Abstract:

Objective　To explore the influencing factors of prognosis after decompression surgery for T10-L2 incomplete burst thoracolumbar vertebral fractures with spinal canal invasion. Methods　A total of 122 patients with spinal canal invasion type T10-L2 incomplete burst thoracolumbar vertebral fractures who were treated in Shaanxi Provincial People's Hospital from January 2021 to January 2024 were selected. Among them, there were 67 males and 55 females; 73 cases were under 60 years old and 49 cases were 60 years old or above. All patients were followed up for 6 months after surgery to analyze the prognosis. The differences in clinical data between poor prognosis and good prognosis patients were compared by independent sample t test or χ² test. Logistic regression analysis was used to identify the influencing factors of poor prognosis. A nomogram model was constructed and its value in predicting poor prognosis was analyzed. Results　All 122 patients successfully completed the surgery and were followed up for 6 months after surgery, including 28 patients with poor prognosis and 94 patients with good prognosis. The proportions of age ≥60 years old, osteoporosis, and Thoracolumbar Injury Classification and Severity Score (TLICS) ≥8 points in the poor prognosis group were 64.29% (18/28), 46.43% (13/28), and 71.43% (20/28), which were higher than those in the good prognosis group (all P<0.05); there was no statistically significant difference in the gender, body mass index, hypertension, diabetes, injured vertebra position, time from injury to admission, compression rate of the injured vertebra, or Cobb angle between the poor prognosis group and the good prognosis group (all P>0.05). Logistic regression analysis showed that age, osteoporosis, and TLICS were risk factors for poor prognosis in patients (all P<0.05). A nomogram model for predicting poor prognosis was constructed based on age, osteoporosis, and TLICS. The area under the curve of the nomogram model for predicting poor prognosis was 0.917 (95%CI: 0.866 - 0.969), P<0.05, with a sensitivity of 90.00% and a specificity of 77.50%. Conclusions　The prognosis of T10-L2 incomplete burst thoracolumbar vertebral fractures with spinal canal invasion after decompression surgery is influenced by the patients' age, osteoporosis, and TLICS. The constructed nomogram model based on these factors has a good predictive value for the patients' prognosis.

Key words:

Spinal canal invasion type, Incomplete burst thoracolumbar vertebral fractures, Decompression surgery, Prognosis, Influencing factors

摘要：

目的　探讨椎管侵占型T10～L2不完全爆裂胸腰椎骨折减压术后预后的影响因素。方法　选取2021年1月至2024年1月在陕西省人民医院治疗的椎管侵占型T10～L2不完全爆裂胸腰椎骨折患者122例，其中男67例，女55例；年龄<60岁73例，≥60岁49例。所有患者术后随访6个月，分析预后情况，采用独立样本t检验或χ²检验比较预后不良和预后良好患者临床资料差异，采用logistic回归分析预后不良的影响因素，构建列线图模型并分析其预测预后不良的价值。结果　122例患者均顺利完成手术，术后6个月随访，其中预后不良28例、预后良好94例。预后不良患者年龄≥60岁、骨质疏松、胸腰椎损伤分类和严重程度评分（TLICS）≥8分比例分别为64.29%（18/28）、46.43%（13/28）和71.43%（20/28），高于预后良好患者（均P<0.05）；预后不良和预后良好患者性别、体重指数、高血压、糖尿病、伤椎位置、受伤至入院时间、伤椎高度压缩率、Cobb角比较差异均无统计学意义（均P>0.05）。logistic回归分析显示：年龄、骨质疏松、TLICS是患者预后不良的危险因素（均P<0.05）。依据年龄、骨质疏松、TLICS进行预测预后不良的列线图模型构建，列线图模型预测预后不良的曲线下面积为0.917（95%CI：0.866～0.969），P<0.05，灵敏度和特异度分别为90.00%和77.50%。结论　椎管侵占型T10～L2不完全爆裂胸腰椎骨折减压术后预后受患者年龄、骨质疏松、TLICS的影响，基于上述因素构建的列线图模型对于患者预后有较好的预测价值。

关键词:

椎管侵占型, 不完全爆裂胸腰椎骨折, 减压术, 预后, 影响因素