摘要
目的探讨单侧双通道脊柱内镜(UBE)行腰椎手术期间发生硬膜撕裂的独立危险因素,并构建直观的列线图预测模型,为临床决策提供依据。方法回顾性分析2021年1月至2025年1月行UBE手术的404例腰椎退行性疾病患者的临床资料,根据术中是否发生硬膜撕裂将其分为两组:硬膜撕裂组和对照组(未发生硬膜撕裂)。比较硬膜撕裂组与对照组的临床特征差异,采用多因素Logistic回归分析筛选出独立危险因素,并利用R软件构建列线图预测模型。通过受试者工作特征曲线(ROC)、校准曲线及决策曲线分析(DCA)评估模型的预测效能。结果UBE术中硬膜撕裂发生率为5.7%(23/404)。多因素Logistic分析显示,年龄≥65岁(OR=2.96,95%CI:1.20~7.29)、腰椎管狭窄症(OR=2.66,95%CI:1.07~6.63)、单侧入路双侧减压(OR=2.74,95%CI:1.09~6.92)及翻修手术(OR=8.46,95%CI:2.17~32.99)均是UBE术中发生硬膜撕裂的独立危险因素(P<0.05)。基于上述因素构建的列线图模型具有优秀的区分度(曲线下面积=0.91)和良好的校准度(Hosmer-Lemeshow检验P=0.866),DCA显示其临床实用性良好。结论年龄≥65岁、腰椎管狭窄症、单侧入路双侧减压及翻修手术明显增加了UBE术中发生硬膜撕裂的风险,本研究构建的列线图模型可有效预测其发生概率,有助于术前风险评估及手术策略优化。
Objective This study aims to explore the independent risk factors for dural tears occurring during unilateral biportal endoscopic(UBE)lumbar surgery and to construct an intuitive nomogram prediction model to provide a basis for clinical decision-making.Methods A retrospective analysis was conducted on the clinical data of 404 patients with lumbar degenerative diseases who underwent UBE surgery from January 2021 to January 2025.Patients were divided into two groups based on the occurrence of dural tears during surgery:the dural tear group and the control group(no dural tear).Clinical characteristics were compared between the two groups,and independent risk factors were identified using multivariate logistic regression analysis.The nomogram prediction model was constructed using R software.The predictive performance of the model was evaluated through receiver operating characteristic(ROC)curves,calibration curves,and decision curve analysis(DCA).Results The incidence of dural tears during UBE surgery was 5.7%(23/404).Multivariate analysis revealed that age≥65 years(OR=2.96,95%CI:1.20-7.29),lumbar spinal stenosis(OR=2.66,95%CI:1.07-6.63),unilateral approach with bilateral decompression(OR=2.74,95%CI:1.09-6.92),and revision surgery(OR=8.46,95%CI:2.17-32.99)were independent risk factors for dural tears during UBE surgery(all P<0.05).The nomogram model constructed based on these factors demonstrated excellent discrimination(area under the curve=0.91)and good calibration(Hosmer-Lemeshow test P=0.866),with decision curve analysis indicating good clinical utility.Conclusion Age≥65 years,lumbar spinal stenosis,unilateral approach with bilateral decompression,and revision surgery significantly increase the risk of dural tears during UBE surgery.The nomogram model developed in this study can effectively predict the probability of occurrence,aiding in preoperative risk assessment and optimization of surgical strategies.
作者
高轩
史相钦
崔家伟
李寒曦
王喆
GAO Xuan;SHI Xiangqin;CUI Jiawei;LI Hanxi;WANG Zhe(First Department of Spinal Surgery,Henan Luoyang Orthopedic Hospital(Henan Orthopedic Hospital),Luoyang 471000)
出处
《颈腰痛杂志》
2025年第5期906-912,共7页
The Journal of Cervicodynia and Lumbodynia
关键词
单侧双通道脊柱内镜
硬膜撕裂
脑脊液漏
风险因素
预测模型
腰椎减压手术
unilateral biportal endoscopy
dural tear
cerebrospinal fluid leak
risk factors
prediction model
lumbar decompression surgery
