[1]裴孝鹏,杨勇,孙宜保,等.胸腰椎爆裂骨折患者内固定术后并发脊柱后凸畸形的危险因素分析及风险预测模型建立[J].中医正骨,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内固定术后并发脊柱后凸畸形的危险因素分析及风险预测模型建立()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第36卷
期数:
2024年12期
页码:
8-13,19
栏目:
临床研究
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:
裴孝鹏; 杨勇; 孙宜保; 陈爽; 范富有; 代耀军; 李毅力
郑州市骨科医院,河南 郑州 450052
Author(s):
PEI Xiaopeng; YANG Yong; SUN Yibao; CHEN Shuang; FAN Fuyou; DAI Yaojun; LI Yili
Zhengzhou Orthopaedic Hospital,Zhengzhou 450052,Henan,China
关键词:
脊柱骨折;  胸椎;  腰椎;  骨折固定术; 内;  手术后并发症;  脊柱后凸;  危险因素;  风险;  预测
Keywords:
spinal fractures;  thoracic vertebrae;  lumbar vertebrae;  fracture fixation; internal;  postoperative complications;  kyphosis;  risk factors;  risk;  forecasting
摘要:
目的:分析胸腰椎爆裂骨折患者内固定术后并发脊柱后凸畸形的危险因素,并建立风险预测模型。方法:以2017年3月至2020年3月,在郑州市骨科医院接受椎弓根螺钉内固定术或椎弓根螺钉内固定术联合仿生骨柱植骨术治疗的患者为研究对象,根据术后2年内是否并发脊柱后凸畸形分为2组。收集2组患者性别、年龄、体质量指数、是否合并内科疾病、骨折节段、骨折原因等一般资料和是否合并椎间盘损伤、骨折爆裂程度、胸腰椎AO脊柱损伤评分(thoracolumbar AO Spine injury score,TLAOSIS)等损伤情况评价指标,以及手术入路、固定节段长短等手术情况。测量术前影像学参数,在术前X线侧位片上测量椎体楔形角、骨折节段Cobb角和椎体前缘高度(计算椎体前缘高度比值),在术前X线正位片上测量上位椎间盘角和下位椎间盘角。比较 2组患者的一般资料、损伤情况评价指标、手术情况和影像学参数,进行单因素分析。根据单因素分析结果,采用Logistic回归分析胸腰椎爆裂骨折患者内固定术后并发脊柱后凸畸形的危险因素。依据危险因素分析结果建立胸腰椎爆裂骨折患者内固定术后并发脊柱后凸畸形的风险预测列线图模型,并对模型进行评价。结果:共纳入176例患者,并发畸形组30例,未并发畸形组 146例。单因素分析结果显示,2组患者合并椎间盘损伤情况、骨折爆裂程度、TLAOSIS,以及术前椎体前缘高度比值、骨折节段Cobb角、上位椎间盘角、下位椎间盘角的组间差异,均有统计学意义。Logistic回归分析结果显示,合并椎间盘损伤、TLAOSIS>8分、完全爆裂骨折、术前椎体前缘高度比值<50%、术前上位椎间盘角≤3.5°是胸腰椎爆裂骨折患者内固定术后并发脊柱后凸畸形的危险因素[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]。列线图模型预测结果显示,上述5个因素对应的胸腰椎爆裂骨折患者内固定术后并发脊柱后凸畸形的风险预测值分别为44.0分、42.5分、33.0分、39.0分、51.5分,并发脊柱后凸畸形的概率为0.10～0.56。受试者操作特征曲线分析结果显示,该模型预测胸腰椎爆裂骨折患者内固定术后并发脊柱后凸畸形的曲线下面积为0.921(P=0.000),灵敏度为78.43%,特异度为85.52%; 模型验证C-index值为0.823,校正曲线和标准曲线拟合度较好,模型校准度良好。决策曲线分析结果显示,根据该模型对胸腰椎爆裂骨折患者内固定术后并发脊柱后凸畸形的风险进行预测,可获得较好的净收益,阈值概率为0.02～0.95。结论:合并椎间盘损伤、TLAOSIS>8分、完全爆裂骨折、术前椎体前缘高度比值<50%、术前上位椎间盘角≤3.5°均为胸腰椎爆裂骨折患者内固定术后并发脊柱后凸畸形的危险因素; 基于这些因素构建的风险预测列线图模型,对于胸腰椎爆裂骨折患者内固定术后并发脊柱后凸畸形具有一定的预测价值。
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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备注/Memo

备注/Memo:
基金项目:郑州市医疗卫生领域科技创新指导计划项目(2024YLZDJH196)
通讯作者:杨勇 E-mail:13603862327@126.com
更新日期/Last Update: 1900-01-01