McGill University Health Centre, Montreal General Hospital Site, Montréal, Québec, Canada.
Spine (Phila Pa 1976). 2018 Dec 1;43(23):1664-1669. doi: 10.1097/BRS.0000000000002697.
Systematic review.
To determine the validity of the Hoffmann sign for the detection of degenerative cervical myelopathy (DCM) for patients presenting with cervical complaints.
While physical examination maneuvers are often used to diagnose DCM, no previous review has synthesized diagnostic accuracy data.
Medline, Embase, and HealthStar were searched for articles from January 1, 1947 to March 1, 2017 using the following terms: Spinal Cord Diseases, Spinal Cord Compression, Cervical Vertebrae, Signs and Symptoms, Physical Examination, Epidemiologic studies, Epidemiologic Research Design, Predictive Value of Tests, and Myelopathy. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS) checklist was applied to determine the level of evidence. Articles included were published in English or French language, rated as QUADAS level 3 or higher with a minimum 10 patients presenting with cervical complaints having undergone the Hoffman sign. Excluded studies recruited patients with a nondegenerative type of cervical myelopathy, and/or no evaluation with magnetic resonance imaging.
A total of 589 articles were selected for review. Following the application of inclusion and exclusion criteria, 45 articles were analyzed using the QUADAS checklist. Only of three articles were of QUADAS quality 3 or higher. Analysis of combined data from 2/3 studies indicated that the Hoffman sign has a positive likelihood ratio of 2.2 (95% CI 1.5-3.3) and a negative likelihood ratio of 0.63 (95% CI 0.5-0.8).
A positive Hoffman alone is unlikely to lead to more than a small change in estimated probability of DCM as compared with the gold standard test (magnetic resonance imaging). Variability in results across individual studies may result from differences in study design. There are insufficient data to support use of the Hoffman sign alone to confirm or refute a diagnosis of DCM.
系统评价。
确定 Hoffmann 征在检测因颈椎症状就诊的退行性颈椎病（DCM）患者中的有效性。
虽然体格检查操作常用于诊断 DCM，但之前没有综述综合诊断准确性数据。
使用以下术语从 1947 年 1 月 1 日至 2017 年 3 月 1 日，在 Medline、Embase 和 HealthStar 中搜索文章：脊髓疾病、脊髓压迫、颈椎、体征和症状、体格检查、流行病学研究、流行病学研究设计、测试预测值和脊髓病。应用质量评估诊断准确性研究（QUADAS）清单来确定证据水平。纳入的文章为英文或法文发表，QUADAS 评分为 3 级或更高，且至少有 10 例因颈椎症状就诊的患者接受了 Hoffmann 征检查。排除的研究招募了非退行性颈椎病的患者，且/或没有进行磁共振成像检查。
共选择了 589 篇文章进行综述。在应用纳入和排除标准后，有 45 篇文章使用 QUADAS 清单进行了分析。只有 3 篇文章的质量为 QUADAS 3 级或更高。对 2/3 研究的合并数据进行分析表明，Hoffmann 征的阳性似然比为 2.2（95%CI 1.5-3.3），阴性似然比为 0.63（95%CI 0.5-0.8）。
与金标准测试（磁共振成像）相比，单凭 Hoffmann 征阳性不太可能导致对 DCM 的估计概率发生较大变化。个别研究之间的结果差异可能源于研究设计的差异。目前尚无足够的数据支持单独使用 Hoffmann 征来确诊或排除 DCM。
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