Tejus M N, Singh Vikram, Ramesh Ananthakrishnan, Kumar V R Roopesh, Maurya Ved Prakash, Madhugiri Venkatesh S
Department of Neurosurgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry 605006, India.
Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore 560029, India.
Clin Neurol Neurosurg. 2015 Jul;134:12-6. doi: 10.1016/j.clineuro.2015.04.009. Epub 2015 Apr 11.
This study aimed at determining the frequency of abnormal finger flexion, Hoffman's and extensor plantar (Babinski) response in healthy adults and to determine the sensitivity and specificity of these tests as markers of spinal cord compression in symptomatic patients.
Patients attending the neurosurgery clinic with neck related complaints formed the case group. The control group consisted of consenting patient attenders and volunteers drawn from the students and faculty of our institute. All subjects underwent examination of the finger flexion, Hoffman's and plantar reflexes and an MRI as per standard protocol. The frequency of the reflexes in the control group, sensitivity and specificity of the reflexes to detect cord compression in the case group were computed.
The frequency of the reflexes in healthy controls were finger flexion - 1%, Hoffman's - 0.3% and Babinski sign - 0%. None of the controls with positive reflexes had any abnormality on MR imaging. A combination of the three reflexes had a sensitivity of 91.7%, specificity of 87.5%, PPV of 95.7% and NPV of 77.8% in detecting spinal cord compression.
A combination of finger flexion, Hoffman's and plantar reflexes could be used effectively as a marker of spinal cord compression in symptomatic individuals. They cannot, however, be depended on as screening tests in asymptomatic individuals.
本研究旨在确定健康成年人中异常手指屈曲、霍夫曼征及跖伸（巴宾斯基）反应的出现频率，并确定这些检查作为有症状患者脊髓受压标志物的敏感性和特异性。
以因颈部相关症状就诊于神经外科门诊的患者作为病例组。对照组由同意参与的就诊患者以及从我院学生和教职员工中招募的志愿者组成。所有受试者均按照标准方案接受手指屈曲、霍夫曼征及跖反射检查以及磁共振成像（MRI）检查。计算对照组中这些反射的出现频率，以及病例组中这些反射检测脊髓受压的敏感性和特异性。
健康对照组中各反射的出现频率为：手指屈曲 - 1%，霍夫曼征 - 0.3%，巴宾斯基征 - 0%。反射阳性的对照组在磁共振成像上均无任何异常。在检测脊髓受压方面，这三种反射联合使用时，敏感性为91.7%，特异性为87.5%，阳性预测值为95.7%，阴性预测值为77.8%。
手指屈曲、霍夫曼征及跖反射联合使用可有效作为有症状个体脊髓受压的标志物。然而，它们不能作为无症状个体的筛查检查。
