目的 采用受试者工作特征曲线分析评价体格检查在腰椎间盘突出症诊断中的价值。方法 回顾性分析2017年5月15日至19日在脊柱外科门诊收治的因腰腿疼痛症状拟诊断腰椎间盘突出症的患者129例,男80例,女49例,年龄21~68岁,平均48.1岁,按照诊断标准（或者金标准）根据病史+体征（体格检查）+影像学检查（MRI、X线、CT等）+或者特殊检查（如肌电图）进行或者排除目标诊断;其中专科体格检查采用评分表评价检查结果,影像学检查（MRI、X线、CT等）结果评价采用最常用的五等级法判断,用受试者工作特征曲线分析评价体格检查结果与影像学检查结果在腰椎间盘突出症诊断中的价值。结果 129例患者均按照诊断标准要求完成相关检查及诊断过程,符合腰椎间盘突出症诊断标准的患者80例,体格检查评分的曲线下面积为0.793, P=0.000,Youden指数0.48,体格检查评分≥38为最佳临界点,对应的灵敏度87.5%、特异度40.4%。影像学检查结果的曲线下面积为0.672, P=0.002,Youden指数0.308,评分≥3.5为最佳临界点,对应的灵敏度60.0%、特异度29.2%。体格检查评分和影像学检查结果的曲线下面积与0.5相比较差异均有统计学意义。结论 在腰椎间盘突出症的诊断中体格检查与影像学检查比较有更高的灵敏度和特异度,有较高的诊断价值,门诊应根据体格检查结果合理选择MRI等影像学检查项目。

Objective To evaluate the value of physical examination in the diagnosis of lumbar disc herniation by receiver operating characteristic （ROC） curve analysis．Methods Retrospectively analyzed 129 cases of low back pain patients intended to diagnosis with lumbar disc herniation in Spine Surgery Clinic from May 15 to 19, 2017. Eligible patients including 80 males and 49 females, aged from 21 to 68 years old, average 48.1. According to the diagnostic criteria （or gold standard） and based on the medical history + signs （physical examination） + imaging tests （MRI, X-ray, CT, etc.） + or special inspection （electromyography） to include or exclude target diagnosis; A score sheet was used to assess the specialist physical examination, a five-levels method was used to evaluate imaging tests （MRI, X-ray, CT, etc.） results, the value of physical examination and imaging tests in the diagnosis of lumbar disc herniation was evaluated by ROC curve analysis.Results All of the 129 patients completed the relevant tests and diagnosis process according to the diagnostic criteria. 80 patients were diagnosed with lumbar intervertebral disc herniation. The area under the ROC curve of physical examination was 0.793, P=0.000, and the Youden index was 0.48, and the score of physical examination ≥38 was the optimal cutoff, with the corresponding sensitivity of 87.5% and specificity of 40.4%. The area under the ROC curve of imaging results was 0.672, P=0.002, and the Youden index was 0.308, and a score ≥3.5 was the optimal cutoff, with the corresponding sensitivity of 60.0% and specificity of 29.2%. The area under the ROC curve of physical examination and the imaging results were statistically significant compared with 0.5.Conclusions In the diagnosis of lumbar disc herniation, physical examination has higher sensitivity and specificity compare to imaging results, with high diagnostic value. MRI and other imaging tests in outpatient service should be reasonable choosed according to the results of the physical examination.