腰椎退行性疾病后路融合手术并发症原因分析及Nomogram模型建立  

Analysis of risk factors for complications in posterior fusion surgery for lumbar degenerative diseases and establishment of a Nomogram model

作　　者：赵宇宙[1] 杨利谦[2] 黄晓洁 ZHAO Yuzhou;YANG Liqian;HUANG Xiaojie(Department of Orthopedics,North China Petroleum Administration General Hospital,Renqiu Hebei 062552,China)

机构地区：[1]华北石油管理局总医院骨科,河北任丘062552 [2]河北省人民医院,河北石家庄050051

出　　处：《中国急救复苏与灾害医学杂志》2023年第12期1631-1635,共5页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：河北省医学科学研究课题计划(编号:20190287)。

摘　　要：目的探讨腰椎退行性疾病后路融合手术后早期并发症的危险因素,并构建Nomogram模型。方法选取2018年1月—2020年12月于华北石油管理局总医院行腰椎退行性疾病后路融合手术的185例患者。术后早期发生并发症37例。按照住院期间是否出现后路融合术后早期并发症分为并发症组和对照组。采用多因素Logistics分析术后发生并发症的风险并构建Nomogram模型。结果单因素分析显示:并发症组体质量指数(BMI)值、美国麻醉医师协会(ASA)分级≥Ⅲ级患者比例、术前合并恶性肿瘤患者比例均高于无并发症组,手术时间长于无并发症组差异有统计学意义(P<0.05)。将单因素分析中有统计学差异的变量进行Logistics多因素分析,BMI、ASA分级、手术时长是腰椎退行性疾病后路融合手术后早期并发症发生的独立危险因素(P<0.05)。采用内部数据进行验证,C-index为0.694(95%CI:0.620~0.810),该Nomogram模型预测与实际观测结果吻合度较好。结论BMI值高,手术时间≥150 min,ASA分级≥Ⅲ级患者比例高是腰椎退行性疾病后路融合手术发生早期并发症的独立风险因素。本研究构建的Nomogram模型有助于指导医师完善个性化围手术期治疗方案。Objective To investigate the risk factors of early complications after posterior fusion surgeries for lumbar degenerative diseases and to construct a Nomogram model.Methods All 185 patients who underwent posterior fusion surgery for lumbar degenerative diseases were selected from January 2018 to December 2020 at North China Petroleum Administration General Hospital.Early postoperative complications occurred in 37 cases.All patients were divided into the complication group and the non-complication group.Multivariate logistic analysis was used to analyze the risk of postoperative complications,and the Nomogram model was established.Results Single-level factor analysis showed a high body mass index(BMI)value,a high American Society of Anesthesiologists(ASA)grade,long surgical time,and a high incidence of preoperative and postoperative complications associated with malignant tumors,with statistically significant differences(P<0.05).Incorporating univariate variables with differences into multivariate logistic analysis,BMI,ASA grade,and surgical duration were independent risk factors for early complications after posterior fusion surgery for lumbar degenerative diseases(P<0.05).The C-index was 0.694(95%CI:0.620-0.810),indicating that the Nomogram model fitted well with the actual observation results.Conclusion High BMI value,surgical time≥150 mins,and ASA grade≥Ⅲare independent risk factors for early complications in posterior fusion surgery for lumbar degenerative diseases.The Nomogram model constructed in this study helps guide physicians in improving personalized patients'perioperative treatment plans.

关 键 词：腰椎 退行性疾病 融合 并发症 Nomogram模型建立 

分 类 号：R681.55[医药卫生—骨科学]