摘要
目的探讨胸腰椎骨质疏松性椎体压缩性骨折(OVCF)椎体成形术后腰背痛残留风险并进一步构建相关预测模型,旨在为后续临床防治方案制定提供参考。方法回顾性纳入2021年1月至2022年12月于本院接受椎体成形术治疗胸腰椎OVCF患者共120例,根据术后4周腰背疼痛视觉模拟评分分为残留组和未残留组,采用单因素和多因素法评估胸腰椎OVCF椎体成形术后腰背痛残留独立危险因素;同时基于上述因素构建预测模型并分析上述模型用于胸腰椎OVCF椎体成形术后腰背痛残留风险预测临床效能。结果120例胸腰椎OVCF患者中术后4周腰背痛残留13例,发生率为10.83%。单因素分析结果显示,椎体骨折数量、有无椎管内真空裂隙征、有无后筋膜水肿、椎旁肌变性分级及骨水泥分布类型均可能与胸腰椎OVCF椎体成形术后腰背痛残留有关(P<0.05);Logistic回归模型多因素分析结果显示,多椎体骨折、椎管内真空裂隙征、椎旁肌变性≥Ⅲ级及骨水泥块状分布均是胸腰椎OVCF椎体成形术后腰背痛残留独立危险因素(P<0.05)。基于多因素分析所确定独立危险因素构建胸腰椎OVCF椎体成形术后腰背痛残留风险预测偏回归系数方程:发生风险Logit(Y)=0.87+1.97×多椎体骨折+2.74×椎管内真空裂隙征+3.11×椎旁肌变性≥Ⅲ级+1.50×骨水泥块状分布;ROC曲线分析结果显示,上述临床预测模型用于老胸腰椎OVCF椎体成形术后腰背痛残留风险预测临床效能显著优于单一危险因素(P<0.05)。结论胸腰椎OVCF椎体成形术后腰背痛残留可能与包括椎体骨折数量、有无椎管内真空裂隙征、椎旁肌变性分级及骨水泥分布类型在内多种因素有关;而基于上述因素构建预测模型在早期准确识别腰椎OVCF椎体成形术后腰背痛残留高危人群方面显示出更佳临床效能。
Objective To investigate the risk factors of residual low back pain risk after thoracolumbar OVCF vertebroplasty and construct related prediction model to provide reference for the follow-up clinical prevention and treatment plan.Methods 120 patients with thoracolumbar and lumbar vertebrae OVCF received vertebroplasty in our hospital from January 2021 to December 2022 were retrospectively included and were divided into residual group and non-residual group according to the visual analog score of lumbar and back pain 4 weeks after surgery.The independent risk factors of residual low back pain after thoracolumbar and lumbar vertebrae OVCF vertebroplasty were evaluated by univariate and multivariate methods and the prediction model was constructed based on the above factors and the clinical efficacy of the model was analyzed in predicting of residual low back pain risk after thoracolumbar OVCF vertebroplasty.Results There were 13 patients with residual low back pain in 4 weeks after surgery with the incidence of 10.83%in all 120 patients underwent vertebroplasty to treat thoracolumbar OVCF.The results of univariate analysis showed that the number of vertebral fractures,the presence or absence of intravertebral vacuum fracture,the presence or absence of posterior fascia edema,the grade of paravertebral muscle degeneration and the type of bone cement distribution may be related to the residual low back pain after thoracolumbar OVCF vertebroplasty(P<0.05).Multivariate analysis of Logistic regression model showed that multiple vertebral fractures,intravertebral vacuum fissure signs,paravertebral muscle degeneration≥Ⅲand bone cement block distribution were independent residual risk factors for low back pain after thoracolumbar OVCF vertebroplasty(P<0.05).Based on the independent risk factors determined by multi-factor analysis,the partial regression coefficient equation in predicting of residual low back pain risk after OVCF vertebroplasty was constructed:risk Logit(Y)=0.87+1.97×multi-vertebral fracture+2.74×intravertebral vacuum fracture sign+3.11×paravertebral muscle degeneration≥Ⅲ+1.50×bone cement block distribution.ROC curve analysis showed that the above clinical prediction model was significantly more effective than single risk factor in predicting the residual risk of low back pain after thoracolumbar OVCF vertebroplasty(P<0.05).Conclusion The residual low back pain after OVCF vertebroplasty may be related to many factors,including the number of vertebral fractures,the presence or absence of intravertebral vacuum fracture,the grade of paravertebral muscle degeneration and the type of bone cement distribution and the prediction model based on the above factors showed better clinical efficacy in early and accurate identification of high-risk groups with residual low back pain after thoracolumbar OVCF vertebroplasty.
作者
章柯杰
张聪
陈威烨
朱利民
ZHANG Kejie;ZHANG Cong;CHEN Weiye(Hangzhou Fuyang Traditional Chinese Medicine Orthopedics Hospital,Zhejiang 311400,China.)
出处
《浙江创伤外科》
2024年第10期1805-1807,1812,共4页
Zhejiang Journal of Traumatic Surgery
基金
杭州市医药卫生科技项目(B20220262)。
关键词
胸腰椎
骨质疏松性椎体压缩性骨折
椎体成形术
腰背痛残留
Thoracolumbar vertebra
Osteoporotic vertebral compression fracture
Vertebroplasty
Residual low back pain
