Si Chen, Hanming Li, Wenjie Wu, Li Huo, Boxin Wang, Chuanqi Zou, Junxiong Cao
{"title":"预测经皮椎体增强术后夹层椎体骨折的nomogram：一项1年随访的多中心研究。","authors":"Si Chen, Hanming Li, Wenjie Wu, Li Huo, Boxin Wang, Chuanqi Zou, Junxiong Cao","doi":"10.1007/s00586-025-08896-9","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.6000,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"A nomogram for predicting fracture of the sandwich vertebrae after percutaneous vertebral augmentation: a multicenter study with 1-year follow-up.\",\"authors\":\"Si Chen, Hanming Li, Wenjie Wu, Li Huo, Boxin Wang, Chuanqi Zou, Junxiong Cao\",\"doi\":\"10.1007/s00586-025-08896-9\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>\",\"PeriodicalId\":12323,\"journal\":{\"name\":\"European Spine Journal\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":2.6000,\"publicationDate\":\"2025-05-27\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"European Spine Journal\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s00586-025-08896-9\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"European Spine Journal","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s00586-025-08896-9","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
A nomogram for predicting fracture of the sandwich vertebrae after percutaneous vertebral augmentation: a multicenter study with 1-year follow-up.
Purpose: 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.
Methods: 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.
Results: 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.
Conclusions: 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.
期刊介绍：
"European Spine Journal" is a publication founded in response to the increasing trend toward specialization in spinal surgery and spinal pathology in general. The Journal is devoted to all spine related disciplines, including functional and surgical anatomy of the spine, biomechanics and pathophysiology, diagnostic procedures, and neurology, surgery and outcomes. The aim of "European Spine Journal" is to support the further development of highly innovative spine treatments including but not restricted to surgery and to provide an integrated and balanced view of diagnostic, research and treatment procedures as well as outcomes that will enhance effective collaboration among specialists worldwide. The “European Spine Journal” also participates in education by means of videos, interactive meetings and the endorsement of educative efforts.
Official publication of EUROSPINE, The Spine Society of Europe
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