背景:影响马尾综合征(CES)减压手术后恢复的因素尚未完全确定。我们旨在研究CES患者术后恢复不良(PPR)的最有价值的预测因子(MVP),并构建列线图以辨别将经历PPR的患者。
方法:在***医院接受治疗的356例腰椎退行性疾病继发CES患者随机分为2:1比例的训练组(N=238)和验证组(N=118)。此外,来自****医院的92名患者组成了测试队列。最小绝对收缩和选择算子回归(LASSO)用于选择MVP。列线图是通过对逻辑回归中MVP的系数进行积分得出的,和它的歧视,校准,和临床效用在所有三个队列中得到验证。
结果:经过3至5年的随访,膀胱功能障碍的残留率,肠功能障碍,性功能障碍,鞍区麻醉占41.9%,44.1%,63.7%,和29.0%,分别。MVP包括压力性尿失禁,膀胱过度活动症,低流,排便困难,大便失禁,和鞍式麻醉。在训练中,列线图的判别能力分别达到0.896、0.919和0.848,验证,和测试队列,分别。此外,列线图在所有队列中均显示良好的校准和临床实用性.此外,用于区分将经历PPR的患者的列线图评分的最佳临界值为148.02,高于该值,术后结局往往较差.
结论:开发并验证了识别将经历PPR的CES患者的第一个治疗前列线图,这将有助于临床医生的临床决策。
BACKGROUND: Factors influencing recovery after decompression surgery for cauda equina syndrome (CES) are not completely identified. The authors aimed to investigate the most valuable predictors (MVPs) of poor postoperative recovery (PPR) in patients with CES and construct a nomogram for discerning those who will experience PPR.
METHODS: Three hundred fifty-six patients with CES secondary to lumbar degenerative diseases treated at Xijing Hospital were randomly divided into training ( N =238) and validation ( N =118) cohorts at a 2:1 ratio. Moreover, 92 patients from the 970 th Hospital composed the testing cohort. Least Absolute Shrinkage and Selection Operator regression (LASSO) was used for selecting MVPs. The nomogram was developed by integrating coefficients of MVPs in the logistic regression, and its discrimination, calibration, and clinical utility were validated in all three cohorts.
RESULTS: After 3 to 5 years of follow-up, the residual rates of bladder dysfunction, bowel dysfunction, sexual dysfunction, and saddle anesthesia were 41.9, 44.1, 63.7, and 29.0%, respectively. MVPs included stress urinary incontinence, overactive bladder, low stream, difficult defecation, fecal incontinence, and saddle anesthesia in order. The discriminatory ability of the nomogram was up to 0.896, 0.919, and 0.848 in the training, validation, and testing cohorts, respectively. Besides, the nomogram showed good calibration and clinical utility in all cohorts. Furthermore, the optimal cutoff value of the nomogram score for distinguishing those who will experience PPR was 148.02, above which postoperative outcomes tend to be poor.
CONCLUSIONS: The first pretreatment nomogram for discerning CES patients who will experience PPR was developed and validated, which will aid clinicians in clinical decision-making.