腰椎融合治疗腰椎退行性病变术后并发邻近节段退变的影响因素及列线图模型建立

Influencing Factors of Adjacent Segment Degeneration after Lumbar Fusion Surgery for Lumbar Degenerative Diseases and Establishment of Nomogram Model

目的探究腰椎融合治疗腰椎退行性病变(LDDD)术后并发邻近节段退变(ASD)的影响因素,并建立列线图模型。方法选取本院2020年5月至2022年5月收治的319例拟行腰椎融合术的LDDD病人作为观察对象,按随机数字表法以7∶3比例分为建模组(223例)与验证组(96例);建模组又根据术后是否发生ASD分为ASD亚组和非ASD亚组。采用多因素Logistic回归分析LDDD病人腰椎融合术后发生ASD的影响因素,并构建列线图模型,采用ROC曲线及校准曲线评估模型预测效能,计算曲线下面积(AUC)。结果建模组223例行腰椎融合术的LDDD病人中,有57例发生ASD(25.56%);多因素Logistic回归分析结果显示,年龄≥60岁[OR=4.146,95%CI(1.163,14.782),P=0.028]、身体质量指数(BMI)≥24 kg/m2[OR=4.581,95%CI(1.409,14.891),P=0.011]、多节段融合[OR=7.825,95%CI(2.036,30.083),P=0.003]、融合程度不良[OR=4.077,95%CI(1.265,13.143),P=0.019]是病人术后发生ASD的危险因素,术前骨盆入射角[OR=0.831,95%CI(0.772,0.894),P<0.001]是病人术后发生ASD的保护因素。该模型在建模组中的AUC为0.965[95%CI(0.932,0.997)],校准曲线显示该模型具有良好的一致性(P=0.678);在验证组中的AUC为0.971[95%CI(0.949,0.994)],具有良好的一致性(P=0.697)。结论年龄大、BMI高、融合节段多、融合程度不良是LDDD病人腰椎融合术后发生ASD的危险因素,术前骨盆入射角为保护因素,构建的列线图模型区分度与一致性良好,能直观预测LDDD病人腰椎融合术后发生ASD的风险。

Objective To explore the influencing factors of adjacent segment degeneration(ASD)in patients with lumbar degenerative disc disease(LDDD)after lumbar fusion surgery and establish a Nomogram model.Methods From May 2020 to May 2022,319 LDDD patients who underwent lumbar fusion surgery in our hospital were selected as the observation subjects.They were randomly grouped into modeling group(223 cases)and validation group(96 cases)in a 7∶3 ratio using a random number table method.The modeling group was separated into ASD subgroup and non⁃ASD subgroup.Multivariate Logistic regression was applied to analyze the factors leading to ASD in LDDD patients after lumbar fusion surgery.Nomogram model was constructed,and the predictive performance of the model was evaluated by ROC curves and calibration curves,and the area under the curve(AUC)was calculated.Results Among 223 LDDD patients who underwent lumbar fusion surgery,57 cases developed ASD,with an incidence rate of 25.56%.Multivariate Logistic regression analysis showed that age≥60 years[OR=4.146,95%CI(1.163,14.782),P=0.028],body mass index(BMI)≥24 kg/m2[OR=4.581,95%CI(1.409,14.891),P=0.011],multiple fusion segments[OR=7.825,95%CI(2.036,30.083),P=0.003]and poor fusion degree[OR=4.077,95%CI(1.265,13.143),P=0.019]were risk factors for postoperative ASD in patients,and preoperative pelvic incidence[OR=0.831,95%CI(0.772,0.894),P<0.001]was a protective factor for postoperative ASD in patients(P<0.05).The AUC of the model in modeling group was 0.965[95%CI(0.932,0.997)],and the calibration curve showed the good consistency(P=0.678);The AUC of the validation group was 0.971[95%CI(0.949,0.994)],and the calibration curve also showed the good consistency(P=0.697).Conclusion Older age,high BMI,multiple fusion segments and poor fusion degree are risk factors for ASD in LDDD patients after lumbar fusion surgery,the preoperative pelvic incidence is a protective factor,and the constructed Nomogram model has good discrimination and consistency,which can intuitively predict the risk of ASD in LDDD patients after lumbar fusion surgery.