Analysis of risk factors for postoperative recurrence of lumbar disc herniation and construction of prediction model
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.
万方数据
维普
