Tian Long, Hu Meng, Lu Junsong, Long Junren. Construction of nomogram model for poor early pain relief of thoracolumbar osteoporotic vertebral compression fractures treated with vertebral augmentation[J]. Journal of Spinal Surgery, 2023, 21(5): 331-337.
Construction of nomogram model for poor early pain relief of thoracolumbar osteoporotic vertebral compression fractures treated with vertebral augmentation
Department of Orthopaedics, Langzhong People's Hospital, Nanchong 637400, Sichuan, China
Abstract: Objective To establish a Nomogram model of poor early pain relief for thoracolumbar osteoporotic vertebral compression fractures(OVCF) treated with vertebral augmentation. Methods A total of 228 patients with OVCF who were treated with vertebral augmentation from January 2020 to April 2022 were selected for the study. The general information, underlying diseases, diseases-related factors and surgery-related factors of the patients were collected. According to the early postoperative pain relief, the patients were divided into pain relief group(n=193)and poor pain relief group(n=35), and the differences in the above data between the 2 groups were compared. LASSO regression was used to screen the covariates, and multivariate logistic regression was performed to select the factors that may affect the early pain relief of OVCF treated with vertebral augmentation. A nomogram model established based on the multivariate analysis results and internal verification was carried out. Results There were statistically significant differences in the history of lumbar injuries, fracture severity, cortical rupture, recovery of anterior vertebral height, recovery of middle vertebral height, bone cement leakage, distribution type of bone cement, number of fractured vertebral bodies, soft tissue sealing, and CT values between the pain relief group and the pain relief poor group(P<0.05). The results of multivariate analysis on the basis of LASSO regression showed that the history of lumbar injury, fracture severity, cortical rupture, percentage of vertebral body with bone cement, recovery of anterior vertebral height, bone cement leakage and distribution type of bone cement were independent influencing factors for poor early pain relief of OVCF treated with vertebral augmentation(P<0.05). The nomogram model was established based on the above factors. The analysis result of the receiver operating characteristic curve showed that the area under the curve of the model was 0.900(95% confidence interval was 0.824 - 0.976). Bootstrap verification showed that the prediction probability of the model was basically consistent with the actual probability. H-L goodness of fit test showed that there was no statistically significant difference between the prediction probability of the nomogram model and the actual probability(P > 0.05). Conclusions Poor early pain relief in OVCF patients treated with vertebral augmentation is mainly affected by the history of lumbar injury, fracture severity, cortical rupture, percentage of vertebral body with bone cement, recovery of anterior vertebral height, leakage of bone cement and distribution type of bone cement. The nomogram model established based on the above factors has high accuracy and differentiation in predicting poor early pain relief.
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