脊柱骨折伴脊髓损伤患者术中压力性损伤列线图预测模型构建与验证OA

Objective To identify risk factors for intraoperative pressure injury(PI)in patients with spinal frac-ture complicated by spinal cord injury(SCI),and to develop and validate a nomogram-based prediction model for early risk stratification and targeted intervention.Methods A total of 210 patients with spinal fracture and SCI treated be-tween January 2022 and May 2024 were included as the training cohort.Patients were categorized into PI and non-PI groups based on the occurrence of intraoperative PI.Univariate analysis and multivariable logistic regression were per-formed to identify independent risk factors,which were subsequently used to construct a nomogram.An independent vali-dation cohort of 90 patients(June 2024 to June 2025)was used for external validation.Model performance was evaluated using the area under the receiver operating characteristic curve(AUC),sensitivity,specificity,calibration curves,and the Hosmer-Lemeshow goodness-of-fit test.Results In the training cohort,44 patients(20.95％)developed intra-operative PI.Multivariable logistic regression identified operative duration,intraoperative blood loss,age,diabetes melli-tus,Braden score,and preoperative serum albumin as independent predictors of intraoperative PI(all P＜0.05).The no-mogram demonstrated good discrimination,with an AUC of 0.862,sensitivity of 0.705,and specificity of 0.886 in the training cohort.Calibration analysis showed good agreement between predicted and observed outcomes.The Hosmer-Lemeshow test indicated adequate model fit(x=7.893,P=0.444).In the validation cohort,the model achieved an AUC of 0.855,sensitivity of 0.714,and specificity of 0.870.Conclusion The nomogram model for predicting intraop-erative pressure injury in patients with spinal fracture and SCI demonstrates good predictive performance and reliability.It may serve as a practical tool for identifying high-risk patients and guiding early preventive strategies in perioperative care.