Hoffmann征对脊髓型颈椎病的早期诊断价值

Value of Hoffmann sign in the early diagnosis of cervical myelopathy

目的 研究Hoffmann征在脊髓型颈椎病中的早期诊断价值。方法 选择2014年4~7月在我院脊柱外科门诊就诊的150例患者及体检中心体检的80例健康人士进行回顾性分析。门诊就诊的患者主诉均与脊柱相关（定义为有症状组）,记录患者就诊时的病理征情况,对确诊为脊髓型颈椎病的患者尚需收集其磁共振等影像学资料,体检的健康人士无任何症状（定义为无症状组）,期间对体检的健康人士进行随访,1年后观察有多少患者进展为脊髓型颈椎病,同样也记录其体检时的病理征情况,最后对两组人群的病理征尤其是Hoffmann征的发生率进行统计分析。结果 有症状组36.00%患者Hoffmann征阳性,无症状组为18.75%;约登系数分别为0.30、0.37;症状组特征曲线下面积为0.65〉0.5,差异有统计学意义（P=0.011〈0.05）;无症状组特征曲线下面积为0.68〉0.5,差异有统计学意义（P=0.043〈0.05）。Hoffmann征阳性患者表观扩散系数值升高,各向异性分数值降低。结论Hoffmann征对筛查脊髓型颈椎病有一定价值,但是不能代替其他症状体征及影像学检查而单独诊断脊髓型颈椎病。故需对Hoffmann征阳性患者进一步行影像学检查,尤其是磁共振扩散张量成像（diffusion tensor imaging,DTI）等,以达到对脊髓型颈椎病早发现、早诊断、早治疗的目的。

Objective To investigate the value of Hoffmann sign in the early diagnosis of cervical myelopathy. Methods 150 patients who were treated in the department of spinal surgery of our hospital as well as 80 healthy people examined in the center of medical examination from April to July 2014 were retrospectively analyzed. The complaints of patients of clinics were all related with the spine （defined as symptom group）, the pathological signs of the patients were record- ed and the imaging materials like magnetic resonance were to be collected for the patients who were diagnosed as cer- vical myelopathy. No symptoms were presented in the healthy people （defined as non-symptom group）, and follow-ups were performed to the healthy people. The number of patients who developed into cervical myelopathy after 1 year was observed and the pathological signs of their physical examination were also recorded. The occurrence rate of pathologi- cal signs especially Hoffmann sign were statistically analyzed of the patients from both groups. Results Positive Hof- mann signs were presented at 36.00% patients from symptom group and 18.75% of the patients from non-symptom group, with the Youden index was respectively 0.30 and 0.37; the area under characteristic curve of symptom group was 0.65〉0.5, P=0.01〈0.05, with statistically significant difference; the area under characteristic curve of symptom group was 0.68〉0.5, P=0.043〈0.05, with statistically significant difference. The value of apparent diffusion coefficient was in- creased while the value of fractional anisotropy was decreased for the patients with positive Hoffmann sign. Conclusion Hoffmann sign has some value in the screening of cervical myelopathy, however it cannot separately diagnose cervical myelopathy taking place of symptoms, body signs and imaging examinations. In result, for the patients presenting posi- tive Hoffmann sign, further imaging examinations especially diffusion tensor imaging should be performed for the early detection, early diagnosis and early treatment.