Author:
Ma Yiming,Lu Qi,Wang Xuezhi,Wang Yalei,Yuan Feng,Chen Hongliang
Abstract
Abstract
Background
To investigate the risk factors for new vertebral compression fractures (NVCFs) after percutaneous kyphoplasty (PKP) for osteoporotic vertebral compression fractures (OVCFs) and to create a nomogram to predict the occurrence of new postoperative fractures.
Methods
This was a retrospective analysis of the clinical data of 529 OVCF patients who received PKP treatment in our hospital from June 2017 to June 2020. Based on whether there were new fractures within 2 years after surgery, the patients were divided into a new fracture group and a nonnew fracture group. Univariate and multivariate analyses were used to determine the risk factors for the occurrence of NVCFs after surgery. The data were randomly divided into a training set (75%) and a testing set (25%). Nomograms predicting the risk of NVCF occurrence were created based on the results of the multivariate analysis, and performance was evaluated using receiver operating characteristic curves (ROCs), calibration curves, and decision curve analyses (DCAs). A web calculator was created to give clinicians a more convenient interactive experience.
Results
A total of 56 patients (10.6%) had NVCFs after surgery. The univariate analysis showed significant differences in sex and the incidences of cerebrovascular disease, a positive fracture history, and bone cement intervertebral leakage between the two groups (P < 0.05). The multivariate analysis showed that sex [OR = 2.621, 95% CI (1.030–6.673), P = 0.043], cerebrovascular disease [OR = 28.522, 95% CI (8.749–92.989), P = 0.000], fracture history [OR = 12.298, 95% CI (6.250–24.199), P = 0.000], and bone cement intervertebral leakage [OR = 2.501, 95% CI (1.029–6.082), P = 0.043] were independent risk factors that were positively associated with the occurrence of NVCFs. The AUCs of the model were 0.795 (95% CI: 0.716–0.874) and 0.861 (95% CI: 0.749–0.974) in the training and testing sets, respectively, and the calibration curves showed high agreement between the predicted and actual states. The areas under the decision curve were 0.021 and 0.036, respectively.
Conclusion
Female sex, cerebrovascular disease, fracture history and bone cement intervertebral leakage are risk factors for NVCF after PKP. Based on this, a highly accurate nomogram was developed, and a webpage calculator (https://new-fracture.shinyapps.io/DynNomapp/) was created.
Publisher
Springer Science and Business Media LLC
Subject
Orthopedics and Sports Medicine,Rheumatology
Reference31 articles.
1. Ensrud KE, Crandall CJ. Osteoporosis. Ann Intern Med. 2017;167(3):ITC17–32. published correction appears in Ann Intern Med. 2017 Oct 3;167(7):528.
2. Zhao G, Liu X, Li F. Balloon kyphoplasty versus percutaneous vertebroplasty for treatment of osteoporotic vertebral compression fractures (OVCFs). Osteoporos Int. 2016;27(9):2823–34.
3. Galibert P, Deramond H, Rosat P, et al. Note préliminaire sur le traitement des angiomes vertébraux par vertébroplastie acrylique percutanée Preliminary note on the treatment of vertebral angioma by percutaneous acrylic vertebroplasty. Neurochirurgie. 1987;33(2):166–8.
4. Long Y, Yi W, Yang D. Advances in vertebral augmentation systems for osteoporotic vertebral compression fractures. Pain Res Manag. 2020;2020:3947368. Published 2020 Dec 7.
5. Martinez-Ferrer A, Blasco J, Carrasco JL, et al. Risk factors for the development of vertebral fractures after percutaneous vertebroplasty. J Bone Miner Res. 2013;28(8):1821–9.