脊髓型颈椎病344例临床特征分析

Analysis of clinical features in 344 patients with cervical spondylotic myelopathy

目的:探讨脊髓型颈椎病患者临床症状、体征及其在诊断中的价值。方法:纳入安徽医科大学附属医院康复医学科1990-01/1997-11收治的344例脊髓型颈椎病患者。对其病历资料进行统计,分析其临床症状及体征。结果:①眩晕、颈痛、上肢麻木和下肢无力分别占67.4%(232/344),43.6%(150/344),57.6%(198/344)和57.6%(198/344)。②改良Hoffmann征、下肢肌张力增高、颈僵、颈椎旁压痛、头后仰压颈试验、椎间孔压缩试验分别占86.3%(297/344),68.9%(237/344),58.4%(200/344),53.4%(184/344),57.8%(199/344)和46.8%(161/344)。结论:脊髓型颈椎病为多症状表现症候群,主要症状为眩晕、颈痛、上肢麻木和下肢无力等;主要体征为改良Hoffmann征、下肢肌张力增高、颈僵、颈椎旁压痛、头后仰压颈试验、椎间孔压缩试验等;其主要症状及体征有助于脊髓型颈椎病的诊断。

AIM： To discuss the clinical symptoms and physical signs and theirs value in diagnosis in patients with cervical spondylotic myelopathy （CSM）. METHODS： 344 patients with CSM, who were treated at the Department of Rehabilitation Medicine, Affiliated Hospital, Anhui Medical University from January 1990 to November 1997, were selected. The data of medical history in the patients were added up.The clinical symptoms and physical signs were analyzed. RESULTS： ① The vertigo, neck pain, upper extremity numbness and lower extremity weakness accounted for 67.4% （232/344）, 43.6% （150/344）, 57.6%（198/344） and 57.6%（198/344）, respectively. ② Improved Hoffmann signs, hypermyotonia of lower extremity, neck stiffness, tenderness of cervical vertebra sides, hypsokinesis of head and compression of neck test and intervertebral foramen compression test accounted for 86.3% （297/344）, 68.9% （ 237/344 ）, 58.4% （200/344）, 53.4% （ 184/344 ）, 57.8%（199/344） and 46.8%（161/344）. CONCLUSION： CSM shows varieties of manifestation. The cardinal symptoms of CSM are vertigo, neck pain, upper extremity numbness and lower extremity weakness etc. The important signs of CSM are improved Hoffmann signs, hypermyotonia of lower extremity, neck stiffness, tenderness of cervical vertebra sides, hypsokinesis of head and compression of neck test and intervertebral foramen compression test etc. Major symptoms and physical signs are helpful to diagnose CSM.