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神经动力或矫形张力测试在腰椎和腰骶神经根病诊断中的应用：诊断有效性研究。

Use of Neurodynamic or Orthopedic Tension Tests for the Diagnosis of Lumbar and Lumbosacral Radiculopathies: Study of the Diagnostic Validity.

机构信息

Andalusian Health Service, Hospital "Puerta Universitario del Mar", Av. Ana de Viya, 21, 11009 Cádiz, Spain.

Nursing and Physiotherapy Department, Cadiz University, Av. Ana de Viya, 52, 11009 Cadiz, Spain.

出版信息

Int J Environ Res Public Health. 2020 Sep 26;17(19):7046. doi: 10.3390/ijerph17197046.

DOI:10.3390/ijerph17197046
PMID:32993094
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7579046/
Abstract

BACKGROUND

Lumbar radiculopathy is a nerve root disorder whose correct diagnosis is essential. The objective of the present study was to analyze the reliability diagnostic validity of eight neurodynamic and/or orthopedic tension tests using magnetic resonance imaging as the Gold Standard.

METHODS

An epidemiological study of randomized consecutive cases which was observational, descriptive, transversal, double blinded and was conducted following the Standards for Reporting Diagnostic accuracy studies (STARD) declaration. The sample size was 864 participants. Internal and external validity (CI = 95%) and reliability, were calculated for all tests performed independently. The diagnostic validity of the combined and multiple tests in parallel was also calculated.

RESULTS

The analysis indicated that only two tests performed independently had external validity, but neither had reliability or precision. The Straight Leg Raise test and the Bragard test performed in a multiple parallel way showed high sensitivity (97,40%), high negative predictive value (PV- 96,64%) and external validity (Likelihood Ratio- 0,05). The combined test of the Slump test and the Dejerine's triad had internal and external validity.

CONCLUSIONS

The Straight Leg Raise test and the Bragard test performed in a multiple parallel way and the combined test of the Slump Test and the Dejerine's triad have clinical validity to discard lumbar or lumbar-sacral radiculopathy.

摘要

背景

腰椎神经根病是一种神经根紊乱疾病，正确的诊断至关重要。本研究的目的是分析八种神经动力和/或骨科张力测试的可靠性诊断有效性，以磁共振成像作为金标准。

方法

这是一项观察性、描述性、横断面、双盲的随机连续病例的流行病学研究，遵循诊断准确性研究报告标准（STARD）声明进行。样本量为 864 名参与者。对所有独立进行的测试计算内部和外部有效性（置信区间为 95%）和可靠性。还计算了联合和多个测试并行的诊断有效性。

结果

分析表明，只有两项独立进行的测试具有外部有效性，但均不具有可靠性或精确性。直腿抬高试验和 Bragard 试验以多种平行方式进行时，具有较高的灵敏度（97.40%）、高阴性预测值（PV-96.64%）和外部有效性（似然比-0.05）。Slump 试验和 Dejerine 三联征的联合试验具有内部和外部有效性。

结论

直腿抬高试验和 Bragard 试验以多种平行方式进行，以及 Slump 试验和 Dejerine 三联征的联合试验具有临床有效性，可以排除腰椎或腰骶神经根病。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/110f/7579046/268b8b726ec9/ijerph-17-07046-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/110f/7579046/268b8b726ec9/ijerph-17-07046-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/110f/7579046/268b8b726ec9/ijerph-17-07046-g001.jpg

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