个体化预测经皮椎间孔镜下微创技术治疗老年腰椎间盘突出症术后恢复不佳的风险模型建立

Establishment of a risk model for individualized prediction of poor recovery after percutaneous transforaminal endoscopic discectomy in elderly patients with lumbar disc herniation

目的建立个体化预测经皮椎间孔镜下腰椎间盘切除术(percutaneous transforaminal endoscopic discectomy,PTED)治疗老年腰椎间盘突出症(lumbar disc herniation,LDH)术后恢复不佳的风险模型。方法选取2020年2月~2022年4月在本院进行PTED手术的157例老年LDH患者,根据术后6个月下腰痛评分分为恢复良好组(n=117例)和恢复不佳组(n=40例),收集两组患者的一般临床信息,采用Logistic回归分析探讨影响术后恢复不佳的影响因素,运用R软件构建老年LDH患者PTED术后恢复不佳的列线图模型,并予以验证。结果两组年龄、病程、BMI≥24 kg/m^(2)、伴骨质疏松、伴纤维环破裂、Pfirrmann分级、疼痛表现、糖尿病史等资料具有统计学差异(均P<0.05)。多因素分析显示,年龄≥70岁(OR=2.532),病程≥1年(OR=2.682)、疼痛表现(OR=2.733),Pfirrmann分级≥Ⅲ级(OR=2.484),合并糖尿病(OR=4.010)是老年LDH患者PTED术后恢复不佳的独立危险因素(均P<0.05)。在Logistic回归分析的基础上构建的列线图模型,其一致性指数为0.817,且校正曲线显示该模型对预测LDH患者PTED治疗术后恢复不佳的概率与实际发生概率具有较好的一致性。结论年龄、病程、Pfirrmann分级、糖尿病史、疼痛表现与老年LDH患者PTED治疗术后恢复不佳有密切的关系,在此基础上构建的列线图模型具有较好的预测效能,可为评估该类患者术后恢复情况提供一定的参考价值。

Objective To establish a risk model for individualized prediction of poor recovery after percutaneous transforaminal endoscopic discectomy(PTED)in elderly patients with lumbar disc herniation(LDH).Methods A total of 157 elderly LDH patients who underwent PTED surgery in our hospital from February 2020 to April 2022 were selected.According to the lower back pain scores of 6 months after surgery,thepatients were divided into two groups:good recovery group(n=117 cases)and poor recovery group(n=40 cases).General clinical information of the two groups of patients was collected.Logistic regression analysis was used to explore the influencing factors of poor recovery after surgery,and R software was used to construct the nomograph model of poor recovery of elderly LDH patients after PTED,which wasthenverified.Results There were statistical differences in age,course of disease,BMI≥24kg/m^(2),osteoporosis,fibrous ring rupture,Pfirrmann grade,pain performance,and diabetes history in two groups(all P<0.05).Multivariate analysis showed that age≥70 years(OR=2.532),duration≥1 year(OR=2.682),pain performance(OR=2.733),Pfirrmann grade≥III(OR=2.484),and diabetes(OR=4.010)were independent risk factors for poor recovery of elderly LDH patients after PTED(all P<0.05).The consistency index of the nomogram model built on the basis of logistic regression analysis was 0.817 and the correction curve showed that the model had good consistency in predicting the probability of poor recovery of LDH patients after PTED treatment with the actual probability of occurrence.Conclusion Age,course of disease,Pfirrmann grade,history of diabetes,and pain performance are closely related to poor recovery of elderly LDH patients after PTED treatment.The nomogram model constructed on this basis has good predictive efficacy,which can provide certain reference value for evaluating the recovery of these patients after PTED treatment.