椎旁肌横截面积及血尿酸水平与腰椎间盘突出症患者椎间孔镜术后复发的相关性
Correlation of paravertebral muscle cross-sectional area and blood uric acid level with postoperative recurrence of lumbar disc herniation after percutaneous intervertebral foraminoscopy
王思远 1王溢文 2陈绵朋 1殷世武1
作者信息
- 1. 安徽医科大学附属合肥医院(合肥市第二人民医院)介入血管疼痛科,合肥市 230011;安徽医科大学第五临床医学院放射影像学系,合肥市 230032
- 2. 安徽医科大学附属合肥医院(合肥市第二人民医院)介入血管疼痛科,合肥市 230011
- 折叠
摘要
目的 探究腰椎间盘突出症(LDH)患者经皮椎间孔镜手术(PETD)术后复发与椎旁肌横截面积(CSA)及血尿酸水平的相关性.方法 回顾性分析从2019年1月1日至2022年9月30日在安徽医科大学附属合肥医院介入血管疼痛科接受PETD治疗的LDH患者215例,所有患者术后随访6个月以上,根据是否复发分为复发组(n=25)和未复发组(n=190).根据患者术前MRI成像,计算多裂肌、竖脊肌和腰大肌的标准化横截面积(SCSA),并评估其脂肪浸润程度.对两组患者术前的一般资料、影像学指标和血液指标进行比较,并应用logistic回归分析LDH术后复发(PRLDH)的独立危险因素,通过ROC曲线评估各项独立危险因素对PRLDH的预测价值.结果 共25例患者出现术后复发,复发率为11.6％(25/215例).单因素分析中,与未复发组相比,复发组患者的体质量指数(BMI)更高,吸烟比例更低,合并糖尿病及高尿酸血症者更多,多裂肌和竖脊肌SCSA更小、脂肪浸润程度更严重(P均＜0.05).logistic多因素回归分析显示,BMI(OR=1.288,95％CI=1.060～1.564,P=0.011)、糖尿病史(OR=3.872,95％CI=1.153～13.001,P=0.028)、高尿酸血症(OR=2.866,95％CI=1.042～7.884,P=0.041)、多裂肌重度脂肪浸润(OR=11.140,95％CI=1.675～74.114,P=0.013)均为 PRLDH 的独立危险因素;而多裂肌 SCSA(OR=0.957,95％CI=0.918～0.999,P=0.043)和竖脊肌 SCSA(OR=0.960,95％CI=0.925～0.995,P=0.026)则是PRLDH的独立保护因素.ROC曲线发现多裂肌SCSA、多裂肌脂肪浸润程度、竖脊肌SCSA、BMI、高尿酸血症五项联合(AUC=0.843,95％CI=0.776～0.911,P＜0.001)对PRLDH的预测能力更高,敏感度为0.840,特异度为0.737.结论 PRLDH与多裂肌、竖脊肌的SCSA及多裂肌脂肪浸润程度存在确切关系,同时也与血尿酸水平存在着一定的相关性.
Abstract
Objective To investigate the correlation between recurrence and paravertebral muscle cross-sectional area(CSA)and uric acid level after percutaneous endoscopic transforaminal discectomy(PETD)in patients with lumbar disc herniation(LDH).Methods From January 1,2019 to September 30,2022,215 patients with LDH treated with PETD were retrospectively analyzed at the Department of Interventional Vascular Pain Medicine,Hefei Hospital,Anhui Medical University,and all patients were followed up for more than 6 months after PETD and finally divided into recurrence group(n=25)and non-recurrence group(n=1 90).The standardized cross-sectional area(SCSA)of the multifidus,erector spinae,and psoas major muscles was calculated from the patients'preoperative MRI imaging,and the degree of fatty infiltration was assessed.The preoperative general data,imaging indexes and blood indexes of the two groups were compared,and the independent influencing factors of postoperative recurrence of LDH(PRLDH)was analyzed by logistic regression,and the predictive value of each independent risk factor for PRLDH was assessed by ROC curve.Results The recurrence rate was 11.6％(25/215 cases).In univariate analysis,patients in the recurrence group had a higher body mass index(BMI),a lower proportion of smoking,more comorbid diabetes and hyperuricemia,and smaller SCSA and more severe fatty infiltration in the multifidus and erector spinae muscles than that in the non-recurrence group(all P＜0.05).Logistic regression analysis showed that BMI(OR=1.288,95％CI=1.060-1.564,P=0.011),history of diabetes(OR=3.872,95％CI=1.153-13.001,P=0.028),hyperuricemia(OR=2.866,95％CI=1.042-7.884,P=0.041),and heavy fatty infiltration of the multifidus muscle(OR=1 1.140,95％CI=1.675-74.114,P=0.013)were all independent risk factors for PRLDH,whereas SCSA of the multifidus(OR=0.957,95％CI=0.918-0.999,P=0.043)and erector spinae muscles(0R=0.960,95％CI=0.925-0.995,P=0.026)were independent protective factors for PRLDH.The ROC curve found that the five-item combination of multiseptate SCSA,degree of fatty infiltration of multiseptate,erector spinae SCSA,BMI,and hyperuricemia(AUC=0.843,95％CI=0.776-0.911,P＜0.001)had a higher predictive power for PRLDH with a sensitivity of 0.840 and a specificity of 0.737.Conclusion There has a definite relationship between PRLDH and SCSA in the multifidus and erector spinae muscles and the degree of fatty infiltration of the multifidus,as well as a correlation with blood uric acid level.
关键词
椎间盘移位/椎旁肌/椎间盘切除术,经皮/复发/危险因素/尿酸Key words
Intervertebral disc displacement/Paravertebral muscles/Diskectomy,percutaneous/Recurrence/Risk factors/Uric acid引用本文复制引用
基金项目
合肥市二院青年科研基金(2021)(2021yqn13)
出版年
2024
NETL
NSTL
万方数据