A risk model for prediction of residual back pain after percutaneous kyphoplasty in patients with osteoporotic vertebral compression fracture

A risk model for prediction of residual back pain after percutaneous kyphoplasty in patients with osteoporotic vertebral compression fracture | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article A risk model for prediction of residual back pain after percutaneous kyphoplasty in patients with osteoporotic vertebral compression fracture Yi Rong, Yihua Zhu, Hao Yu, Heng Yin, Zhen Hua, Yang Shao, Shaoshuo Li, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5716384/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Severe residual back pain (RBP) after percutaneous kyphoplasty (PKP) significantly impacts postoperative prognosis and quality of life in patients. This study aims to identify the risk factors for RBP in patients with osteoporotic vertebral compression fractures (OVCF) following PKP, and to establish and validate a risk prediction model for RBP occurrence after PKP, so as to deepen our understanding of the risk of RBP after PKP, and improve clinical management strategies. Methods 647 patients with OVCF who had PKP surgery from 2018 to 2020 were retrospectively analyzed. 569 cases were used for training the model, and 78 for external validation. The study focused on RBP occurrence after PKP. A nomogram for risk prediction was constructed and the model was tested for accuracy and clinical applicability. Additionally, bootstrap sampling (1000 times) was used for internal validation. Results Based on the model training set, multivariate logistic regression analysis showed that relatively young age, bone mineral density, history of trauma, low back fascia edema, high platelet distribution width value, low serum chlorine value, and no recovery of middle vertebral height were independent risk factors for RBP after PKP (P ≤ 0.05). Calibration curves of the model training and validation sets were between the standard curve and the acceptable line. The Hosmer-Lemeshow goodness-of-fit test indicated that the model training and validation sets were χ 2 = 6.354 and χ 2 = 7.240, respectively (P = 0.608 and 0.511). The clinical decision-making curve showed that the threshold probability interval of the net benefit value of the model was 6.3–82.3% for the training set, 8.7–55.6%, and 72.5–81.3% for the validation set. Conclusion Each independent risk factor and the combined model had good predictive ability, while the combined model had a more vital predictive ability. The constructed nomogram model for predicting RBP risk showed good diagnostic efficacy, accuracy, and clinical applicability and provided a scientific rationale and guidance for clinical prevention and treatment. Trial registration Clinical trianumber not applicable Study design Retrospective casecontrol study. osteoporotic vertebral compression fracture percutaneous kyphoplasty residual back pain regression analysis risk prediction Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9 Figure 10 Figure 11 Figure 12 1. Background With the society aging, the prevalence of osteoporosis is increasing and the decrease in bone strength increases the susceptibility to fracture (Reid and McClung, 2024 ). OVCF is one of the most common complications of osteoporosis, accounting for almost half of the fractures (Park and Park, 2021 ). It usually lacks a clear history of trauma or occurs after low-energy injury neglected by patients, resulting in persistent severe pain, local vertebral kyphosis, respiratory dysfunction, increased risk and mortality of new fractures, and severe decline in quality of life (QoL) (Wen et al., 2022 ). The clinical treatment of OVCF is currently divided into conservative and surgical approaches (Parreira et al., 2017 ). Conservative treatments include bed rest, pain relief with analgesics, muscle relaxants, and other drugs, or braces or external fixation. However, these approaches have slow effects, and prolonged bed rest can worsen bone and mineral loss, thereby increasing the risk of secondary fractures(Ma et al., 2020 ; Jin et al., 2019 ). Percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) are two commonly used surgical approaches for the treatment of OVCF. The injection of polymethylmethacrylate (PMMA) bone cement enhances bone strength and achieves mechanical stability, resulting in immediate pain relief. PMMA treatment has been widely used as OVCF treatment (Long et al., 2020 ). Compared to conservative treatment, minimally invasive surgery can improve patient QoL and improve survival by up to 2 years (Wang et al., 2023 ). PKP relieves pain and improves motor function, while reducing the risk of polymethylmethacrylate leakage, significantly improving patient prognosis (Liu et al., 2024 ; Yu et al., 2022 ). Nonetheless, some patients still experience RBP after surgery, which impede early ambulation, delay functional recovery and significantly affect daily life due to moderate or severe pain (Lin et al., 2023 ; Yang et al., 2019 ). Therefore, early prevention, timely and accurate diagnosis, and treatment are important to the occurrence, development, and prognosis of RBP in OVCF patients. Studies have identified risk factors for RBP after PVP, including low BMD, presence of intraspinal vacuum fissure, combined low back fascia injury, paravertebral muscle degeneration, sarcopenia, multisegment OVCF, unsatisfactory bone cement distribution, inadequate bone cement filling, unrecoverable vertebral body height, large pelvic angle of C7 vertical sagittal axis (SVA) T1 (TPA), and lumbar lordosis (LL)-pelvic incidence (PI) mismatch (Luo et al., 2022 ; Xia et al., 2019 ; Li et al., 2021 ; Bo et al., 2022 ) . As a modified technique based on PVP, PKP uses a balloon (inflatable bone damping) to correct kyphosis caused by vertebral collapse, reducing the average difference in kyphotic wedge angle and the risk of cement leakage while restoring vertebral height and enhancing vertebral stability (Hoyt et al., 2020 ; Wang et al., 2018 ). The pain relief caused by PKP in OVCF patients with vertebral fractures and a residual cavity is more durable than PVP (Wang et al., 2010 ). However, few studies have reported on the risk factors for RBP after PKP. This study hypothesized that a comprehensive analysis of risk factors, the diagnostic efficacy of independent risk factors, and their respective and combined factors could be used to establish a nomogram model to predict the risk of the disease, to provide a rationale and guidance for effective clinical prevention and treatment, to help improve the prognosis through timely intervention. 2. Methods 2.1 Study design A retrospective case-control study was conducted, with univariate analysis and multivariate logistic regression analysis performed. The diagnostic efficacy of each independent risk factor and the combined model was evaluated using receiver operating characteristic (ROC) curves. The nomogram model for predicting risk was further constructed and verified. 2.2 Time and place OVCF patients who were treated in the orthopedic and traumatology ward of the Wuxi Traditional Chinese Medicine Hospital from January 2018 to December 2020 were selected. 2.3 Study subjects The clinical data from 647 OVCF patients who underwent PKP surgery were collected. Data from 569 patients between January 2018 and June 2020 were used as the model training set, including 122 males and 447 females aged 50–97 years (mean ± SD, 71.76 ± 9.066 years). Data from 78 patients collected between July 2020 and December 2020 were used as the model validation set, including 16 males and 62 females, aged 51–96 years (mean ± SD, 73.04 ± 10.43 years). This study was conducted in accordance with the principles outlined in the Declaration of Helsinki and approved by the Institutional Review Board of Wuxi Hospital of Traditional Chinese Medicine (Approval Number: SSF2022022504]). All patients provided signed informed consent. The patients were divided into a pain group (n = 117) and a no pain group (n = 452) based on the diagnostic criteria of postoperative RBP. 2.3.1 Diagnostic criteria for osteoporotic vertebral compression fracture (Skjødt and Abrahamsen, 2023 ) (1) Having a history of osteoporotic fracture or slight trauma, persistent chest, waist, and back pain; pain relief or disappearance when lying down and resting; and pain worsening when changing posture; physical examination indicating activity of the chest and waist was limited, and the vertebrae involved in the fracture showed tenderness and percussion pain. Generally, there is no evidence of lower limb nerve damage, the height was short, or the back was deformed. (2) Imaging examination: radiographic imaging examination revealed a wedge-shaped change or "double concave sign", and some showed a "vacuum sign" in the vertebral body and the formation of false joints. Magnetic resonance imaging (MRI) revealed a hypointense fracture on T1WI, hyperintense or isointense signs on T2WI, and hyperintense signs on the lipid suppression sequence. (3) BMD examination: Dual-energy X-ray absorptiometry (DXA) was used to determine the T value at the spine/hip joint ≤-2.5. Diagnostic criteria for RBP (Li et al., 2021 ) : VAS scores ≥ 4 at 3 days and 1 month after the operation. 2.3.2 Inclusion criteria (1) meets the diagnostic criteria of OVCF and has no neurological injury; (2) received PKP surgery; (3) a single vertebra was responsible for the fracture; (4) meets the diagnostic criteria of RBP; (5) Clinical records and follow-up data were complete. 2.3.3 Exclusion criteria : (1) previous spinal surgery; (2) OVCF patients caused by tumor, infection, or tuberculosis; (3) patients with coagulation dysfunction or systemic disease who cannot tolerate surgery; (4) systemic or local infection; (5) new vertebral fracture occurred after the operation; (6) spinal cord compression and obvious neurological symptoms, such as numbness and/or muscle weakness; (7) clinical medical records and follow-up data were incomplete. 2.4 Surgical method and postoperative management Patients were placed in the prone position, the chest and hip were positioned on a pillow, and the waist was extended. Under the guidance of C-arm fluoroscopy, the pedicle shadow was located on both sides of the fractured vertebral body. Following 1% lidocaine anesthesia, a small opening was cut. The cook needle was inserted through the pedicle of both sides of the vertebral fracture body to 0.5–0.8 cm from the posterior edge of the vertebral body, the guide needle was inserted, and the cook needle was retrieved and then inserted into the working channel. The guide pin was removed, the cancellous bone in the vertebral body was placed 0.5 cm from the leading edge of the vertebral body with the core of the bone cement pusher, and the expansion balloon was expanded to 2.0 mL. The bone cement was prepared and injected into the vertebral body from the working channels on both sides of the patient by the bone cement pusher during the agglomeration period. The bone cement was filled, and the patient reported no adverse reactions. The working channel was removed, and pressure was applied to stop the bleeding. All patients received vitamin D and salmon calcitonin postoperatively. The patients were examined by anteroposterior and lateral X-rays 24 hours postoperatively and were discharged 2–3 days after the operation. Radiographs of the injured vertebrae were regularly examined postoperatively. Patients did not receive nonsteroidal anti-inflammatory drugs (NSAIDs) or opioid analgesics postoperatively unless the patient's postoperative pain was not relieved. 2.5 Main observations Relevant information regarding patients was collected by referring to electronic medical records. Preoperative, intraoperative, and postoperative factors that may affect back pain were evaluated, including (1) general data: sex, age, height, weight, body mass index (BMI); (2) preoperative complications: diabetes, hypertension, pulmonary disease, cardiovascular, and cerebrovascular disease; (3) clinical data: history of trauma, fracture segment, lumbar and dorsal fascia edema, BMD, time from injury to operation and duration of operation; (4) Laboratory examination: preoperative blood cell analysis, liver and kidney function, and coagulation function; (5) Preoperative and postoperative radiological parameters: Cobb angle of the fractured vertebral body before the operation, whether the heights of the anterior, middle, and posterior vertebral bodies are restored 24 hours after the operation, Cobb angle, volume, distribution and shape of bone cement infusion, leakage and position of bone cement, and recovery rate of the vertebral body (Fig. 1 – 7 ). 2.6 Statistical analysis SPSS 25.0 (SPSS, Inc., IBM) software was used to analyze the differences between the two groups. For continuous variables that are consistent with the normal distribution, two independent sample t-tests were conducted. The rank sum test was used for continuous variables that did not conform to normal distribution. For categorical variables, the chi-square test was used for statistical analysis. P-values < 0.05 were considered statistically significant, and α = 0.05 (both sides) was the inspection level. In the model training set, the independent risk factors of RBP after PKP were analyzed by multivariate logistic regression, with the factors with significant differences screened by univariate analysis as independent variables. The ROC curve was used to analyze each independent risk factor, and the combined model was used to predict RBP. The area under the curve (AUC) was calculated to evaluate sensitivity and specificity. Based on this, the nomogram model for predicting the risk of RBP after PKP in OVCF patients was further constructed using RStudio software car, RMS, proc and rmda, and calibration curves were drawn to verify the consistency between the predicted and the actual risk. The clinical decision curve was used to verify the clinical applicability of the model. The bootstrap repeatedly extracted data 1000 times in the training set to verify the model internally, and the validation set is used to verify the model externally. 3. Results 3.1 Univariate analysis of residual back pain after PKP in patients with OVCF Of the 569 patients who underwent PKP surgery, 117 (20.56%) were classified as the postoperative RBP group, and 452 (79.44%) in the same period were identified as the pain-free group. Univariate analysis was performed on the clinical data of the two groups of patients with postoperative RBP. Age, sex, height, weight, BMD, history of trauma, presence or absence of low back fascia edema, platelet distribution width (PDW), serum chlorine, lactate dehydrogenase, whether bone cement was applied to the lower edge of the vertebral body, the amount of bone cement injected, restored height of the anterior and middle vertebrae. The difference in the recovery rate of the vertebral body was statistically significant ( P < 0.05); There were no significant differences between the two groups in BMI, fracture segment, fracture-to-operation time, operation duration, combined medical basic diseases, other laboratory examination results and operation factors ( P > 0.05) ( Table. 1–3 ). 3.2 Multivariate logistic regression analysis of residual back pain after PKP in patients with OVCF Multivariate logistic regression analysis showed that age, BMD value of 2.5 | t | ≤3.5, history of trauma, low back fascia edema, high platelet distribution width, low serum chlorine, and no recovery of middle vertebral height were independent risk factors for RBP after PKP in patients with OVCF ( P 0.05). Table 1 Univariate analysis of clinical data of OVCF patients with residual back pain after PKP. Factor Total number (569 cases) Pain-free group (452 cases) Pain group (117 cases) P-value T-value Age (y) 71.76 ± 9.066 72.23 ± 9.08 69.19 ± 8.56 0.001 3.273 Sex (%) Male (cases) 122 (21.44) 86 (19.03) 36 (30.77) 0.006 7.609 Female (cases) 447 (78.56) 366 (80.97) 81 (69.23) Height (cm) 160.03 ± 7.02 159.59 ± 6.86 161.54 ± 7.95 0.008 -2.645 Weight (kg) 59.20 ± 10.02 58.76 ± 10.04 61.33 ± 9.60 0.013 -2.488 BMI 23.05 ± 3.23 23.01 ± 3.28 23.45 ± 2.90 0.187 -1.321 BMD (%) |t|>3.5 (cases) 251 (44.11) 217 (48.01) 34 (29.06) 0.000 13.53 2.5≤ |t| ≤3.5 (cases) 318 (55.89) 235 (51.99) 83 (70.94) Trauma (%) Yes (cases) 420 (73.81) 320 (70.80) 100 (85.47) 0.001 10.35 No (cases) 149 (26.19) 132 (29.20) 17 (14.53) Posterior fascia edema (%) Yes (cases) 52 (9.14) 25 (5.53) 27 (23.08) 0.000 34.45 No (cases) 517 (90.86) 427 (94.47) 90 (76.92) Fracture segment - 0.636 8.842 Injury time 11.23 ± 22.40 9.33 ± 14.31 9.76 ± 13.41 0.769 -0.294 Operation duration (min) 49.97 ± 17.79 48.22 ± 16.49 48.85 ± 16.77 0.714 -0.367 Complication (%) Hypertension (cases) 154 (27.07) 114 (31.86) 40 (34.19) 0.052 3.786 Diabetes (cases) 44 (7.73) 38 (8.41) 6 (5.13) 0.237 1.400 Pulmonary disease (cases) 8 (1.41) 7 (1.55) 1 (0.85) 0.570 0.323 Cardiovascular disease (cases) 38 (6.68) 29 (6.42) 9 (7.69) 0.622 0.243 Cerebrovascular disease (cases) 32 (5.62) 25 (5.53) 7 (5.98) 0.850 0.036 Table 2 Univariate analysis of laboratory examination of patients with residual back pain after PKP in VCF. Factor Pain free group (452 cases) Pain group (117 cases) P-value T-value RBC (10^12/L) 4.23 ± 0.44 4.20 ± 0.44 0.473 0.718 WBC (10^9/L) 6.23 ± 1.91 6.08 ± 1.75 0.434 0.783 PLT (10^9/L) 203.27 ± 66.11 194.98 ± 64.89 0.225 1.214 HGB (g/L) 127.14 ± 13.38 126.46 ± 12.27 0.621 0.495 LYMPH% 24.55 ± 8.55 23.96 ± 8.72 0.511 0.657 NEUT% 67.10 ± 9.49 67.49 ± 9.80 0.693 -0.395 HCT% 38.80 ± 3.78 38.66 ± 3.78 0.709 0.374 MCH (pg) 30.09 ± 1.50 30.20 ± 1.59 0.512 -0.656 MCHC (g/L) 327.55 ± 10.00 327.01 ± 9.40 0.598 0.527 MCV (fL) 91.87 ± 3.93 92.34 ± 4.53 0.262 -1.123 PDW 12.69 ± 2.35 13.27 ± 2.61 0.020 -2.326 RDW-CV 13.19 ± 0.84 13.27 ± 0.82 0.376 -0.887 CRP (mg/L) 16.09 ± 20.85 20.08 ± 28.19 0.089 -1.703 K (mmol/L) 3.91 ± 0.35 3.86 ± 0.36 0.175 1.358 NA (mmol/L) 140.11 ± 2.68 139.97 ± 3.20 0.635 0.475 CL (mmol/L) 104.07 ± 3.04 103.06 ± 4.28 0.004 2.910 CA (mmol/L) 2.27 ± 0.10 2.26 ± 0.11 0.453 0.750 ALT (U/L) 17.91 ± 17.71 19.50 ± 16.84 0.385 -0.869 AST (U/L) 22.57 ± 16.91 22.70 ± 6.78 0.935 -0.082 CH (mmol/L) 4.62 ± 0.98 4.61 ± 0.98 0.906 0.118 TG (mmol/L) 1.35 ± 0.74 1.29 ± 0.54 0.374 0.890 GLU (mmol/L) 5.68 ± 1.68 5.57 ± 1.09 0.497 0.680 UREA (mmol/L) 281.81 ± 80.89 276.83 ± 80.82 0.553 0.593 CREA (umol/L) 60.51 ± 15.18 58.55 ± 13.45 0.203 1.274 CHE (U/L) 7111.31 ± 1625.56 6990.16 ± 1724.66 0.478 0.709 LDH (U/L) 203.06 ± 53.57 214.60 ± 54.24 0.039 -2.072 ALP (U/L) 104.09 ± 35.82 99.99 ± 43.37 0.293 1.053 TP (g/L) 67.32 ± 4.93 67.13 ± 5.49 0.722 0.356 CK (U/L) 90.82 ± 166.35 85.27 ± 99.32 0.730 0.345 CKMB9 (ng/mL) 11.38 ± 8.62 11.20 ± 5.80 0.836 0.207 TBIL (µmol/L) 16.01 ± 9.58 16.06 ± 6.62 0.961 -0.048 IBIL (µmol/L) 13.14 ± 6.52 13.27 ± 5.59 0.841 -0.201 DBIL (µmol/L) 2.88 ± 4.10 2.79 ± 1.26 0.818 0.230 GLD (g/L) 28.21 ± 4.26 27.92 ± 4.01 0.502 0.671 GSP (mmol/L) 230.02 ± 57.61 231.40 ± 48.95 0.812 -0.237 AMY (U/L) 56.42 ± 24.12 53.66 ± 22.57 0.265 1.115 DD2 (ng/mL) 2.44 ± 3.45 2.24 ± 2.56 0.555 0.591 FIB-RP (mg/dL) 3.37 ± 0.82 3.32 ± 0.74 0.569 0.570 APTT(s) 28.58 ± 6.21 28.72 ± 6.12 0.820 -0.228 FDP (mg/L) 7.66 ± 12.27 7.56 ± 10.78 0.940 0.075 TT(s) 17.50 ± 4.60 17.16 ± 1.96 0.441 0.771 INR 0.93 ± 0.10 0.94 ± 0.07 0.827 -0.218 PT(s) 11.54 ± 1.37 11.54 ± 1.10 0.991 0.011 Myo (µg/L) 19.19 ± 17.70 19.83 ± 25.63 0.755 -0.312 NT-proBNP (pg/mL) 448.51 ± 1667.14 470.05 ± 733.73 0.892 -0.136 PCT (ng/mL) 0.21 ± 0.07 0.20 ± 0.06 0.469 0.724 Table 3 Univariate analysis of surgical factors of patients with residual back pain after PKP in OVCF. Factor Pain-free group (452 cases) Pain group (117 cases) P-value T-value Leakage of boneless cement (cases, %) 430 (95.13) 108 (92.31) 0.230 1.440 Bone cement leakage (cases, %) 22 (4.87) 9 (7.69) Leakage into intervertebral space (cases, %) 16 (3.54) 8 (6.84) 0.114 * 2.502 Leakage into paravertebral tissue (cases, %) 9 (1.99) 1 (0.85) 0.404 0.695 Poured to the upper edge (cases, %) 327 (72.35) 74 (63.25) 0.055 3.697 Poured to the lower edge (cases, %) 309 (68.36) 68 (58.12) 0.037 4.362 Massive bone cement (cases, %) 271 (59.96) 68 (58.12) 0.718 0.130 Bone cement volume (mL) 5.07 ± 1.49 4.64 ± 0.83 0.003 2.955 AVH restored (cases, %) 343 (75.88) 68 (58.12) 0.000 14.625 MVH restored (cases, %) 382 (84.51) 66 (56.41) 0.000 43.841 PVH restored (cases, %) 446 (98.67) 116 (99.15) 0.679 0.171 Preoperative cob angle (°) 11.36 ± 5.53 10.39 ± 5.71 0.096 1.667 Postoperative cob angle (°) 7.60 ± 4.84 7.52 ± 5.21 0.875 0.158 Coronary perfusion ratio (%) 43.78 ± 13.74 43.79 ± 13.61 0.998 -0.002 Sagittal perfusion ratio (%) 44.86 ± 12.13 44.76 ± 12.55 0.941 0.075 Recovery rate (%) 36.02 ± 24.95 30.52 ± 24.42 0.033 2.136 Table 4 Multivariate logistic regression analysis of residual back pain after PKP in OVCF patients. Risk factors Regression coefficient OR P-value 95% Confidence interval Lower Upper Age -0.038 0.963 0.007 0.937 0.990 Sex 0.295 1.343 0.360 0.715 2.522 Height 0.012 1.012 0.596 0.968 1.057 Weight 0.001 0.954 0.954 0.971 1.032 BMD’s |t| >3.5 -0.553 0.575 0.035 0.344 0.962 Trauma history 0.797 2.219 0.013 1.182 4.165 PFO 1.804 6.076 0.000 3.079 11.990 PDW 0.139 1.149 0.003 1.049 1.260 CL -0.097 0.908 0.004 0.850 0.969 LDH 0.002 1.002 0.274 0.998 1.007 Bone cement volume -0.194 0.824 0.103 0.652 1.040 Poured to the lower edge -0.205 0.815 0.427 0.491 1.351 AVH restored -0.211 0.810 0.436 0.477 1.376 MVH restored -1.349 0.260 0.000 0.154 0.437 Recovery rate -0.452 0.637 0.391 0.227 1.787 constant 8.689 5935.06 0.075 Table 5 Multivariate logistic regression analysis variable assignment. Variable Assignment Age continuous variable Sex Female = 0, Male = 1 Height continuous variable Weight continuous variable BMD|t|>3.5 No = 0, Yes = 1 Trauma history No = 0, Yes = 1 PFO No = 0, Yes = 1 PDW continuous variable CL continuous variable LDH continuous variable Bone cement volume continuous variable Poured to the lower edge No = 0, Yes = 1 AVH restored No = 0, Yes = 1 MVH restored No = 0, Yes = 1 Recovery rate RBP continuous variable No = 0, Yes = 1 3.3 ROC curve analysis of independent risk factors and their combined models The ROC curve analysis was conducted on various independent risk factors, as well as their combined models. The analysis revealed that the area under the curve (AUC) for each individual risk factor was as follows: BMD (0.595), trauma history (0.573), lumbar dorsal fascia edema (0.588), platelet distribution width (0.575), and serum chlorine (0.561). Furthermore, the height of the middle vertebral body did not recover (0.641), and the combined model had an AUC of 0.788 (95% CI, 0.740–0.836) with cut-off values of 0.710 and 0.761, respectively. All of these results were statistically significant ( P < 0.05). The model had good discrimination and a high diagnostic value (Figs. 8 & 9 ; Table 6 ). The assignment of each factor is shown in Table 5 . Table 6 ROC curve of each independent risk factor. Factor AUC P-value Sensitivity % Specificity % 95% Confidence interval Lower Upper Age 0.600 0.029 70.1 52.4 0.544 0.656 BMD’s |t| >3.5 0.595 0.029 70.9 52 0.539 0.651 Trauma history 0.573 0.028 85.5 70.8 0.518 0.629 PFO 0.588 0.032 23.1 5.5 0.526 0.650 PDW 0.575 0.029 60.7 44.5 0.518 0.632 CL 0.561 0.029 70.9 61.3 0.504 0.618 MVH restored 0.641 0.031 43.6 15.5 0.580 0.701 Prediction probability 0.788 0.024 76.1 29.0 0.740 0.836 3.4 Construction of a nomogram model to predict the risk of residual back pain after PKP in patients with OVCF The ROC curve analysis indicated that the diagnostic value of the combination of independent risk factors was higher than that of each independent risk factor. Therefore, RStudio was used to build a nomogram model to predict the risk of RBP after PKP in patients with OVCF. The total score of the patients is calculated according to the sum of the scores corresponding to the factors in the nomogram model, and the total score was used as a vertical line to intersect the points on the lower risk axis, that is, the risk of RBP after vertebroplasty for osteoporotic vertebral compression fracture (Fig. 10 & Table 7 ). Table 7 Nomogram model score for predicting the risk of residual back pain after PKP in OVCF patients. Variable Score/point Age 0.95× (100-Age) BMD’s |t| >3.5 Yes 0 No 16.32 Trauma history Yes 19.58 PFO PDW No Yes No 0 44.21 0 3.47× (PDW-6) CL MVH restored Yes 2.55× (115-CL) 0 No 35.68 3.5 Calibration curve analysis of the model The calibration curve of the nomogram was drawn. The standard curve was a straight line passing through the origin of the coordinate axis with a slope of 1. The predicted calibration curve fell between the standard and acceptable lines and fit well with the standard curve. The predicted risk of the nomogram was in good agreement with the actual risk and had a good prediction ability (Fig. 11 ). 3.6 Clinical decision curve analysis of model As shown in Fig. 12 , the red curve in the decision curve analysis represents the nomogram model, the gray curve and the black curve indicate the two extreme cases, the gray line indicates the assumption that all patients have postoperative RBP, and the black line represents the assumption that no patient had postoperative RBP. The x-axis in Fig. 12 represents the threshold probability, and the y-axis represents the net benefit rate. The decision curve showed that if the probability of the threshold of the patient or the doctor was 6.3–82.3%, the nomogram model could predict postoperative RBP and would provide more benefit than treatment of all patients or not treatment. 3.7 Internal and external validation of the model The ROC curve cutoff value of the model training set was 0.184, the specificity and sensitivity were 0.710 and 0.761, respectively, and the AUC was 0.788. Internal validation of the model: after the bootstrap was repeatedly sampled 1000 times in the training set, the AUC of the model was 0.784. The validation set externally validated the model. The ROC curve cutoff value was 0.379, the specificity and sensitivity were 0.918 and 0.647. The AUC was 0.792, indicating that the model had high discrimination (Fig. 9 ). The calibration curves of the model training set and the validation set fell approximately between the standard curve and the acceptable line, indicating that the probability of postoperative RBP predicted by the model as consistent with the actual probability (Fig. 11 ). The Hosmer-Lemeshow goodness-of-fit test showed that the model training set and the validation set χ2 were 6.354 and 7.240, respectively. The P -values were 0.608 and 0.511, indicating that the model calibration was good. The clinical decision curve shows that the probability interval of the net benefit threshold of the centralized training model was 6.3–82.3% and the probability interval of the net benefit threshold of the centralized validation model was 8.7–55.6%, and 72.5–81.3%. When the threshold probability of postoperative RBP of patients fell within this interval, the net benefit rate of using this model was significantly higher than that of the "no intervention" and "full intervention" schemes, indicating that the model has good clinical applicability (Fig. 12 ). 4. Discussion The aging population has made OVCF a significant global health issue. Approximately 20% of the world's population is over the age of 70, and at least one in five patients over the age of 50 has one or more vertebral fractures (Karmakar et al., 2017 ; Kendler et al., 2016 ). The complications of OVCF, including persistent pain, kyphosis, weight loss, and depression, lead to a decline in quality of life (QoL) and can even result in death (Beall et al., 2015 ). PKP is a minimally invasive surgery commonly used in the clinical treatment of OVCF. Although it has the advantages of small trauma, fast pain relief, early mobilization, and effectively improving the prognosis of patients, some patients still experience postoperative RBP (Patel et al., 2022 ). RBP is the most common complication of PKP and PVP, with approximately 9%-35% of patients having residual pain after treatment, which is a significant concern for patients (Li et al., 2020 ; Xu et al., 2021 ). However, insufficient attention has been placed on RBP after PKP, with few relevant studies addressing this issue. The diagnosis of postoperative residual pain primarily relies on patient self-reports during postoperative rounds, lacking early, effective, and accurate prediction, and diagnosis. Therefore, identifying the risk factors for postoperative RBP in OVCF patients is essential, as it allows for targeted prevention of RBP and facilitates early intervention to improve prognosis. Meanwhile, in the clinical setting, many patients have high expectations for their prognosis after minimally invasive surgery. Once RBP occurs in the postoperative period, patient dissatisfaction or hostility can easily be aroused. Relatively accurate prediction enables clinicians to identify high-risk patients and manage their expectations, ensuring they are more realistic and well-informed. This, in turn, helps prevent unnecessary doctor-patient disputes and promotes a harmonious relationship between doctors and patients. This study identified several independent risk factors for postoperative RBP in OVCF patients, including young age, high BMD, history of trauma, low back fascia edema, high PDW, low serum chloride levels, and no recovery of middle vertebral height. Previous studies have suggested no statistical difference in the age of patients between the postoperative pain and pain-free groups, indicating that age is not a risk factor for the occurrence of RBP. However, this study obtained contrasting results, identifying age as a significant risk factor for RBP. In this sample, the younger the age, the higher the incidence of residual pain. Chen et al. (Chen et al., 2024 ) reported that low preoperative BMD was an independent risk factor for RBP after PKP. Conversely, the results of this study showed that the incidence of residual pain was higher when BMD was 2.5≤| t |≤3.5, while patients with preoperative | t |>3.5 were less likely to experience RBP after PKP. This finding may be attributed to having a low preoperative BMD value, which may be associated with more serious osteoporosis, or to low-energy injuries that may lead to a vertebral compression fracture in patients. In contrast, patients with relatively high BMD exhibit less osteoporosis, and fractures are preceded by greater trauma. Therefore, patients with high BMD values experience a more serious injury, accompanied by the possibility of relatively higher postoperative RBP. In addition, the results of this study suggest that a clear trauma history is also an independent risk factor for residual pain after PKP. Osteoporotic vertebral compression fractures usually occur in older adults. Impaired physical coordination, along with a decline in the strength of muscles, ligaments, and other structures, increases their susceptibility to trauma. At the same time, fractures often cause varying degrees of soft tissue damage. The pain from the preoperative fracture may overshadow this, but as the fracture heals, postoperative soft tissue pain becomes more pronounced, leading to RBP. According to Yan et al. (Yan et al., 2015 ), the prevalence of fasciopathy in patients with OVCF is as high as 42.1%. Luo et al. (Luo et al., 2022 ) identified thoracolumbar fascial injury was one of the causes of RBP. Our study also found that thoracolumbar fascia injury is a strong risk factor (OR = 6.076) for residual pain after PKP. Other studies have also proposed sacrospinal myofasciitis may contribute to residual pain (Yang et al., 2024b ; Ge et al., 2022 ). It is challenging to determine whether sacrospinal myofasciitis exists preoperatively, with fracture pain masking its presence, or if the pain is a result of intraoperative injury radiating along the sacrospinal muscle. However, the residual postoperative pain of patients with lumbar dorsal fascia injury is more serious than that of patients without lumbar dorsal fascia injury (Yang et al., 2024a ). This coincides with the results of our study, whereby lumbar dorsal fascia edema is an independent risk factor for residual pain. This may be due to the following reasons: (1) lumbar soft tissue injuries, such as superficial fascia and muscle, leads to local pain; (2) pain can be induced by fascial injury and soft tissue edema, which compresses the branches of the dorsal root of the spinal nerve and stimulation of inflammatory factors. PKP is used exclusively for the treatment of vertebral fractures and cannot relieve pain caused by fascia and soft tissue injury. This study analyzed the results of the preoperative laboratory findings of patients. A high PDW and a low serum chlorine value were independent risk factors for residual pain after PKP. PDW is a parameter that represents the variation of platelet volumes in the blood, which is used to express the degree of homogeneity of platelet and is used to detect larger platelets that are more active in both enzymatically and metabolically. The change in the PDW value may be associated with lifestyle-related disease factors, thrombopoietin level, platelet activity, and megakaryocyte production (Khatib-Massalha and Méndez-Ferrer, 2022 ; Pogorzelska et al., 2020 ). It is also a determinant of platelet activation and is considered a marker of inflammatory disease. During platelet activation, the release of various inflammatory cytokines leads to the formation of platelet clots and the formation of a thrombus (Kaiser et al., 2023 ). A decrease in complement Cl concentrations can enhance the inflammatory response of endothelial cells (Valdivieso Á and Santa-Coloma, 2019; Yang et al., 2012 ). Cl- reduction is the key to the formation and inflammation of foam cells (Wu et al., 2016 ). Fibromyalgia (FMS) is in a prethrombotic state, which may be enhanced by increasing the intensity of inflammation (Molina et al., 2019 ). Detection of PDW contributes to diagnosing patients with FMS (Aktürk and Büyükavcı, 2017 ). Similarly, in this study, when the patient was in such a prethrombotic state of inflammatory intensity, an increase in inflammatory factors and poor blood circulation can increase pain. Such pain interferes with early functional exercise activity and reduces muscle strength, leading to further pain. PDW and low serum chloride can be used as biomarkers to predict residual pain after PKP in patients with OVCF. Our study found a statistical difference between the two groups regarding whether the height of the anterior and middle vertebrae recovered, but only the middle height of the vertebral body did not recover, which was identified as an independent risk factor for the occurrence of residual pain. Denis’ three-column theory holds that the anterior and middle columns of vertebral bodies bear 80% of the stress, and the middle column plays a key role in maintaining the spine's stability. During PKP, balloon expansion restores the middle height of the vertebral body, bone cement is fully dispersed, chemical neurolysis and thermal neurolysis of PMMA can effectively relieve pain in the fracture, and a wedge-shaped change of the vertebral body is restored, micro and/or macro movements of the fracture site of the vertebral body disappear (Zhu et al., 2020 ; Seesala et al., 2024 ). The biomechanical environment is restored to equilibrium which brings about an improvement in the compliance of the soft tissues of the back to reduce the possibility of residual pain in the postoperative period (Mei et al., 2017 ). Conversely, if the middle vertebral height is not fully restored, the incidence of RBP can be increased. Furthermore, previous studies have shown that facet joint violations, a large number of fracture segments, fracture location, refractive fracture of adjacent or operated vertebral bodies, insufficient dispersion of bone cement in the fracture line area, leakage of bone cement, bone cement volume, inflammatory reaction or local ischemia caused by bone cement, and segmental kyphosis are also independent risk factors for residual pain (Li et al., 2020 ; Yang et al., 2022 ). The ROC curve shows that the predictive ability of the combined model was stronger than that of each independent factor, indicating that a complete assessment of multiple factors is required to improve accuracy when predicting the risk of RBP. Furthermore, a nomogram model was established that could calculate the risk of RBP after PKP for a patient with OVCF patient. This nomogram may help medical personnel identify high-risk patients with RBP after PKP promptly and could provide a basis for the early formulation of prevention strategies, treatment methods, surgical intervention, and surgical details. Sample calculations for scores using different variables for an 80-year-old patient can be estimated as follows: patient with OVCF (score 0.95 × (100 − 80) = 19), lumbar BMD t of -2.0 (score 16.32), with a clear history of trauma (score 19.58), edema of the lumbar dorsal fascia (score 44.21), and a measured PDW value of 12.80 (3.47 × (12.80-6) = 23.60), and with a serum chlorine value of 105 (score 2.55 × (115 − 105) = 25.5), if the height of 1/3 of the vertebral body is not recovered (score 35.68), the total score is indicated by the sum of the above scores (183.89) and the corresponding risk value is close to 80%. Therefore, the clinician should pay greater attention to the possibility of RBP after surgery and provide timely intervention. This study currently has some limitations. This study is a retrospective case-control study. Only a visual analogue scale (VAS) in medical records and follow-up records were used to determine whether patients experienced RBP. The follow-up time was short, and the VAS score results were subjective. The diagnostic criteria were not comprehensive, and objectivity was lacking. Secondly, the data and potential risk factors included in this study are limited, and the variables were not comprehensive, which may have partially impacted the conclusion. This study was a single-center study, and the model may not be generalizable to the settings outside the study site. Therefore, a large sample, multicenter, and long-term follow-up prospective study is needed to analyze the risk factors for RBP after PKP in patients with OVCF and to build and verify the validity of the prediction model with regard to the risk of occurrence. 5. Conclusions This study analyzed the risk factors for RBP after PKP in patients with OVCF. The results showed that young age, high BMD, history of trauma, low back fascia edema, high PDW, low serum chlorine, and no recovery of middle vertebral height were independent risk factors for RBP after PKP in patients with OVCF, and the predictive value of combined factors was higher. Thus, a visual nomogram model was constructed and established to predict the risk of residual pain that is simple and easy to read. The nomogram model demonstrated strong predictive ability, good calibration, and high clinical applicability for predicting postoperative RBP in OVCF patients undergoing PKP. Its ability to accurately identify patients at risk for RBP enables targeted intervention, thereby improving clinical outcomes. The model's practical utility is further supported by its performance in both internal and external validations and decision curve analysis. Therefore, this model can guide clinical risk assessment and take measures against high-risk factors for the timely prevention of RBP. Abbreviations RBP: residual back pain; PKP: percutaneous kyphoplasty; OVCF: osteoporotic vertebral compression fracture; BMD: bone mineral density; PVP: percutaneous vertebroplasty; PMMA: polymethylmethacrylate; QoL: quality of life; LL: lumbar lordosis; PI: pelvic incidence; ROC: receiver operating characteristic; MRI: Magnetic resonance imaging; DXA: Dual-energy X-ray absorptiometry; NSAIDs: nonsteroidal anti-inflammatory drugs; BMI: body mass index; AUC: area under the curve; PDW: platelet distribution width; Declarations Ethics approval and consent to participate This study was conducted in accordance with the principles outlined in the Declaration of Helsinki and approved by the Institutional Review Board of Wuxi Hospital of Traditional Chinese Medicine (Approval Number: SSF2022022504]). Consent for publication All participants provided written informed consent prior to their participation in the study, including consent for publication of anonymized data. Availability of data and materials The data that support the findings of this study are available from the corresponding author upon reasonable request. Competing interests The authors report no conflicts of interest in this work. Funding This study was supported by the Wuxi Municipal Health Commission (NO. XSMZDXK002), National Natural Science Foundation of China (NO. 82205142), and Postgraduate Research & Practice Innovation Program of Jiangsu Province (KYCX22_2062). Authors' contributions Yi Rong, Jianwei Wang, Yihua Zhu, Yong Ma and Hao Yu spearheaded and supervised all the trials. Hao Yu, Yi Rong, Yihua Zhu, Yang Guo, Heng Yin and Lining Wang designed the study and trials. Yang Shao and Shaoshuo Li conducted the trials and analyzed the data. Yi Rong, Yihua Zhu, Zhen Hua and Jiapeng Ye wrote and revised the manuscript. All authors reviewed and approved the final version of the manuscript, ensuring integrity and accuracy in all aspects of the work. Acknowledgements We Acknowledge all those who participated in the revision of the manuscript. References Aktürk S and Büyükavcı R. (2017) Evaluation of blood neutrophil-lymphocyte ratio and platelet distribution width as inflammatory markers in patients with fibromyalgia. Clin Rheumatol 36: 1885-1889. Beall DP, Olan WJ, Kakad P, et al. (2015) Economic Analysis of Kiva VCF Treatment System Compared to Balloon Kyphoplasty Using Randomized Kiva Safety and Effectiveness Trial (KAST) Data. Pain Physician 18: E299-306. Bo J, Zhao X, Hua Z, et al. (2022) Impact of sarcopenia and sagittal parameters on the residual back pain after percutaneous vertebroplasty in patients with osteoporotic vertebral compression fracture. J Orthop Surg Res 17: 111. Chen C, Wu B, Yu H, et al. (2024) Association between vertebral bone quality score and residual back pain following percutaneous vertebroplasty for osteoporotic vertebral compression fractures. Eur Spine J . Ge C, Chen Z, Lin Y, et al. (2022) Preoperative prediction of residual back pain after vertebral augmentation for osteoporotic vertebral compression fractures: Initial application of a radiomics score based nomogram. Front Endocrinol (Lausanne) 13: 1093508. Hoyt D, Urits I, Orhurhu V, et al. (2020) Current Concepts in the Management of Vertebral Compression Fractures. Curr Pain Headache Rep 24: 16. Jin YZ, Lee JH, Xu B, et al. (2019) Effect of medications on prevention of secondary osteoporotic vertebral compression fracture, non-vertebral fracture, and discontinuation due to adverse events: a meta-analysis of randomized controlled trials. BMC Musculoskelet Disord 20: 399. Kaiser R, Escaig R and Nicolai L. (2023) Hemostasis without clot formation: how platelets guard the vasculature in inflammation, infection, and malignancy. Blood 142: 1413-1425. Karmakar A, Acharya S, Biswas D, et al. (2017) Evaluation of Percutaneous Vertebroplasty for Management of Symptomatic Osteoporotic Compression Fracture. J Clin Diagn Res 11: Rc07-rc10. Kendler DL, Bauer DC, Davison KS, et al. (2016) Vertebral Fractures: Clinical Importance and Management. Am J Med 129: 221.e221-210. Khatib-Massalha E and Méndez-Ferrer S. (2022) Megakaryocyte Diversity in Ontogeny, Functions and Cell-Cell Interactions. Front Oncol 12: 840044. Li Q, Shi L, Wang Y, et al. (2021) A Nomogram for Predicting the Residual Back Pain after Percutaneous Vertebroplasty for Osteoporotic Vertebral Compression Fractures. Pain Res Manag 2021: 3624614. Li Y, Yue J, Huang M, et al. (2020) Risk factors for postoperative residual back pain after percutaneous kyphoplasty for osteoporotic vertebral compression fractures. Eur Spine J 29: 2568-2575. Lin M, Wen X, Huang Z, et al. (2023) A nomogram for predicting residual low back pain after percutaneous kyphoplasty in osteoporotic vertebral compression fractures. Osteoporos Int 34: 749-762. Liu D, Wen T, Li X, et al. (2024) Percutaneous Vertebroplasty Versus Balloon Kyphoplasty in the Treatment of Osteoporotic Vertebral Compression Fractures: Evaluating the Overlapping Meta-analyses. Pain Physician 27: E383-e394. Long Y, Yi W and Yang D. (2020) Advances in Vertebral Augmentation Systems for Osteoporotic Vertebral Compression Fractures. Pain Res Manag 2020: 3947368. Luo Y, Jiang T, Guo H, et al. (2022) Osteoporotic vertebral compression fracture accompanied with thoracolumbar fascial injury: risk factors and the association with residual pain after percutaneous vertebroplasty. BMC Musculoskelet Disord 23: 343. Ma Y, Wu X, Xiao X, et al. (2020) Effects of teriparatide versus percutaneous vertebroplasty on pain relief, quality of life and cost-effectiveness in postmenopausal females with acute osteoporotic vertebral compression fracture: A prospective cohort study. Bone 131: 115154. Mei X, Sun ZY, Zhou F, et al. (2017) Analysis of Pre- and Postoperative Pain Variation in Osteoporotic Vertebral Compression Fracture Patients Undergoing Kyphoplasty. Med Sci Monit 23: 5994-6000. Molina F, Del Moral ML, La Rubia M, et al. (2019) Are Patients With Fibromyalgia in a Prothrombotic State? Biol Res Nurs 21: 224-230. Park JS and Park YS. (2021) Survival analysis and risk factors of new vertebral fracture after vertebroplasty for osteoporotic vertebral compression fracture. Spine J 21: 1355-1361. Parreira PCS, Maher CG, Megale RZ, et al. (2017) An overview of clinical guidelines for the management of vertebral compression fracture: a systematic review. Spine J 17: 1932-1938. Patel D, Liu J and Ebraheim NA. (2022) Managements of osteoporotic vertebral compression fractures: A narrative review. World J Orthop 13: 564-573. Pogorzelska K, Krętowska A, Krawczuk-Rybak M, et al. (2020) Characteristics of platelet indices and their prognostic significance in selected medical condition - a systematic review. Adv Med Sci 65: 310-315. Reid IR and McClung MR. (2024) Osteopenia: a key target for fracture prevention. Lancet Diabetes Endocrinol 12: 856-864. Seesala VS, Sheikh L, Basu B, et al. (2024) Mechanical and Bioactive Properties of PMMA Bone Cement: A Review. ACS Biomater Sci Eng 10: 5939-5959. Skjødt MK and Abrahamsen B. (2023) New Insights in the Pathophysiology, Epidemiology, and Response to Treatment of Osteoporotic Vertebral Fractures. J Clin Endocrinol Metab 108: e1175-e1185. Valdivieso Á G and Santa-Coloma TA. (2019) The chloride anion as a signalling effector. Biol Rev Camb Philos Soc 94: 1839-1856. Wang B, Zhao CP, Song LX, et al. (2018) Balloon kyphoplasty versus percutaneous vertebroplasty for osteoporotic vertebral compression fracture: a meta-analysis and systematic review. J Orthop Surg Res 13: 264. Wang G, Yang H and Chen K. (2010) Osteoporotic vertebral compression fractures with an intravertebral cleft treated by percutaneous balloon kyphoplasty. J Bone Joint Surg Br 92: 1553-1557. Wang W, Liu Y, Wan H, et al. (2023) Effectiveness and prognostic factors of different minimally invasive surgeries for vertebral compression fractures. BMC Musculoskelet Disord 24: 11. Wen Z, Mo X, Zhao S, et al. (2022) Study on Risk Factors of Primary Non-traumatic OVCF in Chinese Elderly and a Novel Prediction Model. Orthop Surg 14: 2925-2938. Wu QQ, Liu XY, Xiong LX, et al. (2016) Reduction of Intracellular Chloride Concentration Promotes Foam Cell Formation. Circ J 80: 1024-1033. Xia W, Fu H, Zhu Z, et al. (2019) Association between back muscle degeneration and spinal-pelvic parameters in patients with degenerative spinal kyphosis. BMC Musculoskelet Disord 20: 454. Xu JJ, Tang XT, Yang J, et al. (2021) The Effect of Medial Branch Block on Postoperative Residual Pain Relieve After Percutaneous Kyphoplasty: A Randomized Controlled Trial With 12-Month Follow-up. Pain Physician 24: E1059-e1066. Yan Y, Xu R and Zou T. (2015) Is thoracolumbar fascia injury the cause of residual back pain after percutaneous vertebroplasty? A prospective cohort study. Osteoporos Int 26: 1119-1124. Yang D, Liu X, Zhou Y, et al. (2022) A novel scoring system to predict the residual back pain after percutaneous kyphoplasty for osteoporotic vertebral compression fracture. Front Surg 9: 1035681. Yang H, Huang LY, Zeng DY, et al. (2012) Decrease of intracellular chloride concentration promotes endothelial cell inflammation by activating nuclear factor-κB pathway. Hypertension 60: 1287-1293. Yang JS, Liu JJ, Chu L, et al. (2019) Causes of Residual Back Pain at Early Stage After Percutaneous Vertebroplasty: A Retrospective Analysis of 1,316 Cases. Pain Physician 22: E495-e503. Yang S, Tang J, Yang Z, et al. (2024a) Effect of thoracolumbar fascia injury on reported outcomes after percutaneous vertebroplasty. Front Surg 11: 1379769. Yang XG, Dong YQ, Liu X, et al. (2024b) Incidence and prognostic factors of residual back pain in patients treated for osteoporotic vertebral compression fractures: a systematic review and meta-analysis. Eur Spine J 33: 4521-4537. Yu D, Liu Z, Wang H, et al. (2022) Treatment of Elderly Patients with Acute Symptomatic OVCF: A Study of Comparison of Conservative Treatment and Percutaneous Kyphoplasty. Front Surg 9: 942195. Zhu J, Yang S, Cai K, et al. (2020) Bioactive poly (methyl methacrylate) bone cement for the treatment of osteoporotic vertebral compression fractures. Theranostics 10: 6544-6560. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5716384","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":396459356,"identity":"6b9c39f0-4fc5-4d8f-acf0-48afc0e7fe01","order_by":0,"name":"Yi Rong","email":"","orcid":"","institution":"Department of Traumatology \u0026 Orthopedics, Wuxi Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Wuxi 214071 China","correspondingAuthor":false,"prefix":"","firstName":"Yi","middleName":"","lastName":"Rong","suffix":""},{"id":396459357,"identity":"e6bed9ec-141b-467b-a314-fb7db8c158d6","order_by":1,"name":"Yihua Zhu","email":"","orcid":"","institution":"Laboratory of New Techniques of Restoration \u0026 Reconstruction, Institute of Traumatology \u0026 Orthopedics, Nanjing University of Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Yihua","middleName":"","lastName":"Zhu","suffix":""},{"id":396459358,"identity":"d9b506da-797e-45fb-9555-3834ecd0d078","order_by":2,"name":"Hao Yu","email":"","orcid":"","institution":"Department of Traumatology \u0026 Orthopedics, Wuxi Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Wuxi 214071 China","correspondingAuthor":false,"prefix":"","firstName":"Hao","middleName":"","lastName":"Yu","suffix":""},{"id":396459359,"identity":"c0b5a976-7d69-485f-bea3-b74cc305017d","order_by":3,"name":"Heng Yin","email":"","orcid":"","institution":"Department of Traumatology \u0026 Orthopedics, Wuxi Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Wuxi 214071 China","correspondingAuthor":false,"prefix":"","firstName":"Heng","middleName":"","lastName":"Yin","suffix":""},{"id":396459360,"identity":"b5988ef3-5f0b-4dfe-a677-643707b17621","order_by":4,"name":"Zhen Hua","email":"","orcid":"","institution":"Department of Traumatology \u0026 Orthopedics, Wuxi Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Wuxi 214071 China","correspondingAuthor":false,"prefix":"","firstName":"Zhen","middleName":"","lastName":"Hua","suffix":""},{"id":396459361,"identity":"4b8db8e4-6a1e-43d1-854e-41d1094813f6","order_by":5,"name":"Yang Shao","email":"","orcid":"","institution":"Department of Traumatology \u0026 Orthopedics, Wuxi Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Wuxi 214071 China","correspondingAuthor":false,"prefix":"","firstName":"Yang","middleName":"","lastName":"Shao","suffix":""},{"id":396459362,"identity":"9afe821d-74bf-4813-abff-a34e5b2bee60","order_by":6,"name":"Shaoshuo Li","email":"","orcid":"","institution":"Department of Traumatology \u0026 Orthopedics, Wuxi Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Wuxi 214071 China","correspondingAuthor":false,"prefix":"","firstName":"Shaoshuo","middleName":"","lastName":"Li","suffix":""},{"id":396459363,"identity":"d5c5c467-98fa-44e7-b3d1-546adc25198f","order_by":7,"name":"Jiapeng Ye","email":"","orcid":"","institution":"Department of Traumatology \u0026 Orthopedics, Wuxi Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Wuxi 214071 China","correspondingAuthor":false,"prefix":"","firstName":"Jiapeng","middleName":"","lastName":"Ye","suffix":""},{"id":396459364,"identity":"22c116be-53c5-4909-ab44-3044c15e7a09","order_by":8,"name":"Yang Guo","email":"","orcid":"","institution":"Laboratory of New Techniques of Restoration \u0026 Reconstruction, Institute of Traumatology \u0026 Orthopedics, Nanjing University of Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Yang","middleName":"","lastName":"Guo","suffix":""},{"id":396459365,"identity":"87bfbd64-2486-4e89-90cb-b12c29b9f1f7","order_by":9,"name":"Yong Ma","email":"","orcid":"","institution":"Laboratory of New Techniques of Restoration \u0026 Reconstruction, Institute of Traumatology \u0026 Orthopedics, Nanjing University of Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Yong","middleName":"","lastName":"Ma","suffix":""},{"id":396459366,"identity":"2ca78be7-0819-40dd-bae8-0bf31a0758da","order_by":10,"name":"Lining Wang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAs0lEQVRIiWNgGAWjYDACdgbGBww8ELYEcVqYGZgNSNbCBldJnBaDw7zHqgtkDsvrNjAfvM3DYJdHhBa+tNszeA4bbjvAlmzNw5BcTFCL2WEes9s8PIcTzA7wmEnzMBxIbCBGSzFEC/834rUwQ21hI06L/WEeY2kennTDbYfZjC3nGCQT1iLZ3mP4mbfHWt7sePPDG28q7AhrAQPGHgZQBAGBAVHqQeAH0SpHwSgYBaNgJAIANiIyLR+igbYAAAAASUVORK5CYII=","orcid":"","institution":"Laboratory of New Techniques of Restoration \u0026 Reconstruction, Institute of Traumatology \u0026 Orthopedics, Nanjing University of Chinese Medicine","correspondingAuthor":true,"prefix":"","firstName":"Lining","middleName":"","lastName":"Wang","suffix":""},{"id":396459367,"identity":"d321562e-1136-4199-be0a-ccb33cf5d5f9","order_by":11,"name":"Jianwei Wang","email":"","orcid":"","institution":"Department of Traumatology \u0026 Orthopedics, Wuxi Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Wuxi 214071 China","correspondingAuthor":false,"prefix":"","firstName":"Jianwei","middleName":"","lastName":"Wang","suffix":""}],"badges":[],"createdAt":"2024-12-26 13:23:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5716384/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5716384/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":72842350,"identity":"82bd4464-be94-46a4-b27a-6fc97ffd898b","added_by":"auto","created_at":"2025-01-02 18:34:10","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":110853,"visible":true,"origin":"","legend":"\u003cp\u003eMRI findings of fascial edema after osteoporotic vertebral compression fracture. (A) T1WI, (B) T2WI, (C) T2-STIR WI. (Note: vertebral body recovery rate= (preoperative Cobb angle - postoperative Cobb angle)/preoperative Cobb angle).\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-5716384/v1/bb52f84a6de2f8a7f52179ea.png"},{"id":72842006,"identity":"5024f93a-af76-4155-ad57-a6ba1ec5e6a1","added_by":"auto","created_at":"2025-01-02 18:26:10","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":76768,"visible":true,"origin":"","legend":"\u003cp\u003eImaging evaluation of the vertebral body of osteoporotic vertebral compression fracture. (A) Anterior vertebral height (AVH); Middle vertebral height (MVH); Postoperative Posterior vertebral height (PVH); (B) Preoperative Cobb angle; (C) Postoperative Cobb angle.\u003cbr\u003e\n (Note: the Cobb angle is defined as the angle formed by line A of the upper endplate and line B of the lower endplate of the fractured vertebral body.)\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-5716384/v1/8d6fd936a0c2fc3df0f7fc4e.png"},{"id":72842349,"identity":"afd6cd2c-256f-4117-8ef0-e5bb8e215dab","added_by":"auto","created_at":"2025-01-02 18:34:10","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":87042,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution characteristics of spongy bone cement. (A) anteroposterior radiograph of spongy diffuse distribution pattern; (B) lateral radiograph of spongy diffuse distribution pattern.\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-5716384/v1/08738b53b9e00f1c6a683b13.png"},{"id":72842004,"identity":"8d3d793c-4b78-4f05-8877-8601c260806a","added_by":"auto","created_at":"2025-01-02 18:26:10","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":85571,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution characteristics of massive bone cement. (A) anteroposterior radiograph film of the local solid distribution pattern of massive bone cement; (B) lateral radiograph of massive local solid distribution pattern.\u003c/p\u003e","description":"","filename":"floatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-5716384/v1/8e8e418d2a8904ab84770f15.png"},{"id":72842008,"identity":"1f7fc473-8d8b-4b35-854d-0c5c3657ba4d","added_by":"auto","created_at":"2025-01-02 18:26:10","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":76714,"visible":true,"origin":"","legend":"\u003cp\u003eImage of bone cement leaking into the intervertebral space. (A) anteroposterior radiograph of bone cement leaking into the intervertebral space; (B) lateral radiograph of bone cement leaking into the intervertebral space.\u003c/p\u003e","description":"","filename":"floatimage5.png","url":"https://assets-eu.researchsquare.com/files/rs-5716384/v1/56cdef99f2a5b459ad107e50.png"},{"id":72842352,"identity":"1337a254-d119-4398-9718-af305733356c","added_by":"auto","created_at":"2025-01-02 18:34:10","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":76942,"visible":true,"origin":"","legend":"\u003cp\u003eImage of bone cement leaking into the paravertebral tissue. (A) anteroposterior radiograph of bone cement leaking into the paravertebral tissue; (B) lateral X-ray film of bone cement leaking into paravertebral tissue.\u003c/p\u003e","description":"","filename":"floatimage6.png","url":"https://assets-eu.researchsquare.com/files/rs-5716384/v1/6e512073a096a7181531adb5.png"},{"id":72842010,"identity":"2386f395-1499-4cea-8173-cdf7d236bc19","added_by":"auto","created_at":"2025-01-02 18:26:10","extension":"png","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":98842,"visible":true,"origin":"","legend":"\u003cp\u003eBone cement perfusion ratio. (A) coronal bone cement perfusion ratio; (B) sagittal bone cement perfusion ratio (Note: bone cement perfusion ratio=bone cement perfusion area/vertebral body area).\u003c/p\u003e","description":"","filename":"floatimage7.png","url":"https://assets-eu.researchsquare.com/files/rs-5716384/v1/95c9571e1f3ed2f07857f4aa.png"},{"id":72842014,"identity":"c250a52c-8743-4668-9a64-a392e872b60a","added_by":"auto","created_at":"2025-01-02 18:26:10","extension":"png","order_by":8,"title":"Figure 8","display":"","copyAsset":false,"role":"figure","size":78270,"visible":true,"origin":"","legend":"\u003cp\u003eROC curve of each independent risk factor and joint model developed using SPSS25.0 software.\u003c/p\u003e","description":"","filename":"floatimage8.png","url":"https://assets-eu.researchsquare.com/files/rs-5716384/v1/c5a8a52984dffb38ecdc7caa.png"},{"id":72842011,"identity":"8183739e-91e2-42cf-ab39-9858062b4e81","added_by":"auto","created_at":"2025-01-02 18:26:10","extension":"png","order_by":9,"title":"Figure 9","display":"","copyAsset":false,"role":"figure","size":56579,"visible":true,"origin":"","legend":"\u003cp\u003eROC curve obtained using RStudio Software. (A) ROC curve of the training set (n=569); (B) ROC curve of validation set (n=78).\u003c/p\u003e","description":"","filename":"floatimage9.png","url":"https://assets-eu.researchsquare.com/files/rs-5716384/v1/c7aaa0c3d22bf392150afe28.png"},{"id":72842354,"identity":"e52e02bf-c664-43b9-a422-4acb54d5dcc8","added_by":"auto","created_at":"2025-01-02 18:34:10","extension":"png","order_by":10,"title":"Figure 10","display":"","copyAsset":false,"role":"figure","size":41685,"visible":true,"origin":"","legend":"\u003cp\u003eNomogram for predicting the risk of residual back pain after PKP in OVCF patients.\u003c/p\u003e","description":"","filename":"floatimage10.png","url":"https://assets-eu.researchsquare.com/files/rs-5716384/v1/e6ab104b4289b5de22750ba4.png"},{"id":72842015,"identity":"074a3290-6c71-4ae3-9158-2bf1e813f98c","added_by":"auto","created_at":"2025-01-02 18:26:10","extension":"png","order_by":11,"title":"Figure 11","display":"","copyAsset":false,"role":"figure","size":66872,"visible":true,"origin":"","legend":"\u003cp\u003eCalibration curve of nomogram model for predicting the risk of residual back pain after PKP in OVCF patients. (A) Calibration curve of training set (n=569); (B) Calibration curve of validation set (n=78).\u003c/p\u003e","description":"","filename":"floatimage11.png","url":"https://assets-eu.researchsquare.com/files/rs-5716384/v1/2cc60470dbfb71bbb1a8f981.png"},{"id":72842017,"identity":"ed7755d5-fc5b-4c2e-9546-e575e20af1d3","added_by":"auto","created_at":"2025-01-02 18:26:10","extension":"png","order_by":12,"title":"Figure 12","display":"","copyAsset":false,"role":"figure","size":79242,"visible":true,"origin":"","legend":"\u003cp\u003eDecision curve analysis for evaluating the net benefit of the nomograph. (A) Clinical decision curve of the training set (n=569); (B) Clinical decision curve of validation set (n=78).\u003c/p\u003e","description":"","filename":"floatimage12.png","url":"https://assets-eu.researchsquare.com/files/rs-5716384/v1/4894b457b81e3059d2808ebd.png"},{"id":75185385,"identity":"4014ade6-a928-4236-953e-18d715559fe3","added_by":"auto","created_at":"2025-01-31 17:16:42","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2576963,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5716384/v1/e6822648-d85e-4ea7-948a-6f21ef420a9a.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"A risk model for prediction of residual back pain after percutaneous kyphoplasty in patients with osteoporotic vertebral compression fracture","fulltext":[{"header":"1. Background","content":"\u003cp\u003eWith the society aging, the prevalence of osteoporosis is increasing and the decrease in bone strength increases the susceptibility to fracture (Reid and McClung, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). OVCF is one of the most common complications of osteoporosis, accounting for almost half of the fractures (Park and Park, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). It usually lacks a clear history of trauma or occurs after low-energy injury neglected by patients, resulting in persistent severe pain, local vertebral kyphosis, respiratory dysfunction, increased risk and mortality of new fractures, and severe decline in quality of life (QoL) (Wen et al., \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe clinical treatment of OVCF is currently divided into conservative and surgical approaches (Parreira et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Conservative treatments include bed rest, pain relief with analgesics, muscle relaxants, and other drugs, or braces or external fixation. However, these approaches have slow effects, and prolonged bed rest can worsen bone and mineral loss, thereby increasing the risk of secondary fractures(Ma et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Jin et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) are two commonly used surgical approaches for the treatment of OVCF. The injection of polymethylmethacrylate (PMMA) bone cement enhances bone strength and achieves mechanical stability, resulting in immediate pain relief. PMMA treatment has been widely used as OVCF treatment (Long et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Compared to conservative treatment, minimally invasive surgery can improve patient QoL and improve survival by up to 2 years (Wang et al., \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). PKP relieves pain and improves motor function, while reducing the risk of polymethylmethacrylate leakage, significantly improving patient prognosis (Liu et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Yu et al., \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Nonetheless, some patients still experience RBP after surgery, which impede early ambulation, delay functional recovery and significantly affect daily life due to moderate or severe pain (Lin et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Yang et al., \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Therefore, early prevention, timely and accurate diagnosis, and treatment are important to the occurrence, development, and prognosis of RBP in OVCF patients.\u003c/p\u003e \u003cp\u003eStudies have identified risk factors for RBP after PVP, including low BMD, presence of intraspinal vacuum fissure, combined low back fascia injury, paravertebral muscle degeneration, sarcopenia, multisegment OVCF, unsatisfactory bone cement distribution, inadequate bone cement filling, unrecoverable vertebral body height, large pelvic angle of C7 vertical sagittal axis (SVA) T1 (TPA), and lumbar lordosis (LL)-pelvic incidence (PI) mismatch (Luo et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Xia et al., \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Li et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Bo et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) .\u003c/p\u003e \u003cp\u003eAs a modified technique based on PVP, PKP uses a balloon (inflatable bone damping) to correct kyphosis caused by vertebral collapse, reducing the average difference in kyphotic wedge angle and the risk of cement leakage while restoring vertebral height and enhancing vertebral stability (Hoyt et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Wang et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). The pain relief caused by PKP in OVCF patients with vertebral fractures and a residual cavity is more durable than PVP (Wang et al., \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2010\u003c/span\u003e). However, few studies have reported on the risk factors for RBP after PKP.\u003c/p\u003e \u003cp\u003eThis study hypothesized that a comprehensive analysis of risk factors, the diagnostic efficacy of independent risk factors, and their respective and combined factors could be used to establish a nomogram model to predict the risk of the disease, to provide a rationale and guidance for effective clinical prevention and treatment, to help improve the prognosis through timely intervention.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Study design\u003c/h2\u003e \u003cp\u003eA retrospective case-control study was conducted, with univariate analysis and multivariate logistic regression analysis performed. The diagnostic efficacy of each independent risk factor and the combined model was evaluated using receiver operating characteristic (ROC) curves. The nomogram model for predicting risk was further constructed and verified.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Time and place\u003c/h2\u003e \u003cp\u003eOVCF patients who were treated in the orthopedic and traumatology ward of the Wuxi Traditional Chinese Medicine Hospital from January 2018 to December 2020 were selected.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Study subjects\u003c/h2\u003e \u003cp\u003eThe clinical data from 647 OVCF patients who underwent PKP surgery were collected. Data from 569 patients between January 2018 and June 2020 were used as the model training set, including 122 males and 447 females aged 50\u0026ndash;97 years (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD, 71.76\u0026thinsp;\u0026plusmn;\u0026thinsp;9.066 years). Data from 78 patients collected between July 2020 and December 2020 were used as the model validation set, including 16 males and 62 females, aged 51\u0026ndash;96 years (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD, 73.04\u0026thinsp;\u0026plusmn;\u0026thinsp;10.43 years). This study was conducted in accordance with the principles outlined in the Declaration of Helsinki and approved by the Institutional Review Board of Wuxi Hospital of Traditional Chinese Medicine (Approval Number: SSF2022022504]). All patients provided signed informed consent. The patients were divided into a pain group (n\u0026thinsp;=\u0026thinsp;117) and a no pain group (n\u0026thinsp;=\u0026thinsp;452) based on the diagnostic criteria of postoperative RBP.\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e \u003ch2\u003e2.3.1 Diagnostic criteria for osteoporotic vertebral compression fracture (Skj\u0026oslash;dt and Abrahamsen, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2023\u003c/span\u003e)\u003c/h2\u003e \u003cp\u003e(1) Having a history of osteoporotic fracture or slight trauma, persistent chest, waist, and back pain; pain relief or disappearance when lying down and resting; and pain worsening when changing posture; physical examination indicating activity of the chest and waist was limited, and the vertebrae involved in the fracture showed tenderness and percussion pain. Generally, there is no evidence of lower limb nerve damage, the height was short, or the back was deformed. (2) Imaging examination: radiographic imaging examination revealed a wedge-shaped change or \"double concave sign\", and some showed a \"vacuum sign\" in the vertebral body and the formation of false joints. Magnetic resonance imaging (MRI) revealed a hypointense fracture on T1WI, hyperintense or isointense signs on T2WI, and hyperintense signs on the lipid suppression sequence. (3) BMD examination: Dual-energy X-ray absorptiometry (DXA) was used to determine the T value at the spine/hip joint \u0026le;-2.5. Diagnostic criteria for RBP (Li et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) : VAS scores\u0026thinsp;\u0026ge;\u0026thinsp;4 at 3 days and 1 month after the operation.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section3\"\u003e \u003ch2\u003e2.3.2 Inclusion criteria\u003c/h2\u003e \u003cp\u003e(1) meets the diagnostic criteria of OVCF and has no neurological injury; (2) received PKP surgery; (3) a single vertebra was responsible for the fracture; (4) meets the diagnostic criteria of RBP; (5) Clinical records and follow-up data were complete.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section3\"\u003e \u003ch2\u003e\u003cb\u003e2.3.3 Exclusion criteria\u003c/b\u003e:\u003c/h2\u003e \u003cp\u003e(1) previous spinal surgery; (2) OVCF patients caused by tumor, infection, or tuberculosis; (3) patients with coagulation dysfunction or systemic disease who cannot tolerate surgery; (4) systemic or local infection; (5) new vertebral fracture occurred after the operation; (6) spinal cord compression and obvious neurological symptoms, such as numbness and/or muscle weakness; (7) clinical medical records and follow-up data were incomplete.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Surgical method and postoperative management\u003c/h2\u003e \u003cp\u003ePatients were placed in the prone position, the chest and hip were positioned on a pillow, and the waist was extended. Under the guidance of C-arm fluoroscopy, the pedicle shadow was located on both sides of the fractured vertebral body. Following 1% lidocaine anesthesia, a small opening was cut. The cook needle was inserted through the pedicle of both sides of the vertebral fracture body to 0.5\u0026ndash;0.8 cm from the posterior edge of the vertebral body, the guide needle was inserted, and the cook needle was retrieved and then inserted into the working channel. The guide pin was removed, the cancellous bone in the vertebral body was placed 0.5 cm from the leading edge of the vertebral body with the core of the bone cement pusher, and the expansion balloon was expanded to 2.0 mL. The bone cement was prepared and injected into the vertebral body from the working channels on both sides of the patient by the bone cement pusher during the agglomeration period. The bone cement was filled, and the patient reported no adverse reactions. The working channel was removed, and pressure was applied to stop the bleeding. All patients received vitamin D and salmon calcitonin postoperatively. The patients were examined by anteroposterior and lateral X-rays 24 hours postoperatively and were discharged 2\u0026ndash;3 days after the operation. Radiographs of the injured vertebrae were regularly examined postoperatively. Patients did not receive nonsteroidal anti-inflammatory drugs (NSAIDs) or opioid analgesics postoperatively unless the patient's postoperative pain was not relieved.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e2.5 Main observations\u003c/h2\u003e \u003cp\u003eRelevant information regarding patients was collected by referring to electronic medical records. Preoperative, intraoperative, and postoperative factors that may affect back pain were evaluated, including (1) general data: sex, age, height, weight, body mass index (BMI); (2) preoperative complications: diabetes, hypertension, pulmonary disease, cardiovascular, and cerebrovascular disease; (3) clinical data: history of trauma, fracture segment, lumbar and dorsal fascia edema, BMD, time from injury to operation and duration of operation; (4) Laboratory examination: preoperative blood cell analysis, liver and kidney function, and coagulation function; (5) Preoperative and postoperative radiological parameters: Cobb angle of the fractured vertebral body before the operation, whether the heights of the anterior, middle, and posterior vertebral bodies are restored 24 hours after the operation, Cobb angle, volume, distribution and shape of bone cement infusion, leakage and position of bone cement, and recovery rate of the vertebral body (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan refid=\"Fig7\" class=\"InternalRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e2.6 Statistical analysis\u003c/h2\u003e \u003cp\u003eSPSS 25.0 (SPSS, Inc., IBM) software was used to analyze the differences between the two groups. For continuous variables that are consistent with the normal distribution, two independent sample t-tests were conducted. The rank sum test was used for continuous variables that did not conform to normal distribution. For categorical variables, the chi-square test was used for statistical analysis. P-values\u0026thinsp;\u0026lt;\u0026thinsp;0.05 were considered statistically significant, and α\u0026thinsp;=\u0026thinsp;0.05 (both sides) was the inspection level. In the model training set, the independent risk factors of RBP after PKP were analyzed by multivariate logistic regression, with the factors with significant differences screened by univariate analysis as independent variables. The ROC curve was used to analyze each independent risk factor, and the combined model was used to predict RBP. The area under the curve (AUC) was calculated to evaluate sensitivity and specificity. Based on this, the nomogram model for predicting the risk of RBP after PKP in OVCF patients was further constructed using RStudio software car, RMS, proc and rmda, and calibration curves were drawn to verify the consistency between the predicted and the actual risk. The clinical decision curve was used to verify the clinical applicability of the model. The bootstrap repeatedly extracted data 1000 times in the training set to verify the model internally, and the validation set is used to verify the model externally.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Univariate analysis of residual back pain after PKP in patients with OVCF\u003c/h2\u003e \u003cp\u003eOf the 569 patients who underwent PKP surgery, 117 (20.56%) were classified as the postoperative RBP group, and 452 (79.44%) in the same period were identified as the pain-free group. Univariate analysis was performed on the clinical data of the two groups of patients with postoperative RBP. Age, sex, height, weight, BMD, history of trauma, presence or absence of low back fascia edema, platelet distribution width (PDW), serum chlorine, lactate dehydrogenase, whether bone cement was applied to the lower edge of the vertebral body, the amount of bone cement injected, restored height of the anterior and middle vertebrae. The difference in the recovery rate of the vertebral body was statistically significant (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05); There were no significant differences between the two groups in BMI, fracture segment, fracture-to-operation time, operation duration, combined medical basic diseases, other laboratory examination results and operation factors (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (\u003cb\u003eTable. 1\u0026ndash;3\u003c/b\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Multivariate logistic regression analysis of residual back pain after PKP in patients with OVCF\u003c/h2\u003e \u003cp\u003eMultivariate logistic regression analysis showed that age, BMD value of 2.5 | t | \u0026le;3.5, history of trauma, low back fascia edema, high platelet distribution width, low serum chlorine, and no recovery of middle vertebral height were independent risk factors for RBP after PKP in patients with OVCF (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Tables\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e \u0026amp; \u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). Hosmer-Lemeshow goodness-of-fit test indicated a good fit (x\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;6.354, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.608, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eUnivariate analysis of clinical data of OVCF patients with residual back pain after PKP.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFactor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal number (569 cases)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePain-free group (452 cases)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePain group (117 cases)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eT-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (y)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e71.76\u0026thinsp;\u0026plusmn;\u0026thinsp;9.066\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e72.23\u0026thinsp;\u0026plusmn;\u0026thinsp;9.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e69.19\u0026thinsp;\u0026plusmn;\u0026thinsp;8.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.273\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eSex (%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale (cases)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e122 (21.44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e86 (19.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36 (30.77)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.006\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e7.609\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale (cases)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e447 (78.56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e366 (80.97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e81 (69.23)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeight (cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e160.03\u0026thinsp;\u0026plusmn;\u0026thinsp;7.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e159.59\u0026thinsp;\u0026plusmn;\u0026thinsp;6.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e161.54\u0026thinsp;\u0026plusmn;\u0026thinsp;7.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.008\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-2.645\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWeight (kg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e59.20\u0026thinsp;\u0026plusmn;\u0026thinsp;10.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58.76\u0026thinsp;\u0026plusmn;\u0026thinsp;10.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e61.33\u0026thinsp;\u0026plusmn;\u0026thinsp;9.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.013\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-2.488\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23.05\u0026thinsp;\u0026plusmn;\u0026thinsp;3.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23.01\u0026thinsp;\u0026plusmn;\u0026thinsp;3.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23.45\u0026thinsp;\u0026plusmn;\u0026thinsp;2.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.187\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-1.321\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMD (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c6\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e|t|\u0026gt;3.5 (cases)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e251 (44.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e217 (48.01)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34 (29.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e13.53\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.5\u0026le; |t| \u0026le;3.5 (cases)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e318 (55.89)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e235 (51.99)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e83 (70.94)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTrauma (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c6\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes (cases)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e420 (73.81)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e320 (70.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e100 (85.47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e10.35\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo (cases)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e149 (26.19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e132 (29.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17 (14.53)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePosterior fascia edema (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c6\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes (cases)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e52 (9.14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25 (5.53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27 (23.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e34.45\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo (cases)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e517 (90.86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e427 (94.47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e90 (76.92)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFracture segment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.636\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8.842\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInjury time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11.23\u0026thinsp;\u0026plusmn;\u0026thinsp;22.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.33\u0026thinsp;\u0026plusmn;\u0026thinsp;14.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.76\u0026thinsp;\u0026plusmn;\u0026thinsp;13.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.769\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.294\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOperation duration (min)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e49.97\u0026thinsp;\u0026plusmn;\u0026thinsp;17.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48.22\u0026thinsp;\u0026plusmn;\u0026thinsp;16.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e48.85\u0026thinsp;\u0026plusmn;\u0026thinsp;16.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.714\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.367\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComplication (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c6\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension (cases)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e154 (27.07)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e114 (31.86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40 (34.19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.052\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.786\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes (cases)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e44 (7.73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38 (8.41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (5.13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.237\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.400\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePulmonary disease (cases)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (1.41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (1.55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (0.85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.570\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.323\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCardiovascular disease (cases)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38 (6.68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29 (6.42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9 (7.69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.622\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.243\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCerebrovascular disease (cases)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32 (5.62)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25 (5.53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (5.98)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.850\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.036\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eUnivariate analysis of laboratory examination of patients with residual back pain after PKP in VCF.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFactor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePain free group\u003c/p\u003e \u003cp\u003e(452 cases)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePain group\u003c/p\u003e \u003cp\u003e(117 cases)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eT-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRBC (10^12/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e4.23\u0026thinsp;\u0026plusmn;\u0026thinsp;0.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e4.20\u0026thinsp;\u0026plusmn;\u0026thinsp;0.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.473\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.718\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWBC (10^9/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e6.23\u0026thinsp;\u0026plusmn;\u0026thinsp;1.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e6.08\u0026thinsp;\u0026plusmn;\u0026thinsp;1.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.434\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.783\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePLT (10^9/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e203.27\u0026thinsp;\u0026plusmn;\u0026thinsp;66.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e194.98\u0026thinsp;\u0026plusmn;\u0026thinsp;64.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.225\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.214\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHGB (g/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e127.14\u0026thinsp;\u0026plusmn;\u0026thinsp;13.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e126.46\u0026thinsp;\u0026plusmn;\u0026thinsp;12.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.621\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.495\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLYMPH%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e24.55\u0026thinsp;\u0026plusmn;\u0026thinsp;8.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e23.96\u0026thinsp;\u0026plusmn;\u0026thinsp;8.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.511\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.657\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNEUT%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e67.10\u0026thinsp;\u0026plusmn;\u0026thinsp;9.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e67.49\u0026thinsp;\u0026plusmn;\u0026thinsp;9.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.693\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.395\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHCT%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e38.80\u0026thinsp;\u0026plusmn;\u0026thinsp;3.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e38.66\u0026thinsp;\u0026plusmn;\u0026thinsp;3.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.709\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.374\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMCH (pg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e30.09\u0026thinsp;\u0026plusmn;\u0026thinsp;1.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e30.20\u0026thinsp;\u0026plusmn;\u0026thinsp;1.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.512\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.656\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMCHC (g/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e327.55\u0026thinsp;\u0026plusmn;\u0026thinsp;10.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e327.01\u0026thinsp;\u0026plusmn;\u0026thinsp;9.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.598\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.527\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMCV (fL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e91.87\u0026thinsp;\u0026plusmn;\u0026thinsp;3.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e92.34\u0026thinsp;\u0026plusmn;\u0026thinsp;4.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.262\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-1.123\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePDW\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e12.69\u0026thinsp;\u0026plusmn;\u0026thinsp;2.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e13.27\u0026thinsp;\u0026plusmn;\u0026thinsp;2.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-2.326\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRDW-CV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e13.19\u0026thinsp;\u0026plusmn;\u0026thinsp;0.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e13.27\u0026thinsp;\u0026plusmn;\u0026thinsp;0.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.376\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.887\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCRP (mg/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e16.09\u0026thinsp;\u0026plusmn;\u0026thinsp;20.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e20.08\u0026thinsp;\u0026plusmn;\u0026thinsp;28.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.089\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-1.703\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eK (mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e3.91\u0026thinsp;\u0026plusmn;\u0026thinsp;0.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e3.86\u0026thinsp;\u0026plusmn;\u0026thinsp;0.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.175\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.358\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNA (mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e140.11\u0026thinsp;\u0026plusmn;\u0026thinsp;2.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e139.97\u0026thinsp;\u0026plusmn;\u0026thinsp;3.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.635\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.475\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCL (mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e104.07\u0026thinsp;\u0026plusmn;\u0026thinsp;3.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e103.06\u0026thinsp;\u0026plusmn;\u0026thinsp;4.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.910\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCA (mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e2.27\u0026thinsp;\u0026plusmn;\u0026thinsp;0.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e2.26\u0026thinsp;\u0026plusmn;\u0026thinsp;0.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.453\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.750\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eALT (U/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e17.91\u0026thinsp;\u0026plusmn;\u0026thinsp;17.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e19.50\u0026thinsp;\u0026plusmn;\u0026thinsp;16.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.385\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.869\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAST (U/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e22.57\u0026thinsp;\u0026plusmn;\u0026thinsp;16.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e22.70\u0026thinsp;\u0026plusmn;\u0026thinsp;6.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.935\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.082\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCH (mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e4.62\u0026thinsp;\u0026plusmn;\u0026thinsp;0.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e4.61\u0026thinsp;\u0026plusmn;\u0026thinsp;0.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.906\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.118\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTG (mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e1.35\u0026thinsp;\u0026plusmn;\u0026thinsp;0.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e1.29\u0026thinsp;\u0026plusmn;\u0026thinsp;0.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.374\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.890\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGLU (mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e5.68\u0026thinsp;\u0026plusmn;\u0026thinsp;1.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e5.57\u0026thinsp;\u0026plusmn;\u0026thinsp;1.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.497\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.680\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUREA (mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e281.81\u0026thinsp;\u0026plusmn;\u0026thinsp;80.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e276.83\u0026thinsp;\u0026plusmn;\u0026thinsp;80.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.553\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.593\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCREA (umol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e60.51\u0026thinsp;\u0026plusmn;\u0026thinsp;15.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e58.55\u0026thinsp;\u0026plusmn;\u0026thinsp;13.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.203\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.274\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCHE (U/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e7111.31\u0026thinsp;\u0026plusmn;\u0026thinsp;1625.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e6990.16\u0026thinsp;\u0026plusmn;\u0026thinsp;1724.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.478\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.709\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLDH (U/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e203.06\u0026thinsp;\u0026plusmn;\u0026thinsp;53.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e214.60\u0026thinsp;\u0026plusmn;\u0026thinsp;54.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.039\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-2.072\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eALP (U/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e104.09\u0026thinsp;\u0026plusmn;\u0026thinsp;35.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e99.99\u0026thinsp;\u0026plusmn;\u0026thinsp;43.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.293\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.053\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTP (g/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e67.32\u0026thinsp;\u0026plusmn;\u0026thinsp;4.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e67.13\u0026thinsp;\u0026plusmn;\u0026thinsp;5.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.722\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.356\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCK (U/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e90.82\u0026thinsp;\u0026plusmn;\u0026thinsp;166.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e85.27\u0026thinsp;\u0026plusmn;\u0026thinsp;99.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.730\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.345\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCKMB9 (ng/mL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e11.38\u0026thinsp;\u0026plusmn;\u0026thinsp;8.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e11.20\u0026thinsp;\u0026plusmn;\u0026thinsp;5.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.836\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.207\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTBIL (\u0026micro;mol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e16.01\u0026thinsp;\u0026plusmn;\u0026thinsp;9.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e16.06\u0026thinsp;\u0026plusmn;\u0026thinsp;6.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.961\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.048\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIBIL (\u0026micro;mol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e13.14\u0026thinsp;\u0026plusmn;\u0026thinsp;6.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e13.27\u0026thinsp;\u0026plusmn;\u0026thinsp;5.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.841\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.201\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDBIL (\u0026micro;mol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e2.88\u0026thinsp;\u0026plusmn;\u0026thinsp;4.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e2.79\u0026thinsp;\u0026plusmn;\u0026thinsp;1.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.818\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.230\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGLD (g/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e28.21\u0026thinsp;\u0026plusmn;\u0026thinsp;4.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e27.92\u0026thinsp;\u0026plusmn;\u0026thinsp;4.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.502\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.671\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGSP (mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e230.02\u0026thinsp;\u0026plusmn;\u0026thinsp;57.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e231.40\u0026thinsp;\u0026plusmn;\u0026thinsp;48.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.812\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.237\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAMY (U/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e56.42\u0026thinsp;\u0026plusmn;\u0026thinsp;24.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e53.66\u0026thinsp;\u0026plusmn;\u0026thinsp;22.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.265\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.115\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDD2 (ng/mL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e2.44\u0026thinsp;\u0026plusmn;\u0026thinsp;3.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e2.24\u0026thinsp;\u0026plusmn;\u0026thinsp;2.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.555\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.591\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFIB-RP (mg/dL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e3.37\u0026thinsp;\u0026plusmn;\u0026thinsp;0.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e3.32\u0026thinsp;\u0026plusmn;\u0026thinsp;0.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.569\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.570\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAPTT(s)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e28.58\u0026thinsp;\u0026plusmn;\u0026thinsp;6.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e28.72\u0026thinsp;\u0026plusmn;\u0026thinsp;6.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.820\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.228\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFDP (mg/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e7.66\u0026thinsp;\u0026plusmn;\u0026thinsp;12.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e7.56\u0026thinsp;\u0026plusmn;\u0026thinsp;10.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.940\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.075\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTT(s)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e17.50\u0026thinsp;\u0026plusmn;\u0026thinsp;4.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e17.16\u0026thinsp;\u0026plusmn;\u0026thinsp;1.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.441\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.771\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eINR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e0.93\u0026thinsp;\u0026plusmn;\u0026thinsp;0.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.94\u0026thinsp;\u0026plusmn;\u0026thinsp;0.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.827\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.218\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePT(s)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e11.54\u0026thinsp;\u0026plusmn;\u0026thinsp;1.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e11.54\u0026thinsp;\u0026plusmn;\u0026thinsp;1.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.991\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.011\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMyo (\u0026micro;g/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e19.19\u0026thinsp;\u0026plusmn;\u0026thinsp;17.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e19.83\u0026thinsp;\u0026plusmn;\u0026thinsp;25.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.755\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.312\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNT-proBNP (pg/mL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e448.51\u0026thinsp;\u0026plusmn;\u0026thinsp;1667.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e470.05\u0026thinsp;\u0026plusmn;\u0026thinsp;733.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.892\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.136\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePCT (ng/mL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e0.21\u0026thinsp;\u0026plusmn;\u0026thinsp;0.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.20\u0026thinsp;\u0026plusmn;\u0026thinsp;0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.469\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.724\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eUnivariate analysis of surgical factors of patients with residual back pain after PKP in OVCF.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFactor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePain-free group\u003c/p\u003e \u003cp\u003e(452 cases)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePain group\u003c/p\u003e \u003cp\u003e(117 cases)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eT-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLeakage of boneless cement\u003c/p\u003e \u003cp\u003e(cases, %)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e430 (95.13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e108 (92.31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.230\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1.440\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBone cement leakage (cases, %)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e22 (4.87)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9 (7.69)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLeakage into intervertebral space (cases, %)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16 (3.54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8 (6.84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.114\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.502\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLeakage into paravertebral tissue\u003c/p\u003e \u003cp\u003e(cases, %)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9 (1.99)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1 (0.85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.404\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.695\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePoured to the upper edge (cases, %)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e327 (72.35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e74 (63.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.055\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.697\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePoured to the lower edge (cases, %)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e309 (68.36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e68 (58.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.037\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4.362\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMassive bone cement (cases, %)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e271 (59.96)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e68 (58.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.718\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.130\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBone cement volume (mL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5.07\u0026thinsp;\u0026plusmn;\u0026thinsp;1.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.64\u0026thinsp;\u0026plusmn;\u0026thinsp;0.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.955\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAVH restored (cases, %)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e343 (75.88)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e68 (58.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e14.625\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMVH restored (cases, %)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e382 (84.51)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e66 (56.41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e43.841\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePVH restored (cases, %)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e446 (98.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e116 (99.15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.679\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.171\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative cob angle (\u0026deg;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11.36\u0026thinsp;\u0026plusmn;\u0026thinsp;5.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10.39\u0026thinsp;\u0026plusmn;\u0026thinsp;5.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.096\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.667\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative cob angle (\u0026deg;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7.60\u0026thinsp;\u0026plusmn;\u0026thinsp;4.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.52\u0026thinsp;\u0026plusmn;\u0026thinsp;5.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.875\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.158\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCoronary perfusion ratio (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e43.78\u0026thinsp;\u0026plusmn;\u0026thinsp;13.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e43.79\u0026thinsp;\u0026plusmn;\u0026thinsp;13.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.998\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSagittal perfusion ratio (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e44.86\u0026thinsp;\u0026plusmn;\u0026thinsp;12.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e44.76\u0026thinsp;\u0026plusmn;\u0026thinsp;12.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.941\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.075\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRecovery rate (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e36.02\u0026thinsp;\u0026plusmn;\u0026thinsp;24.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e30.52\u0026thinsp;\u0026plusmn;\u0026thinsp;24.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.033\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.136\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultivariate logistic regression analysis of residual back pain after PKP in OVCF patients.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eRisk factors\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eRegression coefficient\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eOR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e95% Confidence interval\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLower\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eUpper\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.038\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.963\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.007\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.937\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.990\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.295\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.343\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.360\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.715\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2.522\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.012\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.012\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.596\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.968\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.057\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWeight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.954\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.954\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.971\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.032\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMD\u0026rsquo;s |t| \u0026gt;3.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.553\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.575\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.035\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.344\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.962\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTrauma history\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.797\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.219\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.013\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.182\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4.165\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePFO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.804\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.076\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.079\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e11.990\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePDW\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.139\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.149\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.049\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.260\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.097\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.908\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.850\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.969\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLDH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.274\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.998\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.007\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBone cement volume\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.194\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.824\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.103\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.652\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.040\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePoured to the lower edge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.205\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.815\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.427\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.491\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.351\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAVH restored\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.211\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.810\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.436\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.477\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.376\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMVH restored\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-1.349\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.260\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.154\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.437\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRecovery rate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.452\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.637\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.391\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.227\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.787\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003econstant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8.689\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5935.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.075\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultivariate logistic regression analysis variable assignment.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAssignment\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003econtinuous variable\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u0026thinsp;=\u0026thinsp;0, Male\u0026thinsp;=\u0026thinsp;1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003econtinuous variable\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWeight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003econtinuous variable\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMD|t|\u0026gt;3.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u0026thinsp;=\u0026thinsp;0, Yes\u0026thinsp;=\u0026thinsp;1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTrauma history\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u0026thinsp;=\u0026thinsp;0, Yes\u0026thinsp;=\u0026thinsp;1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePFO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u0026thinsp;=\u0026thinsp;0, Yes\u0026thinsp;=\u0026thinsp;1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePDW\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003econtinuous variable\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003econtinuous variable\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLDH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003econtinuous variable\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBone cement volume\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003econtinuous variable\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePoured to the lower edge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u0026thinsp;=\u0026thinsp;0, Yes\u0026thinsp;=\u0026thinsp;1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAVH restored\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u0026thinsp;=\u0026thinsp;0, Yes\u0026thinsp;=\u0026thinsp;1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMVH restored\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u0026thinsp;=\u0026thinsp;0, Yes\u0026thinsp;=\u0026thinsp;1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eRecovery rate\u003c/p\u003e \u003cp\u003eRBP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003econtinuous variable\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u0026thinsp;=\u0026thinsp;0, Yes\u0026thinsp;=\u0026thinsp;1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003e3.3 ROC curve analysis of independent risk factors and their combined models\u003c/h2\u003e \u003cp\u003eThe ROC curve analysis was conducted on various independent risk factors, as well as their combined models. The analysis revealed that the area under the curve (AUC) for each individual risk factor was as follows: BMD (0.595), trauma history (0.573), lumbar dorsal fascia edema (0.588), platelet distribution width (0.575), and serum chlorine (0.561). Furthermore, the height of the middle vertebral body did not recover (0.641), and the combined model had an AUC of 0.788 (95% CI, 0.740\u0026ndash;0.836) with cut-off values of 0.710 and 0.761, respectively. All of these results were statistically significant (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The model had good discrimination and a high diagnostic value (Figs.\u0026nbsp;\u003cspan refid=\"Fig8\" class=\"InternalRef\"\u003e8\u003c/span\u003e \u0026amp; \u003cspan refid=\"Fig9\" class=\"InternalRef\"\u003e9\u003c/span\u003e; Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e). The assignment of each factor is shown in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eROC curve of each independent risk factor.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFactor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAUC\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSensitivity %\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSpecificity %\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e95% Confidence interval\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eLower\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eUpper\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.600\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.029\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e70.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e52.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.544\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.656\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMD\u0026rsquo;s |t| \u0026gt;3.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.595\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.029\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e70.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.539\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.651\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTrauma history\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.573\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.028\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e85.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e70.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.518\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.629\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePFO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.588\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.032\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e23.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.526\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.650\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePDW\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.575\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.029\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e60.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e44.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.518\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.632\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.561\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.029\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e70.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e61.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.504\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.618\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMVH restored\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.641\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.031\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e43.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.580\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.701\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrediction probability\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.788\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e76.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e29.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.740\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.836\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003e3.4 Construction of a nomogram model to predict the risk of residual back pain after PKP in patients with OVCF\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe ROC curve analysis indicated that the diagnostic value of the combination of independent risk factors was higher than that of each independent risk factor. Therefore, RStudio was used to build a nomogram model to predict the risk of RBP after PKP in patients with OVCF. The total score of the patients is calculated according to the sum of the scores corresponding to the factors in the nomogram model, and the total score was used as a vertical line to intersect the points on the lower risk axis, that is, the risk of RBP after vertebroplasty for osteoporotic vertebral compression fracture (Fig.\u0026nbsp;\u003cspan refid=\"Fig10\" class=\"InternalRef\"\u003e10\u003c/span\u003e \u003cb\u003e\u0026amp;\u003c/b\u003e Table\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab7\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eNomogram model score for predicting the risk of residual back pain after PKP in OVCF patients.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eScore/point\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.95\u0026times; (100-Age)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMD\u0026rsquo;s |t| \u0026gt;3.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16.32\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTrauma history\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19.58\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePFO\u003c/p\u003e \u003cp\u003ePDW\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e44.21\u003c/p\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.47\u0026times; (PDW-6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCL\u003c/p\u003e \u003cp\u003eMVH restored\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.55\u0026times; (115-CL)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35.68\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003e3.5 Calibration curve analysis of the model\u003c/h2\u003e \u003cp\u003eThe calibration curve of the nomogram was drawn. The standard curve was a straight line passing through the origin of the coordinate axis with a slope of 1. The predicted calibration curve fell between the standard and acceptable lines and fit well with the standard curve. The predicted risk of the nomogram was in good agreement with the actual risk and had a good prediction ability (Fig.\u0026nbsp;\u003cspan refid=\"Fig11\" class=\"InternalRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003e3.6 Clinical decision curve analysis of model\u003c/h2\u003e \u003cp\u003eAs shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig12\" class=\"InternalRef\"\u003e12\u003c/span\u003e, the red curve in the decision curve analysis represents the nomogram model, the gray curve and the black curve indicate the two extreme cases, the gray line indicates the assumption that all patients have postoperative RBP, and the black line represents the assumption that no patient had postoperative RBP. The x-axis in Fig.\u0026nbsp;\u003cspan refid=\"Fig12\" class=\"InternalRef\"\u003e12\u003c/span\u003e represents the threshold probability, and the y-axis represents the net benefit rate. The decision curve showed that if the probability of the threshold of the patient or the doctor was 6.3\u0026ndash;82.3%, the nomogram model could predict postoperative RBP and would provide more benefit than treatment of all patients or not treatment.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003e3.7 Internal and external validation of the model\u003c/h2\u003e \u003cp\u003eThe ROC curve cutoff value of the model training set was 0.184, the specificity and sensitivity were 0.710 and 0.761, respectively, and the AUC was 0.788. Internal validation of the model: after the bootstrap was repeatedly sampled 1000 times in the training set, the AUC of the model was 0.784. The validation set externally validated the model. The ROC curve cutoff value was 0.379, the specificity and sensitivity were 0.918 and 0.647. The AUC was 0.792, indicating that the model had high discrimination (Fig.\u0026nbsp;\u003cspan refid=\"Fig9\" class=\"InternalRef\"\u003e9\u003c/span\u003e). The calibration curves of the model training set and the validation set fell approximately between the standard curve and the acceptable line, indicating that the probability of postoperative RBP predicted by the model as consistent with the actual probability (Fig.\u0026nbsp;\u003cspan refid=\"Fig11\" class=\"InternalRef\"\u003e11\u003c/span\u003e). The Hosmer-Lemeshow goodness-of-fit test showed that the model training set and the validation set χ2 were 6.354 and 7.240, respectively. The \u003cem\u003eP\u003c/em\u003e-values were 0.608 and 0.511, indicating that the model calibration was good. The clinical decision curve shows that the probability interval of the net benefit threshold of the centralized training model was 6.3\u0026ndash;82.3% and the probability interval of the net benefit threshold of the centralized validation model was 8.7\u0026ndash;55.6%, and 72.5\u0026ndash;81.3%. When the threshold probability of postoperative RBP of patients fell within this interval, the net benefit rate of using this model was significantly higher than that of the \"no intervention\" and \"full intervention\" schemes, indicating that the model has good clinical applicability (Fig.\u0026nbsp;\u003cspan refid=\"Fig12\" class=\"InternalRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThe aging population has made OVCF a significant global health issue. Approximately 20% of the world's population is over the age of 70, and at least one in five patients over the age of 50 has one or more vertebral fractures (Karmakar et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Kendler et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). The complications of OVCF, including persistent pain, kyphosis, weight loss, and depression, lead to a decline in quality of life (QoL) and can even result in death (Beall et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). PKP is a minimally invasive surgery commonly used in the clinical treatment of OVCF. Although it has the advantages of small trauma, fast pain relief, early mobilization, and effectively improving the prognosis of patients, some patients still experience postoperative RBP (Patel et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). RBP is the most common complication of PKP and PVP, with approximately 9%-35% of patients having residual pain after treatment, which is a significant concern for patients (Li et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Xu et al., \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). However, insufficient attention has been placed on RBP after PKP, with few relevant studies addressing this issue. The diagnosis of postoperative residual pain primarily relies on patient self-reports during postoperative rounds, lacking early, effective, and accurate prediction, and diagnosis. Therefore, identifying the risk factors for postoperative RBP in OVCF patients is essential, as it allows for targeted prevention of RBP and facilitates early intervention to improve prognosis. Meanwhile, in the clinical setting, many patients have high expectations for their prognosis after minimally invasive surgery. Once RBP occurs in the postoperative period, patient dissatisfaction or hostility can easily be aroused. Relatively accurate prediction enables clinicians to identify high-risk patients and manage their expectations, ensuring they are more realistic and well-informed. This, in turn, helps prevent unnecessary doctor-patient disputes and promotes a harmonious relationship between doctors and patients. This study identified several independent risk factors for postoperative RBP in OVCF patients, including young age, high BMD, history of trauma, low back fascia edema, high PDW, low serum chloride levels, and no recovery of middle vertebral height.\u003c/p\u003e \u003cp\u003ePrevious studies have suggested no statistical difference in the age of patients between the postoperative pain and pain-free groups, indicating that age is not a risk factor for the occurrence of RBP. However, this study obtained contrasting results, identifying age as a significant risk factor for RBP. In this sample, the younger the age, the higher the incidence of residual pain. Chen et al. (Chen et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2024\u003c/span\u003e) reported that low preoperative BMD was an independent risk factor for RBP after PKP. Conversely, the results of this study showed that the incidence of residual pain was higher when BMD was 2.5\u0026le;| t |\u0026le;3.5, while patients with preoperative | t |\u0026gt;3.5 were less likely to experience RBP after PKP. This finding may be attributed to having a low preoperative BMD value, which may be associated with more serious osteoporosis, or to low-energy injuries that may lead to a vertebral compression fracture in patients. In contrast, patients with relatively high BMD exhibit less osteoporosis, and fractures are preceded by greater trauma. Therefore, patients with high BMD values experience a more serious injury, accompanied by the possibility of relatively higher postoperative RBP.\u003c/p\u003e \u003cp\u003eIn addition, the results of this study suggest that a clear trauma history is also an independent risk factor for residual pain after PKP. Osteoporotic vertebral compression fractures usually occur in older adults. Impaired physical coordination, along with a decline in the strength of muscles, ligaments, and other structures, increases their susceptibility to trauma. At the same time, fractures often cause varying degrees of soft tissue damage. The pain from the preoperative fracture may overshadow this, but as the fracture heals, postoperative soft tissue pain becomes more pronounced, leading to RBP. According to Yan et al. (Yan et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2015\u003c/span\u003e), the prevalence of fasciopathy in patients with OVCF is as high as 42.1%. Luo et al. (Luo et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) identified thoracolumbar fascial injury was one of the causes of RBP. Our study also found that thoracolumbar fascia injury is a strong risk factor (OR\u0026thinsp;=\u0026thinsp;6.076) for residual pain after PKP. Other studies have also proposed sacrospinal myofasciitis may contribute to residual pain (Yang et al., \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2024b\u003c/span\u003e; Ge et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). It is challenging to determine whether sacrospinal myofasciitis exists preoperatively, with fracture pain masking its presence, or if the pain is a result of intraoperative injury radiating along the sacrospinal muscle. However, the residual postoperative pain of patients with lumbar dorsal fascia injury is more serious than that of patients without lumbar dorsal fascia injury (Yang et al., \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2024a\u003c/span\u003e). This coincides with the results of our study, whereby lumbar dorsal fascia edema is an independent risk factor for residual pain. This may be due to the following reasons: (1) lumbar soft tissue injuries, such as superficial fascia and muscle, leads to local pain; (2) pain can be induced by fascial injury and soft tissue edema, which compresses the branches of the dorsal root of the spinal nerve and stimulation of inflammatory factors. PKP is used exclusively for the treatment of vertebral fractures and cannot relieve pain caused by fascia and soft tissue injury.\u003c/p\u003e \u003cp\u003eThis study analyzed the results of the preoperative laboratory findings of patients. A high PDW and a low serum chlorine value were independent risk factors for residual pain after PKP. PDW is a parameter that represents the variation of platelet volumes in the blood, which is used to express the degree of homogeneity of platelet and is used to detect larger platelets that are more active in both enzymatically and metabolically. The change in the PDW value may be associated with lifestyle-related disease factors, thrombopoietin level, platelet activity, and megakaryocyte production (Khatib-Massalha and M\u0026eacute;ndez-Ferrer, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Pogorzelska et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). It is also a determinant of platelet activation and is considered a marker of inflammatory disease. During platelet activation, the release of various inflammatory cytokines leads to the formation of platelet clots and the formation of a thrombus (Kaiser et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). A decrease in complement Cl concentrations can enhance the inflammatory response of endothelial cells (Valdivieso \u0026Aacute; and Santa-Coloma, 2019; Yang et al., \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). Cl- reduction is the key to the formation and inflammation of foam cells (Wu et al., \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). Fibromyalgia (FMS) is in a prethrombotic state, which may be enhanced by increasing the intensity of inflammation (Molina et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Detection of PDW contributes to diagnosing patients with FMS (Akt\u0026uuml;rk and B\u0026uuml;y\u0026uuml;kavcı, \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Similarly, in this study, when the patient was in such a prethrombotic state of inflammatory intensity, an increase in inflammatory factors and poor blood circulation can increase pain. Such pain interferes with early functional exercise activity and reduces muscle strength, leading to further pain. PDW and low serum chloride can be used as biomarkers to predict residual pain after PKP in patients with OVCF.\u003c/p\u003e \u003cp\u003eOur study found a statistical difference between the two groups regarding whether the height of the anterior and middle vertebrae recovered, but only the middle height of the vertebral body did not recover, which was identified as an independent risk factor for the occurrence of residual pain. Denis\u0026rsquo; three-column theory holds that the anterior and middle columns of vertebral bodies bear 80% of the stress, and the middle column plays a key role in maintaining the spine's stability. During PKP, balloon expansion restores the middle height of the vertebral body, bone cement is fully dispersed, chemical neurolysis and thermal neurolysis of PMMA can effectively relieve pain in the fracture, and a wedge-shaped change of the vertebral body is restored, micro and/or macro movements of the fracture site of the vertebral body disappear (Zhu et al., \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Seesala et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). The biomechanical environment is restored to equilibrium which brings about an improvement in the compliance of the soft tissues of the back to reduce the possibility of residual pain in the postoperative period (Mei et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Conversely, if the middle vertebral height is not fully restored, the incidence of RBP can be increased.\u003c/p\u003e \u003cp\u003eFurthermore, previous studies have shown that facet joint violations, a large number of fracture segments, fracture location, refractive fracture of adjacent or operated vertebral bodies, insufficient dispersion of bone cement in the fracture line area, leakage of bone cement, bone cement volume, inflammatory reaction or local ischemia caused by bone cement, and segmental kyphosis are also independent risk factors for residual pain (Li et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Yang et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe ROC curve shows that the predictive ability of the combined model was stronger than that of each independent factor, indicating that a complete assessment of multiple factors is required to improve accuracy when predicting the risk of RBP. Furthermore, a nomogram model was established that could calculate the risk of RBP after PKP for a patient with OVCF patient. This nomogram may help medical personnel identify high-risk patients with RBP after PKP promptly and could provide a basis for the early formulation of prevention strategies, treatment methods, surgical intervention, and surgical details. Sample calculations for scores using different variables for an 80-year-old patient can be estimated as follows: patient with OVCF (score 0.95 \u0026times; (100\u0026thinsp;\u0026minus;\u0026thinsp;80)\u0026thinsp;=\u0026thinsp;19), lumbar BMD t of -2.0 (score 16.32), with a clear history of trauma (score 19.58), edema of the lumbar dorsal fascia (score 44.21), and a measured PDW value of 12.80 (3.47 \u0026times; (12.80-6)\u0026thinsp;=\u0026thinsp;23.60), and with a serum chlorine value of 105 (score 2.55 \u0026times; (115\u0026thinsp;\u0026minus;\u0026thinsp;105)\u0026thinsp;=\u0026thinsp;25.5), if the height of 1/3 of the vertebral body is not recovered (score 35.68), the total score is indicated by the sum of the above scores (183.89) and the corresponding risk value is close to 80%. Therefore, the clinician should pay greater attention to the possibility of RBP after surgery and provide timely intervention.\u003c/p\u003e \u003cp\u003eThis study currently has some limitations. This study is a retrospective case-control study. Only a visual analogue scale (VAS) in medical records and follow-up records were used to determine whether patients experienced RBP. The follow-up time was short, and the VAS score results were subjective. The diagnostic criteria were not comprehensive, and objectivity was lacking. Secondly, the data and potential risk factors included in this study are limited, and the variables were not comprehensive, which may have partially impacted the conclusion. This study was a single-center study, and the model may not be generalizable to the settings outside the study site. Therefore, a large sample, multicenter, and long-term follow-up prospective study is needed to analyze the risk factors for RBP after PKP in patients with OVCF and to build and verify the validity of the prediction model with regard to the risk of occurrence.\u003c/p\u003e"},{"header":"5. Conclusions","content":"\u003cp\u003eThis study analyzed the risk factors for RBP after PKP in patients with OVCF. The results showed that young age, high BMD, history of trauma, low back fascia edema, high PDW, low serum chlorine, and no recovery of middle vertebral height were independent risk factors for RBP after PKP in patients with OVCF, and the predictive value of combined factors was higher. Thus, a visual nomogram model was constructed and established to predict the risk of residual pain that is simple and easy to read. The nomogram model demonstrated strong predictive ability, good calibration, and high clinical applicability for predicting postoperative RBP in OVCF patients undergoing PKP. Its ability to accurately identify patients at risk for RBP enables targeted intervention, thereby improving clinical outcomes. The model's practical utility is further supported by its performance in both internal and external validations and decision curve analysis. Therefore, this model can guide clinical risk assessment and take measures against high-risk factors for the timely prevention of RBP.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eRBP: residual back pain; PKP: percutaneous kyphoplasty; OVCF: osteoporotic vertebral compression fracture; BMD: bone mineral density; PVP: percutaneous vertebroplasty; PMMA: polymethylmethacrylate; QoL: quality of life; LL: lumbar lordosis; PI: pelvic incidence; ROC: \u0026nbsp;receiver operating characteristic; MRI: Magnetic resonance imaging; DXA: Dual-energy X-ray absorptiometry; NSAIDs: nonsteroidal anti-inflammatory drugs; BMI: body mass index; AUC: area under the curve; PDW: platelet distribution width;\u0026nbsp;\u003c/p\u003e\n"},{"header":"Declarations","content":"\u003ch4\u003eEthics approval and consent to participate\u003c/h4\u003e\n\u003cp\u003eThis study was conducted in accordance with the principles outlined in the Declaration of Helsinki and approved by the Institutional Review Board of Wuxi Hospital of Traditional Chinese Medicine (Approval Number: SSF2022022504]).\u0026nbsp;\u003c/p\u003e\n\u003ch4\u003eConsent for publication\u003c/h4\u003e\n\u003cp\u003eAll participants provided written informed consent prior to their participation in the study, including consent for publication of anonymized data.\u003c/p\u003e\n\u003ch4\u003eAvailability of data and materials\u003c/h4\u003e\n\u003cp\u003eThe data that support the findings of this study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003ch4\u003eCompeting interests\u003c/h4\u003e\n\u003cp\u003eThe authors report no conflicts of interest in this work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by the Wuxi Municipal Health Commission (NO. XSMZDXK002), National Natural Science Foundation of China (NO. 82205142), and Postgraduate Research \u0026amp; Practice Innovation Program of Jiangsu Province (KYCX22_2062).\u003c/p\u003e\n\u003ch4\u003eAuthors\u0026apos; contributions\u003c/h4\u003e\n\u003cp\u003eYi Rong,\u0026nbsp;Jianwei Wang,\u0026nbsp;Yihua Zhu,\u0026nbsp;Yong Ma\u0026nbsp;and\u0026nbsp;Hao Yu\u0026nbsp;spearheaded and supervised all the trials.\u0026nbsp;Hao Yu,\u0026nbsp;Yi Rong,\u0026nbsp;Yihua Zhu, Yang Guo, Heng Yin and Lining Wang\u0026nbsp;designed the study and trials.\u0026nbsp;Yang Shao\u0026nbsp;and\u0026nbsp;Shaoshuo Li\u0026nbsp;conducted the trials and analyzed the data.\u0026nbsp;Yi Rong,\u0026nbsp;Yihua Zhu,\u0026nbsp;Zhen Hua\u0026nbsp;and\u0026nbsp;Jiapeng Ye\u0026nbsp;wrote and revised the manuscript. All authors reviewed and approved the final version of the manuscript, ensuring integrity and accuracy in all aspects of the work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe Acknowledge all those who participated in the revision of the manuscript.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAkt\u0026uuml;rk S and B\u0026uuml;y\u0026uuml;kavcı R. (2017) Evaluation of blood neutrophil-lymphocyte ratio and platelet distribution width as inflammatory markers in patients with fibromyalgia. \u003cem\u003eClin Rheumatol\u003c/em\u003e 36: 1885-1889.\u003c/li\u003e\n\u003cli\u003eBeall DP, Olan WJ, Kakad P, et al. (2015) Economic Analysis of Kiva VCF Treatment System Compared to Balloon Kyphoplasty Using Randomized Kiva Safety and Effectiveness Trial (KAST) Data. \u003cem\u003ePain Physician\u003c/em\u003e 18: E299-306.\u003c/li\u003e\n\u003cli\u003eBo J, Zhao X, Hua Z, et al. (2022) Impact of sarcopenia and sagittal parameters on the residual back pain after percutaneous vertebroplasty in patients with osteoporotic vertebral compression fracture. \u003cem\u003eJ Orthop Surg Res\u003c/em\u003e 17: 111.\u003c/li\u003e\n\u003cli\u003eChen C, Wu B, Yu H, et al. (2024) Association between vertebral bone quality score and residual back pain following percutaneous vertebroplasty for osteoporotic vertebral compression fractures. \u003cem\u003eEur Spine J\u003c/em\u003e.\u003c/li\u003e\n\u003cli\u003eGe C, Chen Z, Lin Y, et al. (2022) Preoperative prediction of residual back pain after vertebral augmentation for osteoporotic vertebral compression fractures: Initial application of a radiomics score based nomogram. \u003cem\u003eFront Endocrinol (Lausanne)\u003c/em\u003e 13: 1093508.\u003c/li\u003e\n\u003cli\u003eHoyt D, Urits I, Orhurhu V, et al. (2020) Current Concepts in the Management of Vertebral Compression Fractures. \u003cem\u003eCurr Pain Headache Rep\u003c/em\u003e 24: 16.\u003c/li\u003e\n\u003cli\u003eJin YZ, Lee JH, Xu B, et al. (2019) Effect of medications on prevention of secondary osteoporotic vertebral compression fracture, non-vertebral fracture, and discontinuation due to adverse events: a meta-analysis of randomized controlled trials. \u003cem\u003eBMC Musculoskelet Disord\u003c/em\u003e 20: 399.\u003c/li\u003e\n\u003cli\u003eKaiser R, Escaig R and Nicolai L. (2023) Hemostasis without clot formation: how platelets guard the vasculature in inflammation, infection, and malignancy. \u003cem\u003eBlood\u003c/em\u003e 142: 1413-1425.\u003c/li\u003e\n\u003cli\u003eKarmakar A, Acharya S, Biswas D, et al. (2017) Evaluation of Percutaneous Vertebroplasty for Management of Symptomatic Osteoporotic Compression Fracture. \u003cem\u003eJ Clin Diagn Res\u003c/em\u003e 11: Rc07-rc10.\u003c/li\u003e\n\u003cli\u003eKendler DL, Bauer DC, Davison KS, et al. (2016) Vertebral Fractures: Clinical Importance and Management. \u003cem\u003eAm J Med\u003c/em\u003e 129: 221.e221-210.\u003c/li\u003e\n\u003cli\u003eKhatib-Massalha E and M\u0026eacute;ndez-Ferrer S. (2022) Megakaryocyte Diversity in Ontogeny, Functions and Cell-Cell Interactions. \u003cem\u003eFront Oncol\u003c/em\u003e 12: 840044.\u003c/li\u003e\n\u003cli\u003eLi Q, Shi L, Wang Y, et al. (2021) A Nomogram for Predicting the Residual Back Pain after Percutaneous Vertebroplasty for Osteoporotic Vertebral Compression Fractures. \u003cem\u003ePain Res Manag\u003c/em\u003e 2021: 3624614.\u003c/li\u003e\n\u003cli\u003eLi Y, Yue J, Huang M, et al. (2020) Risk factors for postoperative residual back pain after percutaneous kyphoplasty for osteoporotic vertebral compression fractures. \u003cem\u003eEur Spine J\u003c/em\u003e 29: 2568-2575.\u003c/li\u003e\n\u003cli\u003eLin M, Wen X, Huang Z, et al. (2023) A nomogram for predicting residual low back pain after percutaneous kyphoplasty in osteoporotic vertebral compression fractures. \u003cem\u003eOsteoporos Int\u003c/em\u003e 34: 749-762.\u003c/li\u003e\n\u003cli\u003eLiu D, Wen T, Li X, et al. (2024) Percutaneous Vertebroplasty Versus Balloon Kyphoplasty in the Treatment of Osteoporotic Vertebral Compression Fractures: Evaluating the Overlapping Meta-analyses. \u003cem\u003ePain Physician\u003c/em\u003e 27: E383-e394.\u003c/li\u003e\n\u003cli\u003eLong Y, Yi W and Yang D. (2020) Advances in Vertebral Augmentation Systems for Osteoporotic Vertebral Compression Fractures. \u003cem\u003ePain Res Manag\u003c/em\u003e 2020: 3947368.\u003c/li\u003e\n\u003cli\u003eLuo Y, Jiang T, Guo H, et al. (2022) Osteoporotic vertebral compression fracture accompanied with thoracolumbar fascial injury: risk factors and the association with residual pain after percutaneous vertebroplasty. \u003cem\u003eBMC Musculoskelet Disord\u003c/em\u003e 23: 343.\u003c/li\u003e\n\u003cli\u003eMa Y, Wu X, Xiao X, et al. (2020) Effects of teriparatide versus percutaneous vertebroplasty on pain relief, quality of life and cost-effectiveness in postmenopausal females with acute osteoporotic vertebral compression fracture: A prospective cohort study. \u003cem\u003eBone\u003c/em\u003e 131: 115154.\u003c/li\u003e\n\u003cli\u003eMei X, Sun ZY, Zhou F, et al. (2017) Analysis of Pre- and Postoperative Pain Variation in Osteoporotic Vertebral Compression Fracture Patients Undergoing Kyphoplasty. \u003cem\u003eMed Sci Monit\u003c/em\u003e 23: 5994-6000.\u003c/li\u003e\n\u003cli\u003eMolina F, Del Moral ML, La Rubia M, et al. (2019) Are Patients With Fibromyalgia in a Prothrombotic State? \u003cem\u003eBiol Res Nurs\u003c/em\u003e 21: 224-230.\u003c/li\u003e\n\u003cli\u003ePark JS and Park YS. (2021) Survival analysis and risk factors of new vertebral fracture after vertebroplasty for osteoporotic vertebral compression fracture. \u003cem\u003eSpine J\u003c/em\u003e 21: 1355-1361.\u003c/li\u003e\n\u003cli\u003eParreira PCS, Maher CG, Megale RZ, et al. (2017) An overview of clinical guidelines for the management of vertebral compression fracture: a systematic review. \u003cem\u003eSpine J\u003c/em\u003e 17: 1932-1938.\u003c/li\u003e\n\u003cli\u003ePatel D, Liu J and Ebraheim NA. (2022) Managements of osteoporotic vertebral compression fractures: A narrative review. \u003cem\u003eWorld J Orthop\u003c/em\u003e 13: 564-573.\u003c/li\u003e\n\u003cli\u003ePogorzelska K, Krętowska A, Krawczuk-Rybak M, et al. (2020) Characteristics of platelet indices and their prognostic significance in selected medical condition - a systematic review. \u003cem\u003eAdv Med Sci\u003c/em\u003e 65: 310-315.\u003c/li\u003e\n\u003cli\u003eReid IR and McClung MR. (2024) Osteopenia: a key target for fracture prevention. \u003cem\u003eLancet Diabetes Endocrinol\u003c/em\u003e 12: 856-864.\u003c/li\u003e\n\u003cli\u003eSeesala VS, Sheikh L, Basu B, et al. (2024) Mechanical and Bioactive Properties of PMMA Bone Cement: A Review. \u003cem\u003eACS Biomater Sci Eng\u003c/em\u003e 10: 5939-5959.\u003c/li\u003e\n\u003cli\u003eSkj\u0026oslash;dt MK and Abrahamsen B. (2023) New Insights in the Pathophysiology, Epidemiology, and Response to Treatment of Osteoporotic Vertebral Fractures. \u003cem\u003eJ Clin Endocrinol Metab\u003c/em\u003e 108: e1175-e1185.\u003c/li\u003e\n\u003cli\u003eValdivieso \u0026Aacute; G and Santa-Coloma TA. (2019) The chloride anion as a signalling effector. \u003cem\u003eBiol Rev Camb Philos Soc\u003c/em\u003e 94: 1839-1856.\u003c/li\u003e\n\u003cli\u003eWang B, Zhao CP, Song LX, et al. (2018) Balloon kyphoplasty versus percutaneous vertebroplasty for osteoporotic vertebral compression fracture: a meta-analysis and systematic review. \u003cem\u003eJ Orthop Surg Res\u003c/em\u003e 13: 264.\u003c/li\u003e\n\u003cli\u003eWang G, Yang H and Chen K. (2010) Osteoporotic vertebral compression fractures with an intravertebral cleft treated by percutaneous balloon kyphoplasty. \u003cem\u003eJ Bone Joint Surg Br\u003c/em\u003e 92: 1553-1557.\u003c/li\u003e\n\u003cli\u003eWang W, Liu Y, Wan H, et al. (2023) Effectiveness and prognostic factors of different minimally invasive surgeries for vertebral compression fractures. \u003cem\u003eBMC Musculoskelet Disord\u003c/em\u003e 24: 11.\u003c/li\u003e\n\u003cli\u003eWen Z, Mo X, Zhao S, et al. (2022) Study on Risk Factors of Primary Non-traumatic OVCF in Chinese Elderly and a Novel Prediction Model. \u003cem\u003eOrthop Surg\u003c/em\u003e 14: 2925-2938.\u003c/li\u003e\n\u003cli\u003eWu QQ, Liu XY, Xiong LX, et al. (2016) Reduction of Intracellular Chloride Concentration Promotes Foam Cell Formation. \u003cem\u003eCirc J\u003c/em\u003e 80: 1024-1033.\u003c/li\u003e\n\u003cli\u003eXia W, Fu H, Zhu Z, et al. (2019) Association between back muscle degeneration and spinal-pelvic parameters in patients with degenerative spinal kyphosis. \u003cem\u003eBMC Musculoskelet Disord\u003c/em\u003e 20: 454.\u003c/li\u003e\n\u003cli\u003eXu JJ, Tang XT, Yang J, et al. (2021) The Effect of Medial Branch Block on Postoperative Residual Pain Relieve After Percutaneous Kyphoplasty: A Randomized Controlled Trial With 12-Month Follow-up. \u003cem\u003ePain Physician\u003c/em\u003e 24: E1059-e1066.\u003c/li\u003e\n\u003cli\u003eYan Y, Xu R and Zou T. (2015) Is thoracolumbar fascia injury the cause of residual back pain after percutaneous vertebroplasty? A prospective cohort study. \u003cem\u003eOsteoporos Int\u003c/em\u003e 26: 1119-1124.\u003c/li\u003e\n\u003cli\u003eYang D, Liu X, Zhou Y, et al. (2022) A novel scoring system to predict the residual back pain after percutaneous kyphoplasty for osteoporotic vertebral compression fracture. \u003cem\u003eFront Surg\u003c/em\u003e 9: 1035681.\u003c/li\u003e\n\u003cli\u003eYang H, Huang LY, Zeng DY, et al. (2012) Decrease of intracellular chloride concentration promotes endothelial cell inflammation by activating nuclear factor-\u0026kappa;B pathway. \u003cem\u003eHypertension\u003c/em\u003e 60: 1287-1293.\u003c/li\u003e\n\u003cli\u003eYang JS, Liu JJ, Chu L, et al. (2019) Causes of Residual Back Pain at Early Stage After Percutaneous Vertebroplasty: A Retrospective Analysis of 1,316 Cases. \u003cem\u003ePain Physician\u003c/em\u003e 22: E495-e503.\u003c/li\u003e\n\u003cli\u003eYang S, Tang J, Yang Z, et al. (2024a) Effect of thoracolumbar fascia injury on reported outcomes after percutaneous vertebroplasty. \u003cem\u003eFront Surg\u003c/em\u003e 11: 1379769.\u003c/li\u003e\n\u003cli\u003eYang XG, Dong YQ, Liu X, et al. (2024b) Incidence and prognostic factors of residual back pain in patients treated for osteoporotic vertebral compression fractures: a systematic review and meta-analysis. \u003cem\u003eEur Spine J\u003c/em\u003e 33: 4521-4537.\u003c/li\u003e\n\u003cli\u003eYu D, Liu Z, Wang H, et al. (2022) Treatment of Elderly Patients with Acute Symptomatic OVCF: A Study of Comparison of Conservative Treatment and Percutaneous Kyphoplasty. \u003cem\u003eFront Surg\u003c/em\u003e 9: 942195.\u003c/li\u003e\n\u003cli\u003eZhu J, Yang S, Cai K, et al. (2020) Bioactive poly (methyl methacrylate) bone cement for the treatment of osteoporotic vertebral compression fractures. \u003cem\u003eTheranostics\u003c/em\u003e 10: 6544-6560.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"osteoporotic vertebral compression fracture, percutaneous kyphoplasty, residual back pain, regression analysis, risk prediction","lastPublishedDoi":"10.21203/rs.3.rs-5716384/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5716384/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eSevere residual back pain (RBP) after percutaneous kyphoplasty (PKP) significantly impacts postoperative prognosis and quality of life in patients. This study aims to identify the risk factors for RBP in patients with osteoporotic vertebral compression fractures (OVCF) following PKP, and to establish and validate a risk prediction model for RBP occurrence after PKP, so as to deepen our understanding of the risk of RBP after PKP, and improve clinical management strategies.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003e647 patients with OVCF who had PKP surgery from 2018 to 2020 were retrospectively analyzed. 569 cases were used for training the model, and 78 for external validation. The study focused on RBP occurrence after PKP. A nomogram for risk prediction was constructed and the model was tested for accuracy and clinical applicability. Additionally, bootstrap sampling (1000 times) was used for internal validation.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eBased on the model training set, multivariate logistic regression analysis showed that relatively young age, bone mineral density, history of trauma, low back fascia edema, high platelet distribution width value, low serum chlorine value, and no recovery of middle vertebral height were independent risk factors for RBP after PKP (P\u0026thinsp;\u0026le;\u0026thinsp;0.05). Calibration curves of the model training and validation sets were between the standard curve and the acceptable line. The Hosmer-Lemeshow goodness-of-fit test indicated that the model training and validation sets were χ\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;6.354 and χ\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;7.240, respectively (P\u0026thinsp;=\u0026thinsp;0.608 and 0.511). The clinical decision-making curve showed that the threshold probability interval of the net benefit value of the model was 6.3\u0026ndash;82.3% for the training set, 8.7\u0026ndash;55.6%, and 72.5\u0026ndash;81.3% for the validation set.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eEach independent risk factor and the combined model had good predictive ability, while the combined model had a more vital predictive ability. The constructed nomogram model for predicting RBP risk showed good diagnostic efficacy, accuracy, and clinical applicability and provided a scientific rationale and guidance for clinical prevention and treatment.\u003c/p\u003e\u003ch2\u003eTrial registration\u003c/h2\u003e \u003cp\u003eClinical trianumber not applicable Study design Retrospective casecontrol study.\u003c/p\u003e","manuscriptTitle":"A risk model for prediction of residual back pain after percutaneous kyphoplasty in patients with osteoporotic vertebral compression fracture","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-01-02 18:26:05","doi":"10.21203/rs.3.rs-5716384/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0e107c44-f0b2-45af-bf7f-f8da2e14d1d4","owner":[],"postedDate":"January 2nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-01-31T17:08:34+00:00","versionOfRecord":[],"versionCreatedAt":"2025-01-02 18:26:05","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5716384","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5716384","identity":"rs-5716384","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}