预测腰椎间盘突出症经皮内窥镜手术后残余腰痛的临床诺模图  

Clinical Nomogram for Predicting Residual Low Back Pain after Percutaneous Endoscopic Lumbar Discectomy for Lumbar Disc Herniation

作　　者：周金龙 陈昌胜 赵俊 罗选祥 阙云端 王东明 崔荣飞 ZHOU Jin-long;CHEN Chang-sheng;ZHAO Jun;LUO Xuan-xiang;QUE Yun-duan;WANG Dong-ming;CUI Rong-fei(Orthopedics Department,Nanjing Gaochun People′s Hospital,Nanjing,Jiangsu 211300,China)

机构地区：[1]南京市高淳人民医院骨科,江苏南京211300

出　　处：《颈腰痛杂志》2024年第4期661-667,共7页The Journal of Cervicodynia and Lumbodynia

基　　金：2021年度南京市卫生科技发展专项资金项目计划(编号:ZKX21063)。

摘　　要：目的探讨影响经皮内窥镜下腰椎间盘切除手术(PELD)术后残留腰痛(PRLBP)的风险因素并构建预测PRLBP的诺模图。方法选择2019年1月至2022年12月在该院接受PELD手术的腰椎间盘突出症(LDH)患者113例作为研究对象,患者按6:4比例随机分为训练队列和验证队列,训练队列分别进行单因素和多因素Logistic回归分析,用于确定独立预后因素并绘制诺模图,验证队列用于验证诺模图的性能,诺模图的辨别能力通过受试者工作曲线(ROC)和曲线下面积(AUC)进行评估,校准曲线评估实际结果和预测结果之间的一致性,决策曲线分析(DCA)用于计算预测模型的净获益。结果根据纳入标准和排除标准,共纳入PELD术后患者113例,其中28例术后4周时VAS评分≥4分,PRLBP发生率为24.78%。多因素Logistic回归分析显示:年龄、Modic改变、椎旁肌浸润指数、腰背筋膜水肿与PRLBP存在相关性(P<0.05)。内外标曲线显示,PRLBP预测诺模图具有良好的一致性,DCA曲线显示诺模图显示出良好的净收益和临床有效性,ROC分析结果显示,训练队列AUC为0.902(95%CI:0.851~0.953),验证队列的AUC为0.897(95%CI:0.846~0.948)。结论年龄、Modic改变、腰背筋膜水肿、椎旁肌脂肪浸润指数是PELD手术患者PRLBP的独立风险因素,构建的诺模图可有效预测PRLBP的发生风险。Objective To explore the risk factors affecting postoperative residual low back pain(PRLBP)after percutaneous endoscopic lumbar discectomy(PELD)and construct a nomogram for predicting PRLBP.Methods A total of 113 patients with lumbar disc herniation(LDH)who underwent PELD surgery in our hospital from January 2019 to December 2022 were selected as the study subjects.The patients were randomly divided into a training cohort and a validation cohort at a ratio of 6:4.Univariate and multivariate Logistic analyses were performed on the training cohort to determine independent prognostic factors and construct a nomogram.The validation cohort was used to validate the performance of the nomogram.The discriminatory ability of the nomogram was evaluated using the receiver operating characteristic(ROC)curve and the area under the curve(AUC).The calibration curve was used to assess the consistency between actual and predicted results.Decision curve analysis(DCA)was used to calculate the net benefit of the prediction model.Results According to the inclusion and exclusion criteria,a total of 113 patients after PELD surgery were included,among whom 28 patients had a VAS score of≥4 at 4 weeks after surgery,and the incidence of PRLBP was 24.78%.Multivariate Logistic regression analysis showed that age,Modic changes,paraspinal muscle infiltration index,and lumbar fascia edema were associated with PRLBP(P<0.05).The internal and external calibration curves showed good consistency of the PRLBP prediction nomogram.The DCA curve showed that the nomogram exhibited good net benefit and clinical effectiveness.ROC analysis showed that the AUC of the training cohort was 0.902(95%CI:0.851-0.953),and the AUC of the validation cohort was 0.897(95%CI:0.846-0.948).Conclusions Age,Modic changes,lumbar fascia edema,and paraspinal muscle fat infiltration index are independent risk factors for PRLBP in patients undergoing PELD surgery.The constructed nomogram can effectively predict the risk of PRLBP occurrence.

关 键 词：腰椎间盘突出症 经皮内窥镜下腰椎间盘切除术 术后残余腰痛 诺模图 

分 类 号：R687.3[医药卫生—骨科学]