Influencing factors of bone cement leakage after percutaneous vertebroplasty and the construction of nomogram prediction model

WU Hengyang; WANG Mingzhu; WANG Baosheng; WANG Xudong; NI Tongwei; ZHENG Jian; XIA Siwei

doi:10.3969/j.issn.1674-666X.2025.02.005

Abstract：Objective To explore the influencing factors of bone cement leakage in patients after percutaneous vertebroplasty(PVP),and to construct nomogram model based on the influencing factors with the aim of providing a reference for accurate clinical prediction of the risk of bone cement leakage.Methods A retrospective analysis was conducted on the clinical data of 161 patients with osteoporotic vertebral fractures who underwent PVP surgery at Yancheng Tinghu District People's Hospital from January 2022 to February 2024.The patients were divided into two groups based on whether bone cement leakage occurred within 12 months after surgery.Among them,48 patients with bone cement leakage were included in the leakage group,and the remaining 113 patients without bone cement leakage were included in the non leakage group.The baseline data of patients were compared between the two groups,the univariate analysis and multiple Logistic regression analysis was used to screen influencing factors for bone cement leakage,and then a predictive nomogram model based on these factors was constructed.Results Univariate analysis showed that there were no statistical differences in vertebral fissure sign,timing of bone cement injection,fracture morphology,puncture path,and bone density between the two groups(P>0.05).In the leakage group,the proportion of severe vertebral compression,preoperative Cobb angle,and bone cement injection volume were all greater than those in the non leakage group,the differences were statistically significant(P<0.05).The results of binary Logistic regression analysis showed that severe vertebral compression,large preoperative Cobb angle,and high injection volume of bone cement were all factors affecting the occurrence of bone cement leakage after PVP(P<0.05).The degree of vertebral compression,preoperative Cobb angle,and bone cement injection volume were then included in the prediction model to construct a nomogram model.The receiver operating characteristic curve showed that the area under the curve of the training set and validation set were 0.825(95%CI:0.755-0.896)and 0.794(95%CI:0.640-0.948),and the cut-off values were 0.232 and 0.499,indicating good predictive performance of the nomogram model.The calibration curve showed that the deviation between the prediction results of the model and the actual results was relatively small,and the decision curve showed that the model was higher than the None and All curves in most threshold probability ranges.Conclusions Severe vertebral compression,large preoperative Cobb angle,and high injection volume of bone cement are all influencing factors for postoperative bone cement leakage in PVP patients.The nomagram model based on these three factors has good predictive performance.