下肢节段性神经根刺激H反射在腰骶神经根病诊断中的意义  

Diagnostic Use of Segmental H-reflex to Spinal Nerve Root Stimulation in Lumbosacral Radiculopathy

作　　者：傅鸿翔[1] 吴萍嘉[2] 邵福源[2] 朱愈 

机构地区：[1]杭州海军疗养院,310002 [2]上海长征医院神经科 [3]美国加州大学欧文医学院神经科

出　　处：《中华物理医学杂志》1997年第1期16-19,共4页Chinese Journal of Physical Medicine and Rehabilitation

摘　　要：目的:探讨节段性神经根刺激H反射(NRSH)在腰骶神经根病诊断中的意义。方法:采用高压短脉冲电刺激直接刺激腰骶神经根,在比目鱼肌及半腱肌记录H反射,共检测正常人60例,S_1及L_5神经根病患者各30例。结果:①NRSH诊断腰骶神经根病的阳性率:比目鱼肌NRSH在S_1神经根病为100%,半腱肌NRSH在L_5神经根病为96.7%。②NRSH各指标中,据H-M间期两侧差,比目鱼肌NRSH在S_1神经根病诊断中的阳性率为100%,半腱肌NRSH在L_5神经根病中的阳性率为93.3%。据H-M间期分别为80%及73.3%。③单侧单节段腰骶神经根病,半腱肌NRSH仅在L_5神经根病出现异常,而在S_1神经根病无显著性改变。结论:NRSH解决了周围神经的"稀释"效应,大大提高了诊断的敏感性,明显优于常规H反射。H-M间期及其两侧差是NRSH诊断腰骶神经根病的理想指标。证实半腱肌NRSH对L_5神经根病具有很好的特异性。Objective: This study attempted to prove the significance of segmental H-reflex to spinal nerve root stimulation (NRSH) in diagnosis of lumbosacral radiculopathy. Methods: Percutaneous high voltage electrical stimulation over the lumbosacral root was used. The H-reflex was recorded from soleus (S_1) and semitendinosus muscle (L_5). 60 normal subjects and 30 cases of S_1 and 30 cases of L_5 radiculopathies were examined. Results: ①The positive rate of solues NRSH was 100% in S_1 radiculopathy and of semitendinosus was 96.7% in L_5 radiculopathy. ②The H-M interval and it's side-to-side difference was the most sensitive indicator in diagnosis of radiculopathy. ③In single side and single segmental radiculopathies, semitendinosus NRSH was changed significantly in L_5 radiculopathy, but there was no significant change in S_1 radiculopathy. Conclusion: NRSH minimized 'dilution' effects and the sensitivity of diagnosis in radiculopathy was improved significantly. The H-M interval and it's side-to-side difference was the best indicator of radiculopathy. There was high specificity in semitendinosus (L_5) NRSH.

关 键 词：多神经根炎 诊断 腰骶部 电刺激 

分 类 号：R681.570.4[医药卫生—骨科学] R745.43[医药卫生—外科学]