H反射在腰腿痛患者中的应用

The application of Hoffmann's reflex latency on the patients with lumbar-leg pain

目的 :探讨H反射在腰腿痛患者中的应用价值。方法 :对象为腰腿痛患者 113例 ,女性 38例 ,男性 75例 ;年龄18— 6 2岁 ;病程 2周— 2 0年。嘱患者安静放松。室温 2 6— 2 8℃。针电极记录。记录电极插入腓肠肌内侧头或外侧头肌腹 ,表面电极刺激部胫神经 ,逐渐增加电流刺激强度 ,直至引出最大波幅H波至M波开始出现为止 ,并且进行双下肢自身对照。结果 :健侧 /患侧H反射潜伏期平均值分别为 :腓肠肌内侧头 2 8.75ms/30 .41ms;外侧头 2 8.6 5ms/30 .0 9ms。两侧之间的差异有显著性 ,同侧之间均无差异。健肢H反射与年龄、身高、性别均呈正相关 ,同侧H反射潜伏期之间高度相关。回归方程分别为 :H反射 (内侧头 ) =4.98+0 .0 4年龄 (岁 ) +0 .13身高 (cm) ;H反射(外侧头 ) =6 .78+0 .0 6年龄 +0 .11身高 (cm)。H反射潜伏期的异常与下肢痛、直腿抬高、跟腱反射相关 ,与腰痛、椎旁压痛关系不大。结论 :H反射潜伏期与年龄、身高和性别相关。运用所得方程 ,临床医生可通过患者的年龄和所测身高来预测H反射潜伏期正常值。H反射潜伏期可用于判断腰腿痛患者腰骶神经损害的部位及程度。

Objective:To investigate the value of application about H reflex latency on the patients with lumbar-leg pain.Method:113 patients with lumbar-leg pain 38 females, 75 males; the age was from 18 to 62 years. Needle electrode was applied to record the H reflex latency from the inside gastrocnemius muscle or outside. Surface electrode stimulated tibial nerve at the popliteus. The electric amount of stimulation switched from zero up to the biggest wave of H reflex latency, and then endded at the appearance of M wave. Two tibial nerve H reflex latency were recoded.Result: (1). The mean H reflex latency from healthy / pain legs was 28.75 ms/30.41 ms; 28.65 ms/30.09 ms for inside and outside tricep surface, respectively. There was a singnificant difference in two legs about H relex latency and no difference between inside and outside of one leg. (2) There was a significant correlation of tibial H reflex latency in the healthy leg to age, body, and sex . The regression formula for inside and outside, respectively, is: H (cm)=4.98 + 0.04 age (year) +0.13 body-high (cm); H (cm)=6.78 + 0.06 age (year) + 0.11 body-high (year).(3)There was a correlation of abnomal H reflex latency to lower limb pain, straight leg up and tendo calcaneus reflex and correlation to lumbago and compress pain at lumbar. Conclusion: There was a significant correlation of tibial H reflex latency in the healthy leg to age, body, and sex . The regression formulas can be used by the clinician to predict a normal mean H reflex latency according to an individual′s age, body high. According to the unobtainable or prolonged H reflex, clinician can assess the damage part and its dimension.