Chen Si, Li Hanming, Wu Wenjie, Huo Li, Wang Boxin, Zou Chuanqi, Cao Junxiong
Affiliated Banan Hospital of Chongqing Medical University, Chongqing, China.
Affiliated Hospital of Southwest Medical University, Luzhou, China.
Eur Spine J. 2025 May 27. doi: 10.1007/s00586-025-08896-9.
This work aimed to investigate the risk factors for fractures in sandwich vertebrae (SDV; an unfractured vertebra located between 2 cemented vertebrae) formed after percutaneous vertebral augmentation (PVA) and to construct a predictive model from this.
This study retrospectively analyzed patients who underwent PVA with the formation of SDV from July 2018 to July 2023 at Affiliated Banan Hospital of Chongqing Medical University. Patients were divided into a fracture group and a control group according to the presence or absence of fracture of the SDV during the 1-year postoperative follow-up period. Independent predictors were confirmed using the least absolute shrinkage and selection operator (LASSO) method, and the nomogram was constructed and transformed into an online calculator. The discrimination, calibration, and clinical applicability of the model were assessed by Area under the receiver operating characteristic curve (AUC), calibration curve analysis, and Decision curve analysis (DCA). Finally, the model was externally validated using data from another centre and internally validated using Bootstrap.
A total of 259 patients were enrolled in this study, and 36 patients had fractures of SDV within one year. Multifactorial analyses showed that low bone mineral density (BMD) (OR = 4.264, 95% CI: 2.245-8.098, P < 0.001), number of PVA > 3 (OR = 3.703, 95% CI: 1.399-9.801, P = 0.008), lack of anti-osteoporosis (OR = 4.051, 95% CI: 1.573-10.430, P = 0.004), postoperative kyphosis angle of sandwich fracture segments (PKASFS) > 10° (OR = 8.273, 95% CI: 2.991-22.881, P < 0.001), and lumbar lordosis minus thoracic kyphosis (LL-TK) < 0° (OR = 3.701, 95% CI: 1.523-8.994, P = 0.004) were screened as independent risk factors. The AUC of the model constructed based on this was 0.881 (95% CI: 0.829-0.933). The calibration curves and DCA verified that the model had satisfactory practical consistency and clinical applicability. The externally validated AUC was 0.859 (95% CI: 0.788-0.930), validating the stability of the model.
BMD, number of PVA, anti-osteoporosis, PKASFS, and LL-TK are independent influencing factors for fractures in SDV within one year, and a model based on this had excellent predictive efficacy.
本研究旨在探讨经皮椎体强化术（PVA）后形成的夹心椎体（SDV，即位于两个骨水泥强化椎体之间的未骨折椎体）骨折的危险因素，并据此构建预测模型。
本研究回顾性分析了2018年7月至2023年7月在重庆医科大学附属巴南医院接受PVA并形成SDV的患者。根据术后1年随访期内SDV是否发生骨折，将患者分为骨折组和对照组。采用最小绝对收缩和选择算子（LASSO）法确定独立预测因素，并构建列线图并转化为在线计算器。通过受试者操作特征曲线下面积（AUC）、校准曲线分析和决策曲线分析（DCA）评估模型的区分度、校准度和临床适用性。最后，使用来自另一个中心的数据对模型进行外部验证，并使用Bootstrap进行内部验证。
本研究共纳入259例患者，其中36例患者在1年内发生SDV骨折。多因素分析显示，低骨密度（BMD）（OR = 4.264，95%CI：2.245 - 8.098，P < 0.001）、PVA次数>3（OR = 3.703，95%CI：1.399 - 9.801，P = 0.008）、未进行抗骨质疏松治疗（OR = 4.051，95%CI：1.573 - 10.430，P = 0.004）、夹心骨折节段术后后凸角（PKASFS）>10°（OR = 8.273，95%CI：2.991 - 22.881，P < 0.001）以及腰椎前凸减去胸椎后凸（LL - TK）<0°（OR = 3.701，95%CI：1.523 - 8.994，P = 0.004）被筛选为独立危险因素。基于此构建的模型AUC为0.881（95%CI：0.829 - 0.933）。校准曲线和DCA验证了该模型具有令人满意的实际一致性和临床适用性。外部验证的AUC为0.859（95%CI：0.788 - 0.930），验证了模型的稳定性。
BMD、PVA次数、抗骨质疏松治疗、PKASFS和LL - TK是1年内SDV骨折的独立影响因素，基于此构建的模型具有出色的预测效能。
