摘要
目的探讨基于MRI的多裂肌脂肪浸润程度及其他临床特征与腰椎间盘突出(LDH)术后复发的关联。方法回顾性收集2023年4月~2024年4月于山西省人民医院行腰椎微创手术的743例LDH患者的病历资料,从MRI成像获取脂肪浸润程度及病灶特征,根据术后12个月内LDH复发情况,将患者分为复发组(n=74)和未复发组(n=669)。通过单因素分析筛选潜在预测因子,采用多因素logistic回归分析确定LDH术后复发的独立风险因素,绘制ROC曲线并计算曲线下面积(AUC)以评估模型预测效能。结果两组患者的性别、年龄、糖尿病、高血压、突出节段的差异无统计学意义(P>0.05)。复发组患者的病程、体质量指数、Pfirrmann分级和多裂肌脂肪浸润程度均高于非复发组(P<0.05)。回归分析结果显示,LDH患者病程长、体质量指数高、多裂肌脂肪浸润程度高、Pfirrmann分级高是LDH术后复发的独立风险因素(P<0.05)。联合预测模型方程为:y=2.030×病程+0.216×体质量指数+0.660×多裂肌脂肪浸润程度+0.931×Pfirrmann分级赋值,AUC为0.991,敏感度为96.43%,特异度为94.63%。结论MRI征象多裂肌脂肪浸润是预测LDH术后复发的关键独立风险因素,其与临床特征联合应用可显著提高预测效能。
Objective To investigate the association between MRI-based multifidus muscle fat infiltration degree and other clinical features and postoperative recurrence of lumbar disc herniation(LDH).Methods The medical records of 743 patients with LDH who received lumbar minimally invasive surgery in Shanxi Provincial People's Hospital from April 2023 to April 2024 were retrospectively collected.The fat infiltration degree and lesion features were obtained from MRI.According to the recurrence status of LDH within 12 months after surgery,the above patients were classified into recurrence group(n=74)and non-recurrence group(n=669).Potential predictors were screened by univariate analysis.Multivariate logistic regression analysis was applied to determine the independent risk factors for postoperative recurrence of LDH.ROC curve was drawn and the area under the curve(AUC)was calculated to evaluate the predictive efficiency of the model.Results There were no statistical differences in gender,age,diabetes mellitus,hypertension and protrusion segment between the two groups of patients(P>0.05).The disease course,body mass index,Pfirrmann grading and multifidus muscle fat infiltration degree in recurrence group were higher than those in non-recurrence group(P<0.05).Regression analysis results showed that long course of disease,high body mass index,high degree of multifidus muscle fat infiltration and high Pfirrmann grade were independent risk factors for postoperative recurrence of LDH(P<0.05).The combined prediction model equation was manifested as y=2.030×disease course+0.216×body mass index+0.660×multifidus muscle fat infiltration degree+0.931×Pfirrmann grading assignment,and the AUC,sensitivity and specificity of the model were 0.991,96.43%and 94.63%respectively.Conclusion MRI sign of multifidus muscle fat infiltration is a key independent risk factor for predicting postoperative recurrence of LDH,and its combined application with clinical features can significantly enhance the predictive efficiency.
作者
杨茜苑
李佳男
梁庆元
师博
李利军
荆志振
YANG Xiyuan;LI Jianan;LIANG Qingyuan;SHI Bo;LI Lijun;JING Zhizhen(Department of Orthopedics,Shanxi Provincial People's Hospital,Taiyuan 030012,China;Department of Orthopedics,The Fifth Clinical Medical College of Shanxi Medical University,Taiyuan 030012,China)
出处
《分子影像学杂志》
2025年第12期1491-1496,共6页
Journal of Molecular Imaging
基金
山西省基础研究计划项目(202203021211056)。
关键词
腰椎间盘突出症
多裂肌
脂肪浸润
磁共振成像
复发
影响因素
lumbar disc herniation
multifidus muscle
fat infiltration
magnetic resonance imaging
recurrence
influencing factors
