【摘要】 目的分析经皮内镜腰椎间盘切除术（PELD）术后复发的危险因素,构建并验证预测复发概率的列线图（Nomogram）图。方法纳入396例郑州大学第一附属医院2013年1月至2019年10月PELD术后患者。根据术后1 a内手术节段椎间盘是否再次突出将其分为复发组（46例）与未复发组（350例）。采用χ²检验对比各变量在复发组与未复发组之间的差异。将差异有统计学意义的变量纳入多因素logistic回归分析,以筛选影响腰椎间盘突出患者PELD术后复发的独立危险因素。基于筛选的相关因素,构建并验证预测患者复发概率的Nomogram图。通过受试者工作特性曲线（ROC）和校准曲线验证Nomogram图的准确度。结果多因素logistic回归分析显示pfirrmann等级≥Ⅲ级、体质量指数（BMI）≥25 kg·m^-2、年龄≥60岁、术后椎间活动度≥10°为PELD术后复发的独立危险因素。ROC曲线下面积为0.898（95%CI:0.817～0.968）。同时,校准曲线接近45°走行,表明模型拟合良好。结论 pfirrmann等级≥Ⅲ级、BMI≥25 kg·m^-2、年龄≥60岁、术后椎间活动度≥10°是PELD术后复发的独立危险因素。基于这些因素构建的Nomogram图作为一个简单有效的预测工具,可为PELD术后复发概率的预测提供一定的参考作用。更多还原

【Abstract】 Objective To analyse the risk factors for recurrence after percutaneous endoscopic lumbar discectomy（PELD） and construct and validate a Nomogram that predictes recurrence probability.Methods The research included 396 patients who underwent PELD from January 2013 to October 2019 in the First Hospital Affiliated to Zhengzhou University. The patients were divided into recurrent group（46 cases） and non-recurrence group（350 cases） according to whether the intervertebral disc herniated in the surgical segment within 1 year after surgery. Chi-square test was used to compare the difference of each variable between the recurrence group and the non-recurrence group. Variables with statistically significant differences were included in multivariate logistic regression analysis to screen independent risk factors for postoperative PELD recurrence in patients with lumbar disc herniation. Nomogram graphs predicting recurrence probability of patients were constructed and validated based on the screened correlation factors. Nomogram accuracy was verified by receiver Operating Characteristic（ROC） and calibration curve.Results Multiariable logistic regression analysis showed that pfirrmann level≥Ⅲ level, body mass index（BMI） ≥25 kg·m^-2, age≥60 years, postoperative intervertebral mobility≥10° were independent risk factors of PELD postoperative recurrence. The area under the ROC curve was 0.898（95% CI: 0.817-0.968）. At the same time, the calibration curve was close to 45°, indicating that the model fits well.Conclusion Pfirrmann≥Ⅲ level, BMI≥25 kg·m^-2, age≥60 years, postoperative intervertebral mobility≥10° are independent risk factors of postoperative recurrence. The Nomogram chart constructed by based on these factors can be used as a simple and effective tool to predict the recurrence probability after PELD.更多还原