临床检查锥体束征的一致性研究

目的评价锥体束征对锥体系统受损判断的价值,研究锥体束征在不同测评者间的一致性。方法选择45例锥体束受累的脑梗死或脊髓病变患者作为研究对象,检查Babinski征、Chaddock征、Oppenheim征、Gordon征和双划征。4名参加测评者为不了解患者病情的医师,对同一患者的检查均在同一天完成。选择肌力好转的脑梗死患者复查。通过Kappa检验评价锥体束征在不同医师间的一致性并比较各种病理征的阳性率。采用Kappa检验,Kappa值为1表示几乎完全一致,为0表示几乎没有一致性,低于0.4表示一致性较差,大于0.75表示一致性良好。结果 Babinski征在不同测评者间的一致性为最高,kappa值为0.7756,其次为双划征(0.7544)。在受累范围大的完全性和部分性前循环梗死患者,各种病理征的Kappa值均高于腔隙性脑梗死患者。肌力≤4级的患者中各种病理征的Kappa值均高于肌力>4级的患者。脑梗死患者的Kappa值高于全部患者的Kappa值。Babinski征和双划征的阳性率最高。结论各种病理征在不同检查者间具有中度到较好的一致性,Babinski征和双划征是最可靠的病理征。病变范围、肌力和疾病类型对检查者间的一致性存在影响。

Clinical research on the agreement of pyramidal tract signs

Objective To evaluate the value of pyramidal signs to the damage of pyramidal system and to compare inter - observer agreement. Methods A total of 45 patients who had cerebral infarction or spinal cord lesions with pyramidal tract involvement were selected and examined for Babinski＇s sign, Gordon＇s sign, Chaddock＇s sign, Oppenheim＇s sign and double - stroke sign. Four physicians participating in the test knew nothing about the patients＇condition. All examinations for one patient were completed in the same day. Patients with cerebral infarction who had their muscle strength improved were se- lected for a review. Inter - observer agreement was analyzed with kappa test and the positive rates of pathological signs were compared. The Kappa value of 1 indicated it was almost identical, 0 indicated that it was of little agreement, below 0.4 poor agreement, greater than 0.75 well agreement. Results Babinski ＂s sign had the highest inter - observer agreement with a kappa value of 0.7756, followed by double -stroke syndrome （0.7544）. Kappa values of various pathological signs were higher in patients with total and partial anterior circulation infarction than in patients with lacunar cerebral infarction. Kappa values of various pathological signs in patients with muscle strength less than or equal to grade 4 were higher than those with muscle strength greater than grade 4. Kappa values in patients with cerebral infarction were above those in all pa- tients. The highest positive rate occurred in Babinski~ sign and double - stroke sign. Conclusions Various pathological signs show a moderate to well agreement among different examiners. Babinski＇s sign and double -stroke sign are the most reliable signs of pathology. The extent of lesions, muscle strength and the type of disease have an impact on the agreement among the examiners.