Abstract：Objective: To construct and verify a Nomogram model for predicting the risk of postoperative venous thromboembolism (VTE) in patients with thoracolumbar fracture, and thus providing a reference for prevention and treatment of VTE. Methods: A total of 252 patients with thoracolumbar fracture admitted to our hospital from June 2020 to February 2023 were enrolled. Lower extremity vascular ultrasound examination was performed at 14 days postoperatively. According to the presence and absence of VTE, the patients were divided into VTE group (n=43) and non-VTE group (n=209). The clinical data of the two groups were assessed, and the influencing factors of postoperative VTE in patients with thoracolumbar fracture were analyzed by least absolute shrinkage and selection operator (LASSO)-Logistic regression. A Nomogram prediction model was constructed, and the model was evaluated by calibration curve and receiver operating characteristic (ROC) curve. Results: The ratio of patients ≥60 years old, hyperlipidemia, general anesthesia, lumbar and back fascia injury, bone mineral density ≥ -2.5g /cm2 and body mass index in VTE group were significantly higher than those in non-VTE group, the time from fracture to admission, the time from fracture to operation and the operation time were significantly longer than those in non-VTE group. Hemoglobin (Hb) and albumin (ALB) in VTE group were significantly lower than those in non-VTE group (P<0.05). The regression screening variables by LASSO regression were age, lumbar and back fascia injury, pooled osteoporosis, body mass index, time from fracture to admission, ALB, Hb, and operation time. Age, lumbar and back fascia injury, pooled osteoporosis, body mass index, time from fracture to admission, ALB, operation time, and Hb were factors that influence the incidence of postoperative VTE in patients with thoracolumbar fractures (P<0.05). Based on the results obtained from LASSO-logistic regression, a Nomogram prediction model was constructed. The ROC curve showed that the model had good predictive value for predicting postoperative VTE in patients in both the training and validation sets. The calibration results showed a high consistency degree of agreement between the predicted incidence of postoperative VTE and actual events in both sets. Conclusion: The factors influencing the occurrence of postoperative VTE in patients with thoracolumbar fractures were age, lumbar and back fascia injury, pooled osteoporosis, body mass index, time from fracture to admission, ALB, Hb, and operation time. Based on these factors, a Nomogram prediction model was constructed to predict the occurrence of postoperative VTE with good consistency and efficacy.
关艳, 徐文硕, 付莹, 孙铭霞, 孙彦豹. 胸腰椎骨折患者术后静脉血栓栓塞风险Nomogram预测模型的建立与验证[J]. 河北医学, 2024, 30(12): 2084-2091.
GUAN Yan, XU Wenshuo, FU Ying, et al. Establishment and Verification of a Nomogram Model to Predict the Risk of Postoperative Venous Thromboembolism in Patients with Thoracolumbar Fracture. HeBei Med, 2024, 30(12): 2084-2091.
[1] Huneidi M,Farah K,Meyer M,et al.Thoracolumbar vertebral fracture in unoperated idiopathic scoliosis[J].Orthop Traumatol Surg Res,2023,109(6):103513. [2] Wang HY,Lv B,Li WF,et al.Diagnostic performance of the caprini risk assessment model combined with d-dimer for preoperative deep vein thrombosis in patients with thoracolumbar fractures caused by high-energy injuries[J].World Neurosurg,2022,157(1):410-416. [3] Vasu ST,Raheja L,Parmar K,et al.Efficacy and safety profile of tranexamic acid in traumatic thoracolumbar fracture management:a systematic review and meta-analysis[J].Int Spine Surg,2022,16(3):567-580. [4] Zhang B,Wang JC,Jiang YZ,et al.Effectiveness and postoperative rehabilitation of one-stage combined anterior-posterior surgery for severe thoracolumbar fractures with spinal cord injury[J].World Clin Cases,2022,10(18):6001-6008. [5] 姚明锋,蒋晖,潘育强,等.3种不同手术入路椎弓根钉棒系统内固定治疗胸腰椎骨折的比较研究[J].中医正骨,2021,33(10):16-22. [6] Al Mamun Choudhury A,Alam MS,Jonayed S,et al.Long-segment versus short-segment pedicle screw fixation including fractured vertebrae for the management of unstable thoracolumbar burst fractures[J].Cureus,2023,15(2):35235. [7] Wang HY,Pei HL,Ding WY,et al.Risk factors of postoperative deep vein thrombosis (DVT) under low molecular weight heparin (LMWH) prophylaxis in patients with thoracolumbar fractures caused by high-energy injuries[J].Thromb Thrombolysis,2021,51(2):397-404. [8] 邵露露,余文霞,唐青,等.胸腰椎骨折术后深静脉血栓的预防与护理[J].中国矫形外科杂志,2019,27(24):2295-2297. [9] 易伟林,梁斌,陈峰,等.腰椎融合术后早期下肢深静脉血栓形成的相关危险因素分析[J].中国脊柱脊髓杂志,2017,27(9):823-828. [10] Zhang JL,Fang YY,Pang HY,et al.Association between age and incidence of deep vein thrombosis in patients with spinal cord injury:an observational cross-sectional study[J].Spinal Cord,2022,60(11):1006-1013. [11] Rastogi P,Kumar N,Ahluwalia J,et al.Thrombophilic risk factors are laterally associated with apolipoprotein E gene polymorphisms in deep vein thrombosis patients:an Indian study[J].Phlebology,2019,34(5):324-335. [12] Wu LQ,Cheng B.A nomogram to predict postoperative deep vein thrombosis in patients with femoral fracture:a retrospective study[J].Orthop Surg Res,2023,18(1):463.
2024, Vol. 30 
冀公网安备13080202000677号