摘要
目的分析颈椎前路椎间盘切除融合术(ACDF)术后发生轴性症状(AS)的危险因素,构建列线图预测模型。方法回顾性分析该院2019-2021年接受ACDF的158例颈椎病患者的临床资料,根据术后是否发生AS将患者分为AS组(45例)和非AS组(113例)。记录两组患者年龄、性别、病程、BMI、吸烟史、糖尿病史、疾病类型、病变节段数目、手术前后日本骨科协会(JOA)评分、手术时间、术中出血量、颈椎活动度、椎间隙高度变化、颈椎融合节段曲度等。多因素logistic回归分析ACDF术后发生AS的独立危险因素并建立列线图预测模型,绘制受试者工作特征(ROC)曲线评价预测价值,Bootstrap法进行内部验证并进行一致性测试。结果纳入研究的158例患者中ACDF术后AS的发生率为28.48%。多因素logistic回归分析显示,颈椎融合节段为轻度后凸(OR=2.865,95%CI:1.034~7.643,P=0.036)或明显后凸(OR=12.726,95%CI:3.156~47.812,P=0.001)、颈椎活动度丢失值(OR=3.525,95%CI:1.587~7.825,P=0.002)、椎间隙高度变化≤2 mm(OR=3.461,95%CI:1.080~11.097,P=0.037)或≥5 mm(OR=5.164,95%CI:1.698~15.709,P=0.004)是ACDF术后发生AS的独立危险因素。构建的列线图预测模型曲线下面积(AUC)为0.818,模型预测价值较高,具备较好的区分度和一致性。结论构建的列线图模型对ACDF术后发生AS有较高的预测价值。
Objective To analyze the risk factors of axial symptoms(AS)after anterior cervical discectomy and fusion(ACDF),and to construct a prediction model based on nomogram.Methods The clinical data of 158 patients with cervical spondylosis who received ACDF from 2019 to 2021 were retrospectively analyzed,and the patients were divided into the AS group(45 cases)and the non-AS group(113 cases)according to whether AS occurred after surgery.Age,gender,course of disease,BMI,smoking history,diabetes history,disease type,number of diseased segments,JOA score before and after surgery,operation time,intraoperative blood loss,cervical motion,vertebral space extension height,cervical fusion segment curvature,etc.were recorded in the two groups.Multivariate logistic regression analysis was conducted to analyze the independent risk factors for AS after ACDF,and the prediction model was established with a column graph.Receiver operating characteristic(ROC)curve was drawn to evaluate the prediction value.Internal validation and consistency test were carried out with Bootstrap method.Results Among the 158 patients included in the study,the incidence of AS after ACDF was 28.48%.Multivariate logistic regression analysis showed that cervical fusion had mild kyphosis(OR=2.865,95%CI:1.034-7.643,P=0.036),obvious kyphosis(OR=12.726,95%CI:3.156-47.812,P=0.001),loss of cervical motion(OR=3.525,95%CI:1.587-7.825,P=0.002),change of vertebral space height≤2 mm(OR=3.461,95%CI:1.080-11.097,P=0.037),and vertebral space height change≥5 mm(OR=5.164,95%CI:1.698-15.709,P=0.004)were independent risk factors for AS after ACDF.The area under the curve(AUC)of the constructed nomogram prediction model was 0.818,which had high prediction value and good differentiation and consistency.Conclusion The constructed nomogram model has high predictive value for AS after ACDF.
作者
沈天宇
尚晖
SHEN Tianyu;SHANG Hui(Department of Spinal Surgery,Taihe Hospital Affiliated to Hubei University of Medicine,Shiyan,Hubei 442000,China)
出处
《重庆医学》
CAS
2023年第19期2958-2964,共7页
Chongqing medicine
关键词
颈椎病
前路手术
轴性症状
危险因素
预测模型
cervical spondylosis
anterior surgery
axial symptoms
risk factors
prediction model
