【摘要】 目的:探讨老年腰椎间盘突出症(LDH)患者经皮椎间孔镜髓核摘除术(PELD)后复发的风险因素，并构建预测模型。方法:回顾性分析110例施行PELD治疗的老年LDH患者的临床资料。根据术后是否复发分为复发组(n=11)和非复发组(n=99)。采用Logistic回归分析法确立影响导致LDH术后复发的危险因素，根据Logistic回归分析结果构建老年LDH患者PELD术后复发的列线图预测模型，并应用ROC曲线验证曲线的预测效能。结果:110例患者中，11例复发，复发率10.00%。两组病程、糖尿病史、Pfirrmann等级、矢状面旋转程度、矢状面滑移程度、工作强度、术中髓核摘除情况、术中纤维破坏情况及术后活动程度比较，差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示，Pfirrmann等级、矢状面旋转程度、术中髓核摘除情况、术中纤维破坏情况及术后活动程度是影响老年LDH患者PELD术后复发的独立风险因素。老年LDH患者PELD术后复发影响因素列线图预测模型的ROC曲线下面积(AUC)值为0.972(95%CI为0.872～0.916),敏感度为89.87%,特异度为96.25%。结论:Pfirrmann等级、矢状面旋转程度、术中髓核摘除情况、术中纤维破坏情况及术后活动程度是影响老年LDH患者PELD术后复发的独立风险因素，基于以上风险因素建立的列线图预测模型具有较好的预测效能。更多还原

【Abstract】 Objective:To investigate the risk factors of recurrence after percutaneous endoscopic lumbar discectomy(PELD) in elderly patients with lumbar disc herniation(LDH),and to construct a nomogram prediction model.Methods:The clinical data of elderly patients with LDH who received PELD were retrospectively analyzed.A total of 110 patients were included and divided into recurrence group(n=11) and non-recurrence group(n=99) according to whether recurrence occurred after operation.The clinical data of the patients were collected, and the risk factors for postoperative recurrence of LDH were determined by Logistic regression analysis.According to the results of Logistic regression analysis, a nomogram prediction model for postoperative recurrence of PELD in elderly LDH patients was constructed, and ROC curve was used to verify the predictive efficacy of the curve.Results:Among the 110 patients, 11 had recurrence, with a recurrence rate of 10.00%.There were significant differences in course of disease, diabetes history, Pfirrmann grade, sagittal rotation degree, sagittal slip degree, working intensity, intraoperative removal of nucleus pulposus, intraoperative fiber destruction and postoperative activity between the two groups(P<0.05).Multivariate Logistic regression analysis showed that Pfirrmann grade, sagittal rotation degree, intraoperative nucleus pulposus removal, intraoperative fiber damage and postoperative activity were independent risk factors for recurrence after PELD in elderly LDH patients.The AUC under ROC of the nomogram prediction model for postoperative recurrence of PELD in elderly LDH patients was 0.972(95%CI:0.872～0.916),with a sensitivity of 89.87% and a specificity of 96.25%.Conclusion:Pfirrmann grade, sagittal rotation degree, intraoperative nucleus pulposus removal, intraoperative fiber damage and postoperative activity are independent risk factors for recurrence after PELD in elderly LDH patients.The nomogram prediction model based on the above risk factors has good prediction performance.更多还原