椎间孔镜治疗腰椎间盘突出症患者术后复发的个体化预警模型的建立  

Establishment of individualized early warning model for predicting recurrence after percutaneous endoscopic lumbar discectomy in patients with lumbar disc herniation

作　　者：邱洪波[1] 唐乐 何甜[1] 丁茜 曹炯哲 QIU Hongbo;TANG Le;HE Tian;DING Qian;CAO Jiongzhe(Department of Anesthesiology and Perioperative Medicine,The First Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710061;Department of Orthopedics,Xi’an Changan District Hospital,Xi’an 710100,China)

机构地区：[1]西安交通大学第一附属医院麻醉手术部,陕西西安710061 [2]西安市长安区医院骨科,陕西西安710100

出　　处：《西安交通大学学报（医学版）》2021年第6期817-822,共6页Journal of Xi’an Jiaotong University（Medical Sciences）

基　　金：陕西省一般社会发展领域项目(No.2020SF-080)。

摘　　要：目的建立个体化预测腰椎间盘突出症(LDH)患者行经皮椎间孔镜髓核摘除术(PELD)后复发的预警模型。方法回顾性分析2017年1月-2020年1月西安交通大学第一附属医院骨科收治的124例行PELD治疗的LDH患者的临床资料,分别用单因素和Logistic回归分析筛选出影响LDH患者PELD术后复发的独立危险因素,并建立相关列线图预测模型。结果患者年龄、糖尿病史、病程、工作强度、椎间盘退变程度(IDDG)是影响LDH患者PELD后复发的独立危险因素(P<0.05)。基于筛选出的危险因素建立列线图预测模型,并对该模型进行验证。结果显示,建模集和验证集的C-index指数分别为0.944(95%CI:0.902~0.963)和0.969(95%CI:0.911~0.978),两组的校正曲线均与标准曲线拟合较好,两组ROC曲线下面积(AUC)分别为0.944和0.969,证明所建模型具有良好的预测精准度。结论本研究基于LDH患者PELD术后复发的危险因素建立的列线图预警模型具有良好的预测能力,有助于LDH患者行PELD手术治疗的术前评估和适应证选择,降低术后复发率。Objective To explore the establishment of individualized prediction model of recurrence after percutaneous endoscopic lumbar discectomy(PELD) in patients with lumbar disc herniation(LDH). Methods We selected 124 LDH patients treated with PELD in Department of Orthopedics, The First Affiliated Hospital of Xi’an Jiaotong University, from January 2017 to January 2020 as the research subjects. Their clinical data were retrospectively analyzed, and the independent risk factors affecting PELD recurrence in the LDH patients were screened by univariate analysis and Logistic regression analysis, respectively;the correlation histogram prediction model was established.Results Age,history of diabetes,course of disease,work intensity and IDDG were the risk factors for the recurrence of PELD in LDH patients(P<0. 05). Based on the risk factors screened out, the prediction model of the histogram was established,and the model was verified. The results showed that the C-index of the modeling set and the validation set was 0. 944(95% CI:0. 902-0. 963)and 0. 969(95% CI:0. 911-0. 978), respectively. The correction curves of both groups were well fitted with the standard curves. The areas under the ROC curve(AUC)in the two groups were 0. 944 and 0. 969, respectively, which proved that the model had good prediction accuracy. Conclusion LDH patients have many independent risk factors for recurrence after PELD,and the model based on risk factors with good predictive ability can be useful in preoperative evaluation,appropriate patient selection,and decrease of recurrence rate after PELD.

关 键 词：腰椎间盘突出症 经皮椎间孔镜髓核摘除术 复发 危险因素 列线图 

分 类 号：R681.5[医药卫生—骨科学]