Lu Yi, Cai Xiaobing, Shen Juexin, Luo Rengui
Department of Orthopedics, Chongming Branch, Shanghai Tenth People's Hospital, Shanghai, China.
Eur Spine J. 2024 Sep 9. doi: 10.1007/s00586-024-08485-2.
Short-term efficacy of percutaneous kyphoplasty (PKP) for treating osteoporotic vertebral compression fracture (OVCF) in elderly patients is good, but long-term complications such as vertebral recompression (VRC) and adjacent vertebral fracture (AVF) may arise. Identifying risk factors in patients with poor prognoses, we developed a nomogram model to mitigate these potential complications.
Patients with OVCFs who underwent PKP had their medical data retrospectively evaluated. Analysis of the sample included their pre- and postoperative conditions. Stepwise logistic regression analyses were conducted to identify independent risk factors for postoperative complications. For forecasting the likelihood of postoperative comorbidities, we offered a nomogram. The prognostic performance was assessed using the receiver operating characteristic curve (ROC), calibration curve, and decision curve analyses (DCA). Internal model validation using the Bootstrap method.
A total of 235 patients were included in this study. Among them, 147 patients were utilized to develop nomograms and for internal validation, while the remaining 88 patients from a different time period were designated as the external validation cohort. The results of stepwise logistic regression analysis showed that thoracolumbar (TL) fracture, posterior wall of vertebral fracture, vertebral compression > 30%, and lack of continuous anti-osteoporosis therapy after surgery as independent risks associated with poor prognosis. The nomogram exhibited outstanding predictive accuracy and clinical utility.
This study identified four independent predictors of poor prognosis following PKP and devised a straightforward yet efficient predictive model. This model offers valuable insights for guiding clinical decision-making in the management of elderly patients with OVCFs.
经皮椎体后凸成形术（PKP）治疗老年骨质疏松性椎体压缩骨折（OVCF）的短期疗效良好，但可能会出现诸如椎体再压缩（VRC）和相邻椎体骨折（AVF）等长期并发症。为了识别预后不良患者的风险因素，我们开发了一种列线图模型以减轻这些潜在并发症。
对接受PKP治疗的OVCF患者的医疗数据进行回顾性评估。样本分析包括术前和术后情况。进行逐步逻辑回归分析以确定术后并发症的独立风险因素。为预测术后合并症的可能性，我们提供了一个列线图。使用受试者操作特征曲线（ROC）、校准曲线和决策曲线分析（DCA）评估预后性能。使用Bootstrap方法进行内部模型验证。
本研究共纳入235例患者。其中，147例患者用于开发列线图并进行内部验证，而来自不同时间段的其余88例患者被指定为外部验证队列。逐步逻辑回归分析结果显示，胸腰椎（TL）骨折、椎体骨折后壁、椎体压缩>30%以及术后缺乏持续抗骨质疏松治疗是与预后不良相关的独立风险因素。该列线图表现出出色的预测准确性和临床实用性。
本研究确定了PKP术后预后不良的四个独立预测因素，并设计了一个简单而有效的预测模型。该模型为指导老年OVCF患者管理中的临床决策提供了有价值的见解。
