Findlay Gordon F G, Balain Birender, Trivedi Jayesh M, Jaffray David C
Walton Centre for Neurology and Neurosurgery NHS Trust, Lower Lane, Fazakerley, Liverpool, UK.
Eur Spine J. 2009 Oct;18(10):1528-31. doi: 10.1007/s00586-009-1008-7. Epub 2009 Apr 22.
The Romberg sign helps demonstrate loss of postural control as a result of severely compromised proprioception. There is still no standard approach to applying the Romberg test in clinical neurology and the criteria for and interpretation of an abnormal result continue to be debated. The value of this sign and its adaptation when walking was evaluated. Detailed clinical examination of 50 consecutive patients of cervical myelopathy was performed prospectively. For the walking Romberg sign, patients were asked to walk 5 m with their eyes open. This was repeated with their eyes closed. Swaying, feeling of instability or inability to complete the walk with eyes closed was interpreted as a positive walking Romberg sign. This test was compared to common clinical signs to evaluate its relevance. Whilst the Hoffman's reflex (79%) was the most prevalent sign seen, the walking Romberg sign was actually present in 74.5% of the cases. The traditional Romberg test was positive in 17 cases and 16 of these had the walking Romberg positive as well. Another 21 patients had a positive walking Romberg test. Though not statistically significant, the mean 30 m walking times were slower in patients with traditional Romberg test than in those with positive walking Romberg test and fastest in those with neither of these tests positive. The combination of either Hoffman's reflex and/or walking Romberg was positive in 96% of patients. The walking Romberg sign is more useful than the traditional Romberg test as it shows evidence of a proprioceptive gait deficit in significantly more patients with cervical myelopathy than is found on conventional neurological examination. The combination of Hoffman's reflex and walking Romberg sign has a potential as useful screening tests to detect clinically significant cervical myelopathy.
闭目难立征有助于证明由于本体感觉严重受损而导致的姿势控制丧失。在临床神经学中，应用闭目难立试验尚无标准方法，异常结果的标准及解读仍存在争议。对该体征及其行走时的适应性价值进行了评估。前瞻性地对50例连续的颈椎病患者进行了详细的临床检查。对于行走闭目难立征，要求患者睁眼行走5米，然后闭眼重复此操作。摇摆、不稳定感或闭眼时无法完成行走被解释为行走闭目难立征阳性。将该试验与常见临床体征进行比较以评估其相关性。虽然霍夫曼反射（79%）是最常见的体征，但行走闭目难立征实际上在74.5%的病例中出现。传统闭目难立试验阳性的有17例，其中16例行走闭目难立征也为阳性。另外21例患者行走闭目难立试验阳性。虽然无统计学意义，但传统闭目难立试验阳性的患者平均30米行走时间比行走闭目难立征阳性的患者慢，而两者均为阴性的患者最快。霍夫曼反射和/或行走闭目难立征两者结合阳性的患者占96%。行走闭目难立征比传统闭目难立试验更有用，因为与传统神经学检查相比它在更多的颈椎病患者中显示出本体感觉步态缺陷证据。霍夫曼反射和行走闭目难立征的结合有潜力作为有用的筛查试验来检测临床上有意义的颈椎病。
