抱头试验在神经根型颈椎病中的鉴别诊断价值

Differential diagnosis value of head holding test in the cervical spondylotic radiculopathy

目的 探讨抱头试验在神经根型颈椎病中的鉴别诊断价值。方法 选取120例神经根型颈椎病患者和同期50例健康志愿者,被检查者坐位或仰卧位,一只手掌放置在头枕部,另一只手放置在其手背上,疼痛减轻为试验阳性。计算抱头试验在两组中的敏感度、特异度、阳性预测值、阴性预测值、似然比。结果 120例神经根型颈椎病患者中抱头试验阳性102例,阴性18例,阳性率为85.0%,敏感度为0.85。50例健康志愿者中抱头试验阳性2例,阴性48例,阳性率为4.0%,真阴性率为96%,特异度为0.96。抱头试验阳性率神经根型颈椎病患者明显高于健康志愿者(P<0.01)。120例神经根型颈椎病患者和50例健康志愿者的阳性预测值为0.98,阴性预测值为0.73,阳性似然比为21.25,阴性似然比为0.16。检查者间κ值为0.79,检查者内κ值为0.78,表明抱头试验的检查者间和检查者内均有较高的可信度。结论 抱头试验诊断神经根型颈椎病简单、有效、快速、可靠性高,患者依从性高。

Objective To investigate the value of head holding test in differential diagnosis of cervical spondylotic radiculopathy.Methods The 120 patients with cervical spondylotic radiculopathy and 50 healthy volunteers were selected. The subjects were in sitting or supine position, the first palm placed on the occipital part of the head and the other hand placed on the back of the hand, pain relief was positive for the test.The sensitivity, specificity, positive predictive value(PPV),negative predictive value(NPV) and likelihood ratio of the head holding test in the two groups were calculated.Results Among 120 patients with cervical spondylotic radiculopathy, 102 cases were positive and 18 cases were negative, with a positive rate of 85.0% and a sensitivity of 0.85.Among the 50 healthy volunteers, 2 cases were positive and 48 cases were negative, the positive rate was 4.0%, the true negative rate was 96%, and the specificity was 0.96.The positive rate of cervical spondylotic radiculopathy patients was significantly higher than that of healthy volunteers(P<0.01).Among 120 patients with cervical spondylotic radiculopathy and 50 healthy volunteers, the positive predictive value, negative predictive value were 0.98 and 0.73,and the positive to likelihood ratio and negative to likelihood ratio were 21.25,0.16, respectively.The inter-examiner κ value was 0.79, and the intra-examiner κ value was 0.78,which indicated there were high confidence in inter-examiner and intra-examiner of the head holding test.Conclusions The diagnosis of cervical spondylotic radiculopathy by head holding test is simple, effective, rapid, reliable, and has high compliance.