构建老年患者胸腰椎椎体成形术后运动恐惧症的风险预测模型OA
Construction of a risk prediction model for kinesiophobia after thoracolumbar vertebroplasty in elderly patients
目的:分析老年患者胸腰椎椎体成形术后发生运动恐惧症的影响因素,并构建预测运动恐惧症发生风险的列线图模型.方法:回顾性分析2021年12月至2024年12月于我院行胸腰椎椎体成形术的196例老年患者的临床资料.根据运动恐惧评定量表(TSK)评分分为有运动恐惧症组(n=138)和无运动恐惧症组(n=58).采用LASSO回归对潜在预测变量进行筛选,采用多因素Logistic回归分析影响运动恐惧症发生的因素,基于影响因素构建预测列线图,并进行内部验证与性能评价.采用受试者工作特征(ROC)曲线下面积评估模型的区分度,校准曲线评估预测准确性,Hosmer-Lemeshow检验评价拟合优度,决策曲线分析评价临床净获益.结果:LASSO回归筛选变量结果显示,共4个因素被筛选为老年患者胸腰椎椎体成形术后运动恐惧症的潜在影响因素.多因素Logistic回归分析结果显示,VAS评分(OR=1.568,95%CI:1.320～1.818)、GAD-2评分(OR=1.145,95%CI:1.013～1.398)、PHQ-2评分(OR=1.402,95%CI:1.272～1.763)、SSRS评分(OR=0.325,95%CI:0.183～0.575)是老年患者胸腰椎椎体成形术后运动恐惧症发生的影响因素(P＜0.05).根据ROC曲线分析,所得AUC为0.995(95%CI:0.971～0.999),区分度较好;校正曲线拟合优度检验显示校准度较好(χ2=0.321,P=0.997＞0.05);决策曲线分析结果显示,模型的阈值＞0.04时,所提供的临床净收益均高于VAS评分、GAD-2评分、PHQ-2评分、SSRS评分.结论:本研究基于VAS评分、GAD-2评分、PHQ-2评分、SSRS评分构建的列线图预测模型展现出良好的预测能力,有助于指导老年患者胸腰椎椎体成形术后运动恐惧症的个体化干预.
Objective:To analyze the influencing factors of kinesiophobia in elderly patients after thoracolumbar vertebroplasty and construct a nomogram model for predicting the risk of kinesiophobia.Methods:The clinical data of 196 elderly patients who underwent thoracolumbar vertebroplasty from Dec 2021 to Dec 2024 in our hospital were retrospectively analyzed.They were divided into kinesiophobia group(n=138)and non-kinesiophobia group(n=58)according to the score of Treadmill Scale for Kinesiophobia(TSK).LASSO regression was used to screen potential predictive variables,and multivariate logistic regression was used to analyze factors influencing the occurrence of kinesiophobia.A predictive nomogram was constructed based on these influencing factors,followed by internal validation and performance evaluation.The model's discriminatory ability was assessed using the area under the receiver operating characteristic(ROC)curve.The predictive accuracy was evaluated via calibration curves,model goodness-of-fit was examined through the Hosmer-Lemeshow test,and clinical net benefit was analyzed using decision curve analysis.Results:LASSO regression results showed that four factors were screened as potential influencing factors for kinesiophobia in elderly patients after thoracolumbar vertebroplasty.Muitivariate logistic regression analysis showed that VAS score(OR=1.568,95%CI:1.320-1.818),GAD-2 score(OR=1.145,95%CI:1.013-1.398),PHQ-2 score(OR=1.402,95%CI:1.272-1.763),and SSRS score(OR=0.325,95%CI:0.183-0.575)were influencing factors for the occurrence of kinesiophobia(P＜0.05).According to the ROC curve analysis,the obtained AUC was 0.995(95%CI:0.971-0.999),indicating good discriminative ability.The goodness-of-fit test of the calibration curve showed good calibration(χ2=0.321,P=0.997＞0.05).The decision curve analysis showed that the model's thresholds of＞0.04 provided higher net clinical benefits than the VAS score,GAD-2 score,PHQ-2 score,and SSRS score.Conclusion:The prediction model based on VAS score,GAD-2 score,PHQ-2 score,and SSRS score demonstrates good predictive ability,which can help to guide the individualized intervention for kinesiophobia after thoracolumbar vertebroplasty in elderly patients.
李文
新余银河医院骨外科,江西 新余 338000
医药卫生
胸腰椎椎体成形术运动恐惧症列线图
thoracolumbar vertebroplastykinesiophobianomogram
《沈阳医学院学报》 2026 (1)
24-29,6
江西省卫生计生委科技计划项目(No.20197333)
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