采用零切迹融合器的ACDF手术预后模型构建与验证:一项基于颈椎矢状位参数的回顾性研究  

Construction and validation of a surgical prognostic model for ACDF using zero-profile cage:a retrospective study based on cervical spine dislocation parameters

作　　者：贺朋飞 李晋虎 陈毅[3] 郭晋伸 殷梦泽 刘晓东[3] HE Pengfei;LI Jinhu;CHEN Yi;GUO Jinshen;YIN Mengze;LIU Xiaodong(First Clinical Medical College,Shanxi Medical University,Taiyuan 030000,China)

机构地区：[1]山西医科大学第一临床医学院,太原030000 [2]山西省运城市中心医院 [3]山西医科大学第一医院神经外科 [4]山西省煤炭中心医院神经外科

出　　处：《临床神经外科杂志》2024年第5期546-552,557,共8页Journal of Clinical Neurosurgery

基　　金：山西省中央引导地方科技发展资金项目(YDZJSX20231A060)。

摘　　要：目的使用LASSO-Logistic回归分析影响采用零切迹融合器颈椎前路椎间盘切除减压植骨融合(ACDF)术后预后的独立风险因素并建立预后预测模型。方法回顾性纳入山西医科大学第一医院神经外科及运城市中心医院神经外科2017年2月-2023年2月因脊髓型颈椎病接受ACDF手术且随访资料完整的297例患者,筛选出潜在风险因素并确定术后患者预后不佳的独立风险因素,构建预后不佳的预测模型并验证。结果所有患者的预后良好率为90.24%。二元Logistic回归分析确定预后不佳的独立风险因素为年龄(OR=1.164,P<0.001,95%CI=1.067~1.270);术前颈椎功能障碍量表(NDI,OR=1.245,P<0.001,95%CI=1.118~1.387);T 2WI高信号(OR=11.611,P<0.001,95%CI=2.989~45.106);术后颈椎前凸角(CL,OR=0.751,P<0.001,95%CI=0.642~0.878);术后T 1倾斜角(T 1S,OR=1.203,P=0.001,95%CI=1.051~1.378)。受试者工作特征(ROC)曲线分析显示列线图体现了良好的预测价值及有效性。结论年龄、T 2WI高信号、术前NDI、术后T1S、术后CL是影响采用零切迹融合器的ACDF术后患者预后的独立风险因素,利用风险因素构建的列线图体现了良好的预测价值及有效性。Objective To analyze the independent risk factors affecting the prognosis of anterior cervical discectomy and fusion(ACDF)with zero-profile cage using LASSO-logistic regression and to establish a prognostic prediction model.Methods A total of 297 patients who underwent ACDF for cervical spondylotic myelopathy from February 2017 to February 2023 in Department of Neurosurgery,the First Hospital of Shanxi Medical University and Yuncheng Central Hospital with complete follow-up data was included retrospectively.The potential risk factors and determine independent risk factors for poor postoperative prognosis were screened out.Prediction models for poor prognosis were constructed and validated.Results The rate of good prognosis was 90.24%.Binary logistic regression analysis identified age as an independent risk factor for poor prognosis(OR=1.164,P<0.001,95%CI=1.067-1.270),preoperative neck disability index(NDI,OR=1.245,P<0.001,95%CI=1.118-1.387),T 2WI hyperintensity(OR=11.611,P<0.001,95%CI=2.989-45.106),postoperative cervical lordosis(CL,OR=0.751,P<0.001,95%CI=0.642-0.878)and postoperative T 1 slope(T 1S,OR=1.203,P=0.001,95%CI=1.051-1.378).Receiver operating characteristic(ROC)curve analysis showed that the nomogram showed good predictive value and effectiveness.Conclusions Age,T 2WI hyperintensity,preoperative NDI,postoperative T 1S,and postoperative CL are independent risk factors affecting the prognosis of patients after ACDF using zero-profile cages,and nomograms constructed using risk factors reflect good predictive value and effectiveness.

关 键 词：脊髓型颈椎病 ACDF 零切迹 预后 风险因素 

分 类 号：R651.2[医药卫生—外科学]