| 摘要: |
| 目的 探究霍夫曼征在颈椎退变性疾病中的临床应用价值。方法 回顾性分析2017年6月至2019年1月在我科接受颈椎前路减压融合术的104例颈椎退变性疾病患者资料，包括霍夫曼征阳性患者49例、阴性患者55例，术后随访至少12个月。评估两组患者的一般临床表现、临床体征、MRI影像学特征、术前临床评分、围手术期并发症和术后神经功能恢复情况。采用ROC曲线评估霍夫曼征与术前临床评分的关系。结果 与霍夫曼征阴性组相比，霍夫曼征阳性组患者多表现为术前脊髓高信号，术前日本骨科协会（JOA）评分和Nurick评分较差（P均<0.05）。ROC曲线分析结果显示，霍夫曼征预测术前JOA评分的灵敏度为85.29%，特异度为42.22%，AUC为0.666（95% CI 0.547～0.785，P=0.012）；预测Nurick评分的灵敏度为67.65%，特异度为75.56%，AUC为0.731（95% CI 0.618～0.845，P<0.01）。JOA亚项评分分析结果显示，与霍夫曼征阴性组相比，霍夫曼征阳性组患者的术前上肢运动功能和下肢感觉功能均较差（P均<0.01）。ROC曲线分析结果显示，霍夫曼征预测上肢运动功能的灵敏度为47.06%，特异度为80.00%，AUC为0.679（95% CI 0.561～0.798，P=0.007）；预测下肢感觉功能的灵敏度为44.12%，特异度为84.45%，AUC为0.660（95% CI 0.536～0.783，P=0.016）。两组患者围手术期并发症发生率差异无统计学意义。与霍夫曼征阴性组相比，霍夫曼征阳性组患者术后末次随访时神经功能恢复率较低，上肢运动功能和下肢感觉功能均较差（P均<0.05）。结论 霍夫曼征能够反映颈椎退变性疾病患者的术前临床表现和术后功能恢复状态，尤其对预测上肢运动和下肢感觉功能恢复有较高的临床价值。 |
| 关键词: 霍夫曼征 颈椎退变性疾病 临床表现 诊断 治疗 |
| DOI：10.16781/j.0258-879x.2021.07.0709 |
| 投稿时间：2021-01-15修订日期：2021-05-07 |
| 基金项目: |
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| Role of Hoffmann sign in predicting the clinical manifestation and postoperative functional recovery of patients with degenerative cervical disorder |
| SUN Kai-qiang,SUN Xiao-fei,HUAN Le,SHI Jian-gang* |
(The Second Ward, Department of Spinal Surgery, Changzheng Hospital, Naval Medical University (Second Military Medical University), Shanghai 200003, China
*Corresponding author) |
| Abstract: |
| Objective To explore the clinical value of Hoffmann sign in patients with degenerative cervical disorder. Methods The clinical data of 104 patients with degenerative cervical disorder who underwent anterior cervical decompression and fusion in our department from Jun. 2017 to Jan. 2019 were retrospectively analyzed, including 49 Hoffmann sign-positive patients and 55 Hoffmann sign-negative patients. The patients were followed up for at least 12 months. The general clinical manifestations, clinical signs, magnetic resonance imaging (MRI), preoperative clinical scores, perioperative complications and postoperative neurological function recovery were evaluated. The correlations between Hoffmann sign and preoperative clinical scores were evaluated by the receiver operating characteristic (ROC) curve. Results Compared with the Hoffmann sign-negative group, the patients in the Hoffmann sign-positive group had more hyperintense spinal cord and worse preoperative Japanese Orthopaedic Association (JOA) and Nurick scores (all P<0.05). ROC curve analysis showed that the sensitivity, specificity and area under curve (AUC) of Hoffmann sign were 85.29%, 42.22% and 0.666 (95% confidence interval[CI] 0.547-0.785, P=0.012) in predicting preoperative JOA score and were 67.65%, 75.56% and 0.731 (95% CI 0.618-0.845, P<0.01) in predicting Nurick score, respectively. JOA score in isolation analysis showed that the upper limb motor function and lower limb sensory function of the patients were worse in the Hoffmann sign-positive group than in the Hoffmann sign-negative group (both P<0.01). ROC curve analysis showed that the sensitivity, specificity and AUC of Hoffmann sign were 47.06%, 80.00% and 0.679 (95% CI 0.561-0.798, P=0.007) in predicting upper limb motor function and were 44.12%, 84.45% and 0.660 (95% CI 0.536-0.783, P=0.016) in predicting lower limb sensory function, respectively. There was no significant difference in the incidence of perioperative complications between the 2 groups. At the final follow-up, the postoperative functional recovery rate was lower, and the upper limb motor function and lower limb sensory function of the patients were worse in the Hoffmann sign-positive group than in the Hoffmann sign-negative group (all P<0.05). Conclusion Hoffmann sign can be used as a reliable clinical index to reflect the preoperative clinical presentation and postoperative functional recovery of patients with degenerative cervical disorder, especially to predict the recovery of upper limb motor function and lower limb sensory function. |
| Key words: Hoffmann sign degenerative cervical disorders clinical manifestations diagnosis treatment |
