Shandong University of Traditional Chinese Medicine, Jinan, China.
Jinan Vocational College of Nursings, Jinan, China.
Orthop Surg. 2023 Apr;15(4):961-972. doi: 10.1111/os.13655. Epub 2023 Jan 31.
New vertebral compression fracture (NVCF) occurring after bone cement injection in middle-aged and elderly patients with vertebral compression fracture is very common. Preoperative baseline characteristics and surgical treatment parameters have been widely studied as a risk factor, but the importance of the patients' laboratory indicators has not been thoroughly explored. We aimed to explore the relationship between laboratory indicators and NVCF, and attempt to construct a clinical prediction model of NVCF together with other risk factors.
Retrospective analysis was performed for 200 patients who underwent bone cement injection (percutaneous kyphoplasty or vertebroplasty) for vertebral compression fractures between January 2019 and January 2020. We consulted the relevant literature and collated the factors affecting the occurrence of NVCF. Feature selection of patients with NVCF was optimized using the least absolute shrinkage and selection operator regression model, which was used to conduct multivariable logistic regression analysis, to create a predictive model incorporating the selected features. The discrimination, calibration, and clinical feasibility of the predictive model were assessed using the concordance index (C-index), calibration plots, and decision curve analysis. Internal validation was performed using Bootstrap resampling verification.
Time from injury to surgery exceeding 7 days, low osteocalcin levels, elevated homocysteine levels, osteoporosis, mode of operation (percutaneous vertebroplasty), lack of postoperative anti-osteoporosis treatment, and poor diffusion of bone cement were independent risk factors for NVCF in middle-aged and elderly patients with vertebral compression fracture after bone cement injection. The C-index of the nomogram constructed using these seven factors was 0.895, indicating good discriminatory ability. The calibration plot showed that the model was well calibrated. Bootstrap resampling verification yielded a significant C-index of 0.866. Decision curve analysis demonstrated that the greatest clinical net benefit for predicting NVCF after bone cement injection could be achieved with a threshold of 1%-91%.
This nomogram can effectively predict NVCF incidence after bone cement injection in middle-aged and elderly patients with vertebral compression fracture, thus aiding clinical decision-making and postoperative management, promoting effective postoperative rehabilitation, and improving the quality of life.
中老年椎体压缩性骨折患者骨水泥注射后新发椎体压缩性骨折（NVCF）非常常见。术前基线特征和手术治疗参数已被广泛研究为危险因素，但患者实验室指标的重要性尚未得到深入探讨。我们旨在探讨实验室指标与 NVCF 的关系，并尝试与其他危险因素一起构建 NVCF 的临床预测模型。
对 2019 年 1 月至 2020 年 1 月期间接受骨水泥注射（经皮椎体后凸成形术或椎体成形术）治疗的 200 例椎体压缩性骨折患者进行回顾性分析。我们查阅了相关文献，整理了影响 NVCF 发生的因素。使用最小绝对收缩和选择算子回归模型对 NVCF 患者的特征进行优化选择，进行多变量逻辑回归分析，创建包含所选特征的预测模型。使用一致性指数（C 指数）、校准图和决策曲线分析评估预测模型的区分度、校准度和临床可行性。使用 Bootstrap 重采样验证进行内部验证。
从受伤到手术的时间超过 7 天、低骨钙素水平、高同型半胱氨酸水平、骨质疏松症、手术方式（经皮椎体成形术）、缺乏术后抗骨质疏松治疗以及骨水泥弥散不良是中老年椎体压缩性骨折患者骨水泥注射后发生 NVCF 的独立危险因素。使用这 7 个因素构建的列线图的 C 指数为 0.895，表明具有良好的区分能力。校准图显示模型校准良好。Bootstrap 重采样验证得到的 C 指数显著为 0.866。决策曲线分析表明，预测骨水泥注射后 NVCF 的最佳临床净效益阈值为 1%-91%。
该列线图可有效预测中老年椎体压缩性骨折患者骨水泥注射后 NVCF 的发生率，从而辅助临床决策和术后管理，促进有效的术后康复，提高生活质量。
