摘要
目的 研究腰椎间盘突出症(lumbar disc herniation,LDH)术后复发的相关危险因素,并构建预测腰椎间盘突出症复发(recurrence of lumbar disc herniation,rLDH)的列线图.方法 选取我院 2018 年 1 月至 2020 年 12 月进行手术治疗的 198 例 LDH 患者.收集患者术前及术中临床资料及影像学参数,包括椎间盘高度指数(disc height index,DHI)、矢状面活动度(sagittal range of motion,sROM)、小关节方向性(facet orientation,FO)和小关节不对称性(facet tropism,FT).采用多因素 COX 比例风险回归模型分析 rLDH 危险因素.使用一致性指数和校准曲线来评价列线图性能.采用决策曲线分析(decision curve analysis,DCA)评估列线图临床净收益.结果 198 例 LDH 患者随访时间为 2～24 个月,随访末期,42 例患者复发,复发率21.2%.年龄(≥51 岁)、吸烟(是)、Pfirrmann 分级、DHI(≥0.37)、sROM(≥10.15°)是 rLDH 的独立危险因素(P<0.05).列线图预测 1 年、1.5 年及 2 年的 rLDH 风险的一致性指数分别为 0.682(95%CI:0.608～0.783)、0.705(95%CI:0.650～0.834)、0.727(95%CI:0.672～0.868),AUC 分别为 0.703、0.774、0.904.列线图预测 1 年、1.5 年及 2 年 rLDH 风险阈值>0.26、>0.15、>0.13 时,提供显著临床净收益.结论 年龄≥51 岁、吸烟、Pfirrmann 分级、DHI≥0.37、sROM≥10.15° 是 rLDH 的危险因素,基于这些危险因素所构建的列线图能在术前有效预测 rLDH风险.
Abstract
Objective To study the risk factors associated with postoperative recurrence of lumbar disc herniation(LDH)and to construct a column chart to predict recurrence of lumbar disc herniation(rLDH).Methods A total of 198 patients with LDH who underwent surgical treatment between January 2018 and December 2020 in our hospital were selected.Preoperative and intraoperative clinical data and imaging parameters such as disc height index(DHI),sagittal range of motion(SROM),facet orientation(FO)and facet asymmetry(FT)were collected.A multifactorial COX proportional risk regression model was used to analyze rLDH risk factors.A consistency index(C-index)and calibration curves were used to evaluate the performance of the column chart.Decision curve analysis(DCA)was used to assess the net clinical benefit of the Nomogram.Results The follow-up period of 198 patients with LDH ranged from 2 to 24 months.At the end of the follow-up,42 patients had recurrence,with a recurrence rate of 21.2%.Age(≥51 years),smoking,Pfirrmann classification,DHI(≥0.37),and sROM(≥10.15°)were independent risk factors for rLDH(P<0.05).The C-index of the Nomogram predicting the risk of rLDH at 1,1.5,and 2 years was 0.682(95%CI:0.608-0.783),0.705(95%CI:0.650-0.834),and 0.727(95%CI:0.672-0.868),respectively.The AUC was 0.703,0.774,0.904,respectively.Nomogram predicted that 1-year,1.5-year,and 2-year rLDH risk thresholds of>0.26,>0.15,and>0.13 provided significant net clinical benefit.Conclusions Age≥51 years,smoking,Pfirrmann classification,DHI≥0.37,and sROM≥10.15° are risk factors for rLDH,and the Nomogram constructed based on these risk factors is effective in predicting the risk of rLDH preoperatively.
维普
万方数据