内镜腰椎间盘切除术后复发的因素及预测模型  

Factors and a predicting model of recurrent lumbar disc herniation after percutaneous endoscopic lumbar discectomy

作　　者：梁啸[1] 李东儒 陈筱[1] 王叶新[1] 李衍朋 高龙飞 孟纯阳[1] LI-ANG Xiao;LI Dong-ru;CHEN Xiao;WANG Ye-xin;LI Yan-peng;GAO Long-fei;MENG Chun-yang(Department of Spinal Surgery,Affiliated Hospital,Jining Medical University,Jining 272000,China;College of Clinical Medicine,Jining Medical University,Jining 272000,China)

机构地区：[1]济宁医学院附属医院脊柱外科,山东济宁272000 [2]济宁医学院临床医学院,山东济宁272000

出　　处：《中国矫形外科杂志》2024年第9期775-780,共6页Orthopedic Journal of China

基　　金：国家自然科学基金项目(编号:81974345);山东省中医药科技项目(编号:M-2022245);济宁市重点研发计划项目(编号:2022XYNS049)。

摘　　要：[目的]探讨经皮内镜腰椎间盘切除术(percutaneous lumbar endoscopic discectomy,PELD)后复发性椎间盘突出(recurrent lumbar disc herniation,rLDH)的影响因素并建立预测模型。[方法]回顾性分析2017年1月—2020年1月作者采用PELD治疗的腰椎间盘突出症的286患者的临床资料。根据术后3年内是否出现复发分为复发组和未复发组,采用单因素比较和多因素逻辑回归分析,筛选出复发的相关因素,并建立数学预测模型,采用受试者工作特征(ROC)曲线等分析以评估模型的临床价值。[结果]286例患者中,44例确诊为复发,占15.4%;242例未复发,占84.6%。单因素比较表明,复发组的BMI[(25.8±3.0)vs(24.2±3.3),P=0.004]和病程[(17.9±18.3)个月vs(10.7±16.8)个月,P=0.01]均显著大于未复发组;复发组的术前影像Modic改变显著多于未复发组[无/有,(30/14)vs(206/36),P=0.006];复发组术前影像测量椎间ROM显著大于未复发组[(9.3±3.4)°vs(7.1±2.8)°,P<0.001];复发组经椎间孔入路手术比率显著大于未复发组[TF/IL,(29/15)vs(114/128),P=0.022]。逻辑回归表明,BMI(OR=1.154,95%CI 1.031~1.291,P=0.013)、病程(OR=1.023,95%CI 1.005~1.042,P=0.013)、Modic改变(OR=3.143,95%CI 1.369~7.070,P=0.007)、椎间ROM(OR=1.264,95%CI 1.126~1.419,P<0.001)和手术入路(椎间孔/椎板间)(OR=2.104,95%CI 1.007~4.396,P=0.048)是复发的独立危险因素。按逻辑回归得出预测模型,其预测值ROC分析的曲线下面积为(AUC)为0.787(95%CI 0.721~0.853);模型校准曲线与实际曲线一致性较好;决策曲线分析表明,风险阈值为10%~50%时,该模型可产生较大净获益。[结论]本研究表明BMI、病程、术前Modic改变、术前椎间ROM和手术入路是PELD术后rLDH的危险因素。本研究得出预测rLDH模型可能帮助临床医生判断术后复发风险。[Objective]To explore the factors related to recurrent lumbar disc herniation(rLDH)after percutaneous endoscopic lumbar discectomy(PELD)and establish a predicting model.[Methods]A retrospective study was conducted on 286 patients who underwent PELD for lumbar disc herniation in our hospital from January 2017 to January 2020.Based on whether rLDH happened within 3 years after the pri⁃mary PELD,the patients were fell into the recurrence group and non-recurrence group.Univariate comparison and multiple logistic regres⁃sion analysis were performed to search the factors related to the recurrence,establish a mathematical predicting model and draw a Nomogram figure.Then,receiver operating characteristic(ROC)curve,and relative analysis were used to evaluate the clinical significance of this mod⁃el.[Results]Among the 286 patients,44 patients were diagnosed of rLDH,accounting for 15.4%,while the remaining 242 patients were con⁃firmed as the non-rLDH,accounting for 84.6%.Regarding univariate comparison,the rLDH group was significantly greater than the nonrLDH group in terms of BMI[(25.8±3.0)vs(24.2±3.3),P=0.004]and course of disease[(17.9±18.3)months vs(10.7±16.8)months,P=0.009].In addition,the rLDH group had significantly more Modic change in preoperative images than the non-rLDH group[no/yes,(30/14)vs(206/36),P=0.006],the former got significantly greater range of motion(ROM)in the affected segment measured on preoperative radiographs than the latter[(9.3±3.4)°vs(7.1±2.8)°,P<0.001].Moreover,the rLDH group had significantly higher ratio the transforaminal approach than the non-rLDH group[transforaminal/interlaminar,(29/15)vs(118/124),P=0.036].As results of logistic regression,the BMI(OR=1.154,95%CI 1.031~1.291,P=0.013),disease course(OR=1.023,95%CI 1.005~1.042,P=0.013),Modic changes(OR=3.143,95%CI 1.369~7.070,P=0.007),intervertebral ROM(OR=1.264,95%CI 1.126~1.419,P<0.001)and surgical approach ratio(foraminal/interlaminar)(OR=2.104,95%CI 1.007~4.396,P=0.048)were independent risk factors for recurrence.The pre

关 键 词：腰椎间盘突出症 经皮内镜椎间盘切除术 复发性椎间盘突出 危险因素 预测模型 

分 类 号：R681.53[医药卫生—骨科学]