脚趾站立试验在退行性脊髓型颈椎病临床诊断中应用的可行性分析
Feasibility analysis for application of test of standing on toes in clinical diagnosis of degenerative cervical myelopathy
刘磊 1宋飞霏 1马超 1刘光普 1商杰 1张越 1韩猛1
作者信息
- 1. 徐州市中心医院脊柱外科,江苏 221000
- 折叠
摘要
目的 评估脚趾站立试验是否可以作为诊断退行性脊髓型颈椎病并判断其严重程度的临床依据.方法 研究时间自2018-01-2018-12,采用PASS 14.0软件进行样本量计算并根据门诊实际情况,观察组(退行性脊髓型颈椎病患者)纳入140例,对照组(排除退行性脊髓型颈椎病的骨科门诊患者)纳入120例.比较观察组与对照组脚趾站立试验阳性率,比较观察组中脚趾站立试验阳性患者与脚趾站立试验阴性患者的性别、年龄、颈椎功能、病程、颈椎MRI结果(蛛网膜下腔是否消失,脊髓信号是否改变)差异.分析观察组中不同脚趾站立试验阳性结果分级与颈椎功能分级的相关性,通过ROC曲线分析脚趾站立试验阳性结果分级评估颈椎功能障碍的灵敏度与特异度.结果 观察组脚趾站立试验阳性率为86.4％,对照组脚趾站立试验阳性率为7.5％;观察组脚趾站立试验阳性率明显高于对照组,差异有统计学意义(P＜0.05).与脚趾站立试验阴性患者相比,脚趾站立试验阳性患者的颈椎功能障碍程度更轻、病程更短、脊髓信号改变更常见,差异有统计学意义(P＜0.05).脚趾站立试验阳性结果分级评估颈椎功能障碍的ROC曲线下面积为0.689(95％CI为0.553～0.824),灵敏度为0.579,特异度为0.752.结论 脚趾站立试验可以作为评价颈部脊髓损伤客观、简单、可行的筛查试验,患者容易遵循相关试验步骤,可用于评估患者的躯干平衡和疾病严重程度,脚趾站立试验阳性的患者可能存在退行性脊髓型颈椎病.
Abstract
Objective o evaluate whether the test of standing on toes(TST)can be used as a clinical basis for diagnosing de-generative cervical myelopathy(DCM)and determining its severity.Methods The study period was from January 2018 to De-cember 2018,using PASS 14.0 software for sample size calculation and based on the actual situation of the outpatient clinic,140 cases were included in the observation group(patients with DCM),and 120 cases were included in the control group(ortho-pedic outpatient clinic patients excluding DCM).The TST positive rate was compared between the observation group and the control group,and the differences in gender,age,cervical spine function,disease duration,and cervical spine MRI results(whether the subarachnoid space disappeared or not,and whether the signal of the spinal cord was changed or not)were com-pared between the TST-positive patients and the negative patients in the observation group.The correlation between different TST positive result grades and cervical spine function grades in the observation group was analyzed,and the sensitivity and spec-ificity of TST positive result grades for assessing cervical spine dysfunction were analyzed by ROC curve.Results The TST positivity rate was 86.4％in the observation group and 7.5％in the control group,the TST positivity rate in the observation group was significantly higher than that in the control group,and the difference was statistically significant(P＜0.05).Compared with negative patients,TST-positive patients had milder cervical spine dysfunction,shorter disease duration,and spinal cord signal changes,with statistically significant differences(P＜0.05).The area under the ROC curve for grading TST-positive results for assessing cervical spine dysfunction was 0.689(95％CI 0.553-0.824),with a sensitivity of 0.579 and a specificity of 0.752.de-gree was 0.75.Conclusion The TST can be used as an objective,simple,and feasible screening test for evaluating cervical spinal cord injuries.Patients easily follow the steps of the test and it can be used to assess the patient's trunk balance and dis-ease severity.Patients with a positive TST may have degenerative cervical myelopathy.
关键词
退行性脊髓型颈椎病/脚趾站立试验/锥体束征/颈椎功能障碍Key words
Degenerative cervical myelopathy/Test of standing on toes/Pyramidal sign/Cervical spine dysfunction引用本文复制引用
基金项目
江苏省卫生健康委员会科研课题(H2019023)
江苏省中医药科技发展技术项目(MS2022068)
徐州市医学科技创新项目(XWKYHT20220122)
徐州市临床医学专家团队及医学领军人才计划(2019TD002)
徐州市临床技术骨干研修计划项目(2019GG007)
徐州市科技局重点研发计划(社会发展)医药卫生面上项目(KC23177)
出版年
2024
NETL
NSTL
万方数据