经皮椎间孔镜髓核摘除术后复发危险因素分析与预测模型

Analysis of risk factors and construction of a prediction model for recurrence after percutaneous endoscopic lumbar discectomy

中文关键词:  腰椎间盘突出症  经皮椎间孔镜髓核摘除术  术后复发  危险因素  预测模型

英文关键词:Lumbar disc herniation  Percutaneous endoscopic lumbar discectomy  Postoperative recurrence  Risk factors  Predictive model

中文摘要:

  【摘要】 目的：探讨经皮椎间孔镜髓核摘除术（percutaneous endoscopic lumbar discectomy，PELD）后复发的独立危险因素，并基于此构建并验证术后复发风险列线图模型，为临床决策提供依据。方法：回顾性纳入2017年1月～2022年12月在我院行PELD的单节段腰椎间盘突出症患者312例，根据是否复发分为两组。收集年龄、性别、BMI（＜25kg/m2、≥25kg/m2）、病程（＜1年、1～2年、＞2年）、术后活动程度评分（0～2分、3～4分、5～6分）、突出类型（突出型、脱出型、游离型）及部位（中央型、旁侧型、极外侧型）、Modic改变（是、否）、Pfirrmann分级（＜Ⅲ级、≥Ⅲ级）等资料。经单因素分析筛选变量后行多因素logistic回归分析，基于独立危险因素构建用于预测PELD术后复发风险的列线图模型，并采用十折交叉验证和受试者工作特性（receiver operating characteristic，ROC）曲线下面积（area under the curve，AUC）评价模型预测性能。结果：单因素分析初步筛选显示，BMI、病程、术后活动程度评分、突出类型、Modic改变及Pfirrmann分级与PELD术后复发相关；多因素logistic回归分析进一步提示，病程＞2年、游离型突出、BMI≥25kg/m2、存在Modic改变、Pfirrmann分级≥Ⅲ级、术后活动程度评分5～6分均为术后复发的独立危险因素。列线图预测AUC为0.803（95%CI：0.738～0.869），十折交叉验证平均得分0.8366，校准良好。结论：BMI≥25kg/m2、病程＞2年、术后活动程度评分5～6分、游离型突出、Modic改变及Pfirrmann≥Ⅲ级为PELD术后复发的独立危险因素。

英文摘要:

  【Abstract】 Objectives: To identify the independent risk factors for recurrence after percutaneous endoscopic lumbar discectomy(PELD) and to develop and validate a nomogram-based model for predicting postoperative recurrence risk to provide reference for clinical decision-making. Methods: A total of 312 patients with single-segment lumbar disc herniation(LDD) who underwent PELD in our hospital from January 2017 to December 2022 were retrospectively included and divided into a recurrence group and a non-recurrence group. Data including age, sex, body mass index(BMI)(<25kg/m2, ≥25kg/m2), disease duration(<1 year, 1-2 years, >2 years), postoperative activity level score(0-2, 3-4, 5-6), herniation type(protrusion, extrusion, sequestration) and location(central, paracentral, far lateral), Modic changes(yes, no), and Pfirrmann grade(2 years, sequestrated herniation, BMI≥25, Modic changes, Pfirrmann grade ≥Ⅲ, and a postoperative activity level score of 5-6 as independent risk factors for postoperative recurrence. The nomogram model showed an AUC of 0.803(95%CI: 0.738-0.869), a mean ten-fold cross-validation score of 0.8366, indicating a good calibration. Conclusions: BMI≥25, disease duration >2 years, postoperative activity level score 5-6, sequestered herniation, Modic changes, and Pfirrmann grade ≥Ⅲ are the independent risk factors for recurrence after PELD.