Hoffmann征与神经影像学表现的临床应用相关性  

Correlation study and application of Hoffmann sign and neuroimaging findings

作　　者：丁祥 周乾坤 牛国旗[2] 阮传江[1] 韩玉虎 DING Xiang;ZHOU Qiankun;NIU Guoqi;RUAN Chuanjiang;HAN Yuhu(Department of Orthopedics,Taihe County People′s Hospi⁃tal,Fuyang 236600,China)

机构地区：[1]太和县人民医院骨科,安徽阜阳236600 [2]蚌埠医学院第二附属医院骨科,安徽蚌埠233000

出　　处：《实用医学杂志》2020年第11期1488-1493,共6页The Journal of Practical Medicine

基　　金：安徽省2018年度重点研究与开发计划项目(编号:1804h08020247)。

摘　　要：目的 Hoffmann征通常被用来作为上运动神经元损害的指标,但其临床效果在以往的报道中仍存在争议。本文探讨颈椎病Hoffmann征与神经影像学表现的相关关系。方法收集60例颈椎不适患者的临床资料进行回顾性病例对照研究,其中,男33例,女27例,平均年龄(63.98±2.05)岁。根据有无Hoffmann征将患者分为2组,Hoffmann征阳性组(PH组)36例,Hoffmann征阴性组(NH组)24例。评价影像学结果,计算Hoffmann征对颈椎病诊断灵敏度、特异度和阳性预测值等。测量颈脊髓受压的比值(E值)、颈椎管比值S-Index以及判断椎间盘突出程度,测量颈椎生理曲度、责任椎间隙活动度(ROM)。结果 NH与PH患者的E值、颈椎生理曲度的差异是有统计学意义(P <0.05)。C4/5、C5/6节段对Hoffmann征阳性率的明显大于C6/7(P <0.05)。Hoffmann征诊断颈椎病脊髓压迫的灵敏度和特异度分别为73.3%和80.0%。Hoffmann征的阳性预测值为91.7%,阴性预测值为50.0%,误诊率为20.0%,漏诊率为26.7%。S-Index值组间比较差异有统计学意义(P <0.05)。计算PH组和NH组各节段进行统计学分析,C4/5、C5/6、C6/7节段组间差异有统计学意义(P <0.05)。结论根据颈椎管与颈段的比值、颈椎生理曲度和E值,生理曲度越小和颈椎管越窄脊髓受压越严重,阳性Hoffmann征的发生率越高。Objective Hoffmann sign is usually used as an indicator of upper motor neuron damage,but its clinical effect is still controversial in previous reports.The purpose of this study was to explore the relationship between Hoffmann sign and neuroimaging findings of cervical spondylosis,as well as its clinical significance.Methods Clinical data of 60 patients with cervical vertebra discomfort were collected for retrospective case⁃con⁃trol study,including 33 males and 27 females,with an average age was(63.98±2.05)years.Patients were divided into two groups according to whether there was Hoffmann sign or not.The imaging results were evaluated.The sensi⁃tivity,specificity and positive predictive value of Hoffmann sign for cervical pathology,segmental and symptomatic were calculated.The ratio(E value)of cervical spinal cord compression,the s⁃index of cervical canal ratio and the degree of disc herniation were measured.The physiological curvature of cervical spine and the activity of responsi⁃ble intervertebral space(ROM)were also measured.Results The E value and cervical curvature of NH and PH patients were significantly different(P<0.05).The positive rate of C4/5 and C5/6 to Hoffmann was significantly higher than that of C6/7(P<0.05).The sensitivity and specificity of Hoffmann sign for the diagnosis of spinal cord compression in cervical spondylosis by surgeons were 73.3%and 80.0%,respectively.The positive predictive value of Hoffmann sign was 91.7%and the negative predictive value was 50.0%.The misdiagnosis rate was 20.0%and the missed diagnosis rate was 26.7%。Statistical analysis was performed on each segment of PH group and NH group,and the differences between C4/5,C5/6 and C6/7 segments were significant(P<0.05).Conclusions Although Hoffmann's sign is not foolproof in the diagnosis of cervical spinal cord compression,it can be used to evaluate patients with spondylosis.According to the ratio of cervical spinal canal to cervical segment,cervical phys⁃iological curvature and E value,we believe that the sma

关 键 词：HOFFMANN征 颈椎病 影像学 

分 类 号：R683.2[医药卫生—骨科学]