摘要
目的:分析后入路颈椎单开门椎管扩大成形术后C5神经根麻痹的影响因素,并构建Nomogram相关预测模型。方法:选取2019年5月至2023年2月收治的255例行后入路颈椎单开门椎管扩大成形术的脊髓型颈椎病患者为研究对象,根据其术后是否出现C5神经根麻痹分为发生组(45例)和未发生组(210例)。比较两组患者的一般资料;采用受试者工作特征(receiver operating characteristic,ROC)曲线分析有统计学意义的连续性变量的预测价值;采用Logistic回归分析患者术后C5神经根麻痹的影响因素;采用决策曲线分析评估Nomogram模型临床效能。结果:与未发生组相比,发生组患者病程较短,术前颈椎曲度、脊髓后移距离较长,肌电异常、椎间孔狭窄、后纵韧带骨化较高,差异均有统计学意义(P<0.05)。术前颈椎曲度较大,脊髓后移距离的曲线下面积(area under the curve,AUC)为0.699、0.697,最佳截断值为21°、3 mm,(P<0.05)。Logistic回归分析结果,肌电异常[OR=6.693,95%CI(2.754,16.264),P<0.001]、术前颈椎曲度[OR=2.254,95%CI(1.215,2.920),P=0.003]、椎间孔狭窄[OR=3.049,95%CI(1.234,7.530),P=0.016]、后纵韧带骨化[OR=2.646,95%CI(1.015,6.899),P=0.047]、脊髓后移距离[OR=0.298,95%CI(0.173,0.513),P<0.001]均是影响该病患者术后C5神经根麻痹的相关因素。Nomogram模型预测患者术后C5神经根麻痹的风险C-index为0.861,95%CI(0.795,0.927),且该模型的风险阈值>0.17。结论:肌电异常、术前颈椎曲度较高、椎间孔狭窄、后纵韧带骨化、脊髓后移距离均是后入路颈椎单开门椎管扩大成形术后C5神经根麻痹的相关因素,建立的以此为基础的预测模型,具有更高的准确度及临床应用价值。
Objective To analyze the factors influencing the occurrence of C5 nerve root palsy after posterior approach cervical single-door enlargement kyphoplasty and construct a Nomogram-related prediction model.Methods A total of 255 patients with cervical spondylotic myelopathy who underwent posterior cervical single-door laminoplasty between May 2019 and February 2023 were selected as the research subjects.They were divided into the occurrence group(45 patients)and the non-occurrence group(210 patients)based on whether C5 nerve root palsy occurred after the operation.The general data of patients in the two groups were compared.The predictive value of statistically significant continuous variables was analyzed using receiver operating characteristic(ROC)curve analysis.The factors influencing patients'postoperative C5 nerve root palsy were analyzed using Logistic regression analysis.And the clinical efficacy of Nomogram model was assessed using decision curve analysis.Results Compared with the non-occurrence group,the patients in the occurrence group had a shorter disease duration,higher preoperative cervical curvature and spinal cord posterior displacement distance,and higher percentage of positive pathological reflexes,foraminal stenosis,and ossification of the posterior longitudinal ligament.The difference was statistically significant P<0.05.The area under the curve(AUC)for cervical curvature and posterior displacement of the spinal cord prior to surgery were 0.699 and 0.697,respectively.The optimal cutoff values were determined to be 21°and 3 mm,with statistically significant differences(P<0.05).Logistic regression analysis showed that abnormal electromyography OR=6.693,95%CI(2.754,16.264),P<0.001;preoperative cervical curvature OR=2.254,95%CI(1.215,2.920),P=0.003;foraminal stenosis OR=3.049,95%CI(1.234,7.530),P=0.016;ossification of the posterior longitudinal ligament OR=2.646,95%CI(1.015,6.899),P=0.047;and the distance of spinal cord posterior displacement OR=0.298,95%CI(0.173,0.513),P<0.001;which were all related factors influencing postoperative C5 nerve root palsy in patients with this disease.The C-index of the Nomogram model for predicting the risk of postoperative C5 nerve root palsy in patients was 0.861,with a 95%confidence interval of(0.795,0.927).The risk threshold of this model was determined to be greater than 0.17.Conclusion Abnormal electromyography,preoperative cervical curvature,intervertebral foramen stenosis,ossification of the posterior longitudinal ligament,and the degree of posterior displacement of the spinal cord are all significant contributing factors to C5 nerve root palsy following posterior cervical single-door laminoplasty.A prediction model developed based on these factors demonstrates enhanced accuracy and substantial clinical application value.
作者
李石头
陈军
张艳锋
LI Shi-tou;CHEN Jun;ZHANG Yan-feng(Nanyang Second People's Hospital,Nanyang 473000,Henan,China)
出处
《中国骨伤》
2025年第7期705-710,共6页
China Journal of Orthopaedics and Traumatology
