建立与验证经皮内窥镜腰椎间盘切除后复发风险的预测模型

Establishment and validation of a prognostic model for the recurrence risk after percutaneous endoscopic lumbar discectomy

背景:腰椎间盘突出症的复发是经皮内窥镜腰椎间盘切除术后的不良事件。准确预测术后复发腰椎间盘突出症的风险仍然是脊柱外科医生面临的重大挑战。目的:探究经皮内窥镜腰椎间盘切除术后复发的危险因素,并开发和验证一个有效的预测模型。方法:回顾性收集了2017-01-01/2020-01-01在徐州医科大学附属医院接受经皮内窥镜腰椎间盘切除术的365例腰椎间盘突出症患者的临床数据。根据LASSO回归分析,筛选出与术后腰椎间盘突出症复发显著相关的预测因子,建立预测模型。使用增强Bootstrap验证法对模型进行内部验证;使用受试者工作特征曲线和校准曲线评估模型的性能;使用决策曲线和临床影响曲线分析了模型的临床实用性。结果与结论:①纳入的365例患者中,经皮内窥镜腰椎间盘切除术后有33例复发腰椎间盘突出症(9.0%);②通过LASSO回归,选择了6个与经皮内窥镜腰椎间盘切除术后复发有显著关联的因素,包括年龄、手术节段、Modic改变、Pfirrmann分级、吸烟史和高强度体力劳动史;③模型的偏差校正曲线与表观曲线拟合良好,受试者工作特征曲线下面积为0.909,95%置信区间为(0.860-0.958);④该模型具有良好的临床实用性,有利于临床医师术前识别高风险患者并进行个体化治疗。

BACKGROUND:Recurrent lumbar disc herniation is an adverse event after percutaneous endoscopic lumbar discectomy.Accurately predicting the risk of recurrent lumbar disc herniation after surgery remains a major challenge for spine surgeons.OBJECTIVE:To investigate the risk factors for recurrent lumbar disc herniation after percutaneous endoscopic lumbar discectomy,and to develop and validate an effective predictive model.METHODS:Clinical data from 365 patients with lumbar disc herniation who underwent percutaneous endoscopic lumbar discectomy at the Affiliated Hospital of Xuzhou Medical University from January 1,2017 to January 1,2020 were retrospectively collected.Predictors significantly associated with postoperative lumbar disc herniation recurrence were screened according to least absolute shrinkage and selection operator(LASSO)regression analysis,and a prediction model was established,followed by internal validation of the model using the enhanced Bootstrap validation method.The performance of the model was evaluated using receiver operating characteristic curve and calibration curves.Finally,the clinical utility of the model was analyzed using decision curves and clinical impact curves.RESULTS AND CONCLUSION:(1)Among the 365 patients included in this study,there were 33 recurrences(9.0%)after percutaneous endoscopic lumbar discectomy.(2)Six factors that were significantly associated with recurrence after percutaneous endoscopic lumbar discectomy were selected by LASSO regression,including age,operative segment,Modic changes,Pfirrmann classification,smoking history,and intense physical work.(3)The bias-corrected curve of the model fitted well with the apparent curve,with an area under the receiver operating characteristic curve of 0.909 and 95%confidence interval of(0.860-0.958).(4)The model has good clinical utility and is useful for clinicians to identify high-risk patients preoperatively and to individualize treatment.