腰椎管狭窄症患者减压融合术后腰痛Nomogram预测模型的构建  

A Nomogram model to predict low back pain for patients with lumbar spinal stenosis after lower decompression and fusion

作　　者：赵玉果[1] 叶向阳[1] 程省[1] Zhao Yuguo;Ye Xiangyang;Cheng Sheng(Department of Orthopedics,Nanyang Central Hospital,Nanyang 473000,China)

机构地区：[1]河南省南阳市中心医院骨科一病区,南阳473000

出　　处：《中华创伤骨科杂志》2024年第10期905-910,共6页Chinese Journal of Orthopaedic Trauma

基　　金：河南省中医药科学研究专项课题(2023ZY2186);2021年和2022年河南省医学科技攻关省部共建重大项目(SBGJ202103108);南阳市2019年市级科技攻关计划项目(KJGG171);河南省科技计划项目(182102310466)

摘　　要：目的探究腰椎管狭窄症患者减压融合术后腰痛发生的影响因素并构建Nomogram预测模型。方法回顾性分析2021年5月至2022年3月河南省南阳市中心医院骨科接受治疗的132例腰椎管狭窄症患者资料, 根据疼痛视觉模拟评分(VAS)分为腰痛未发组(≤2分, 104例)和腰痛组(>2, 28例)。采用单因素分析和多因素logistic回归分析腰痛发生的影响因素并构建腰椎管狭窄症患者减压融合术后腰痛发生风险的Nomogram预测模型, 模型准确度以受试者工作特征(ROC)曲线判断。另取2022年5月至2023年3月符合纳入标准的66例腰椎管狭窄症患者资料作为外部验证模型进行模型准确率预测, 并通过Hosmer-Lemeshow检验评价该模型的拟合度。结果多因素分析结果显示, 白细胞介素(IL-1β)、术后椎管内无菌性炎症及术中出血量为腰痛是否发生的独立危险因素(P<0.05)。在此基础上建立风险预测模型, 其ROC曲线结果显示曲线下面积为0.975, 敏感度为92.90%, 特异度为91.30%, Youden指数为0.842。外部验证模型预测总准确率为99.80%, 模型拟合度良好(χ^(2)=3.512, P=0.898)。结论 IL-1β、术后椎管内无菌性炎症及术中出血量是腰椎管狭窄症患者减压融合术后腰痛发生的主要影响因素。据此构建的Nomogram预测模型具有极好的预测效能。Objective To explore the influencing factors for low back pain after decompression and fusion in patients with lumbar spinal stenosis and to construct a Nomogram prediction model.Methods A retrospective study was conducted to analyze the 132 patients with lumbar spinal stenosis who had been treated at Department of Orthopedics,Nanyang Central Hospital from May 2021 to March 2022.The patients were divided into 2 groups according to their visual analog scale(VAS)pain score:a back pain-free group(104 cases with VAS≤2)and a back pain group(28 cases with VAS>2).Univariate and multiple logistic regression analyses were employed to identify the influencing factors for occurrence of lower back pain and a Nomogram prediction model for the risk of lower back pain was constructed in patients with lumbar spinal stenosis after decompression and fusion.The accuracy of the model was assessed using the receiver operating characteristic(ROC)curve.Furthermore,the model accuracy was pre-tested using an external validation model which included 66 illegible patients with lumbar spinal stenosis treated at Department of Orthopedics,Nanyang Central Hospital from May 2022 to March 2023.A comparison was made between the outcomes predicted by the model and the actual outcomes observed.The fit of the model was evaluated through the Hosmer-Lemeshow test.Results The results of the multifactorial analysis indicated that interleukin(IL-1β),postoperative aseptic inflammation in the vertebral canal,and intraoperative blood loss were independent influencing factors for the occurrence of lower back pain(all P<0.05).A risk Nomogram prediction model was thus established based on these factors.The area under the curve(AUC)was 0.975,the sensitivity 92.90%,the specificity 91.30%,and the Youden index 0.842.External validation of the model showed an overall accuracy of 99.80%.The Hosmer-Lemeshow test demonstrated good model fit(χ^(2)=3.512,P=0.898).Conclusions IL-1β,postoperative aseptic inflammation in the vertebral canal,and intraoperative blood lo

关 键 词：椎管狭窄 脊柱融合术 腰痛 列线图 预测模型 

分 类 号：R681.5[医药卫生—骨科学]