009; OR=1.921,95%CI(0.716,3.357),P=0.022; OR=2.221,95%CI(0.986,3.627),P=0.013; OR=3.654,95%CI(1.867,4.853),P=0.000]。列線圖模型預(yù)測(cè)結(jié)果顯示,上述5個(gè)因素對(duì)應(yīng)的胸腰椎爆裂骨折患者內(nèi)固定術(shù)后并發(fā)脊柱后凸畸形的風(fēng)險(xiǎn)預(yù)測(cè)值分別為44.0分、42.5分、33.0分、39.0分、51.5分,并發(fā)脊柱后凸畸形的概率為0.10~0.56。受試者操作特征曲線分析結(jié)果顯示,該模型預(yù)測(cè)胸腰椎爆裂骨折患者內(nèi)固定術(shù)后并發(fā)脊柱后凸畸形的曲線下面積為0.921(P=0.000),靈敏度為78.43%,特異度為85.52%; 模型驗(yàn)證C-index值為0.823,校正曲線和標(biāo)準(zhǔn)曲線擬合度較好,模型校準(zhǔn)度良好。決策曲線分析結(jié)果顯示,根據(jù)該模型對(duì)胸腰椎爆裂骨折患者內(nèi)固定術(shù)后并發(fā)脊柱后凸畸形的風(fēng)險(xiǎn)進(jìn)行預(yù)測(cè),可獲得較好的凈收益,閾值概率為0.02~0.95。結(jié)論:合并椎間盤損傷、TLAOSIS>8分、完全爆裂骨折、術(shù)前椎體前緣高度比值<50%、術(shù)前上位椎間盤角≤3.5°均為胸腰椎爆裂骨折患者內(nèi)固定術(shù)后并發(fā)脊柱后凸畸形的危險(xiǎn)因素; 基于這些因素構(gòu)建的風(fēng)險(xiǎn)預(yù)測(cè)列線圖模型,對(duì)于胸腰椎爆裂骨折患者內(nèi)固定術(shù)后并發(fā)脊柱后凸畸形具有一定的預(yù)測(cè)價(jià)值。
Abstract:
Objective:To analyze the risk factors for spinal kyphosis deformity after internal fixation in patients with thoracolumbar burst fractures(TLBF),and to build a risk prediction model.Methods:The TLBF patients who underwent internal fixation with pedicle screws or internal fixation with pedicle screws combined with bionic bone pillar bone grafting in Zhengzhou Orthopaedic Hospital from March 2017 to March 2020 were selected as the subjects,and they were divided into concurrent deformity group and non-concurrent deformity group according to whether spinal kyphosis deformity was found within 2 years after the surgery.The general information of the patients,including gender,age,body mass index,whether combined with morbus internus,fractured segment,cause of fracture; the injury evaluation information,including whether combined with intervertebral disc(IVD)injury,degree of fracture burst,and thoracolumbar AO Spine injury score(TLAOSIS); the surgical conditions,including surgical approach and length of fixed segments,was collected.In addition,the presurgical X-ray films were extracted for measuring the wedge angle of the vertebral body,the Cobb's angle of the fractured segment,and the anterior border height of the vertebral body(the anterior border height ratio was calculated)on the presurgical lateral X-ray films,as well as the upper and lower IVD angles on the presurgical anteroposterior X-ray films.After that,the general information,injury evaluation indicators,surgical conditions and radiological parameters were compared between the 2 groups,and a single factor analysis was performed,based on which the risk factors for spinal kyphosis deformity after internal fixation in TLBF patients were analyzed by logistic regression,and then,according to the findings,a risk prediction nomogram model for spinal kyphosis deformity after internal fixation in TLBF patients was constructed and evaluated.Results:One hundred and seventy-six TLBF patients were included in the final analysis,with 30 ones in the concurrent deformity group,and 146 ones in the non-concurrent deformity group.The single factor analysis showed that the differences were statistically significant between the 2 groups in combined with IVD injury,the degree of fracture burst,TLAOSIS,presurgical vertebral anterior border height ratio,the Cobb's angle of the fractured segment,the upper IVD angle,and the lower IVD angle.The logistic regression analysis revealed that combined with IVD injury,TLAOSIS>8 points,complete burst fracture,presurgical vertebral anterior border height ratio<50%,and presurgical upper IVD angle≤3.5 degrees were the risk factors for spinal kyphosis deformity after internal fixation in TLBF patients(OR=2.965,95%CI(1.682,4.534),P=0.003; OR=2.707,95%CI(1.364,4.216),P=0.009; OR=1.921,95%CI(0.716,3.357),P=0.022; OR=2.221,95%CI(0.986,3.627),P=0.013; OR=3.654,95%CI(1.867,4.853),P=0.000).The risk prediction nomogram model showcased that the values of the above five factors in predicting spinal kyphosis deformity after internal fixation in TLBF patients were 44.0,42.5,33.0,39.0,and 51.5 points,respectively,with a probability of developing spinal kyphosis deformity ranged from 0.10 to 0.56.The receiver operating characteristics(ROC)curve analysis showed that the area under ROC curve(AUC)of the risk prediction nomogram model in predicting spinal kyphosis deformity after internal fixation in TLBF patients was 0.921(P=0.000),with a sensitivity of 78.43% and a specificity of 85.52%; besides,a good goodness-of-fit presented between the calibration curve and the standard curve,with a concordance index(C-index)of 0.823,suggesting the model had a good calibration.Furthermore,the decision curve analysis(DCA)indicated that a better net benefit was obtained using the nomogram model in predicting spinal kyphosis deformity after internal fixation in TLBF patients,with the threshold probability ranged from 0.02 to 0.95.Conclusion:Combined with IVD injury,TLAOSIS>8 points,complete burst fracture,presurgical vertebral anterior border height ratio<50%,and presurgical upper IVD angle≤3.5 degrees are all the risk factors for spinal kyphosis deformity after internal fixation in TLBF patients.The risk prediction nomogram model constructed based on the above five risk factors has a certain applied value in predicting the risk for spinal kyphosis deformity after internal fixation in TLBF patients.

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備注/Memo

備注/Memo:
基金項(xiàng)目:鄭州市醫(yī)療衛(wèi)生領(lǐng)域科技創(chuàng)新指導(dǎo)計(jì)劃項(xiàng)目(2024YLZDJH196)
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更新日期/Last Update: 1900-01-01