侧路脊柱内镜手术治疗腰椎管狭窄术后复发的影响因素分析

Influencing factors of recurrence of lumbar spinal stenosis after lateral spinal endoscopic surgery

目的探讨侧路脊柱内镜手术治疗腰椎管狭窄(LSS)术后复发的影响因素,并构建风险预测模型。方法选择于我院接受侧路脊柱内镜手术治疗的462例LSS患者为研究对象,依据术后复发情况将患者分为复发组(n=30)和未复发组(n=432)。采用单因素和多因素Logistic回归分析LSS患者侧路脊柱内镜手术后复发的影响因素;构建风险预测模型,并评价其预测效能。结果462例患者中有30例术后复发,复发率为6.49%。复发组与未复发组在病程、BMI、手术时间、术后活动强度、腰椎管狭窄分级、吸烟及手术前后椎管横截面积差、硬膜囊横截面积差、椎间孔矢状径差、侧隐窝宽度差方面差异具有统计学意义(P<0.05)。多因素Logistic回归分析显示,腰椎管狭窄3级是影响LSS患者术后复发的独立危险因素(P<0.05),手术前后硬膜囊横截面积差>0.15 cm^(2)和侧隐窝宽度差>1.55 mm是保护因素(P<0.05)。根据独立影响因素构建风险预测模型,模型的曲线下面积(AUC)为0.846(95%CI:0.822~0.863,P<0.001),灵敏度、特异度分别为88.45%和87.59%,模型预测的区分度和校准度均较好。结论经侧路脊柱内镜手术治疗LSS的复发率低,疗效较好,安全性较高。腰椎管狭窄3级是影响LSS患者术后复发的独立危险因素,手术前后硬膜囊横截面积差>0.15 cm^(2)和侧隐窝宽度差>1.55 mm是保护因素,把控相关影响因素可预测并降低LSS患者术后复发率。

Objective To explore the influencing factors of recurrence of lumbar spinal stenosis(LSS)after lateral spinal endoscopic surgery,and to construct a risk prediction model.Methods A total of 462 patients with LSS who underwent lateral spinal endoscopic surgery in our hospital were selected as the research objects.According to the postoperative recurrence,the patients were divided into the recurrence group(n=30)and the non-recurrence group(n=432).Univariate and multivariate Logistic regression were used to analyze the influencing factors of recurrence after lateral spinal endoscopic surgery in patients with LSS;a risk prediction model was constructed,and its prediction efficiency was evaluated.Results A total of 30 cases of the 462 patients had recurrence after operation,and the recurrence rate was 6.49%.There were statistically significant differences in the course of disease,BMI,operation time,postoperative activity intensity,lumbar spinal stenosis classification,smoking,difference in cross-sectional area of spinal canal,difference in cross-sectional area of dural sac,difference in sagittal diameter of intervertebral foramen and difference in width of lateral recess before and after operation between the recurrence group and the non-recurrence group(P<0.05).Multivariate Logistic regression analysis showed that grade 3 lumbar spinal stenosis was an independent risk factor for postoperative recurrence in patients with LSS(P<0.05),and the difference in cross-sectional area of dural sac>0.15 cm^(2) and the difference in width of lateral recess>1.55 mm before and after operation were the protective factors(P<0.05).The risk prediction model was constructed according to the independent influencing factors.The area under the curve(AUC)of the model was 0.846(95%CI:0.822 to 0.863,P<0.001),and the sensitivity and specificity were 88.45%and 87.59%,respectively.The model had good prediction discrimination and calibration degree.Conclusion The recurrence rate of LSS after lateral spinal endoscopic surgery is lower,with good curative effect and high safety.Grade 3 lumbar spinal stenosis is an independent risk factor for postoperative recurrence in patients with LSS,the difference in cross-sectional area of dural sac>0.15 cm^(2) and the difference in width of lateral recess>1.55 mm before and after operation are the protective factors.Controlling the relevant influencing factors can predict and reduce the postoperative recurrence rate in patients with LSS.