寰枢椎脱位外科预后模型的建立与探讨  

Establishing and evaluating a prognostic model for the surgical outcomes of patients with atlanto-axial dislocations

作　　者：郭帅[1] 陈杰[1] 杨保辉[1] 李浩鹏[2] 

机构地区：[1]西安交通大学医学部,西安710061 [2]西安交通大学第二附属医院骨二科

出　　处：《临床神经外科杂志》2016年第3期181-185,共5页Journal of Clinical Neurosurgery

摘　　要：目的回顾寰枢椎脱位病例,建立其手术治疗的预后模型以评价预后。方法分析108位寰枢椎脱位患者资料,以术后6个月的改良日本骨科学会（m JOA）评分≥16分为阈值,收集年龄、性别、吸烟史、是否合并其他脊柱或神经系统疾病、术前m JOA评分、病程、MRI T2WI中寰枢椎水平颈髓有无高强度信号等7个可能影响预后的因素数据并行二分类logistic回归分析建模,采用内部验证（internal validation）方法分析,包括自助（bootstrap）法抽样、绘制吻合线（calibration plot）及计算受试者曲线下面积（AUC）分别评价模型吻合力（calibration）与分辨力（discrimination）。结果预后模型为：logit（P）=-2.242 8＋0.316 8SCORE-2.0357SIGNAL,其中SCORE指术前m JOA评分（0～17）,SIGNAL指高信号（0=＂无＂,1=＂有＂）。AUC=0.808 1（0.725 9,0.890 3）。结论预后模型吻合力与分辨力均较理想,其中术前m JOA评分为保护因素,T2WI中异常高信号为危险因素,当logit（P）≥-0.728 2时可认为预后良好,模型虽有待完善,但已初具一定临床应用价值。Objective： To develop a clinical rule to determine the surgical outcomes of patients with atlanto-axial dislocations （AADs）. Methods This is a retrospective study using modified Japanese Orthopedic Association （mJOA） assessment scale as the outcome measure. The model was established based on data from a sample of 108 related patients by applying multiple binary logistic regression analysis and was evaluated using a calibration plot and the area under the receiver operating curve （AUC）. Bootstrapping was used for internal validation. Results The prognostic model can be expressed as： logit（P） = - 2. 242 8 ＋ 0. 316 8SCORE - 2. 035 7SIGNAL , in which two covariates were accepted （SCORE represents the preoperative mJOA score and SIGNAL represents the intramedullary hyperintense Te WI with AUC = 0. 808 1 ）. Conclusions The model was internally valid, and the preoperative mJOA score and hyperintense T2 WI were important predictors of outcomes. The threshold was defined as logit （P） = - 0. 728 2 according to the receiver operating curve （ROC）.

关 键 词：寰枢椎脱位 回顾性 预后模型 

分 类 号：R739.41[医药卫生—肿瘤]