vestimИзвестия Национальной академии наук Беларуси. Серия медицинских наукProceedings of the National Academy of Sciences of Belarus, Medical series1814-60232524-2350The Republican Unitary Enterprise Publishing House "Belaruskaya Navuka"10.29235/1814-6023-2024-21-4-316-325vestim-1000Research ArticleКЛИНИЧЕСКАЯ И ЭКСПЕРИМЕНТАЛЬНАЯ МЕДИЦИНАCLINICAL AND EXPERIMENTAL MEDICINEЭлектронейромиографическая характеристика поздних ответов при радикулопатии S1Characteristics of late responses in S1 radiculopathyhttps://orcid.org/0000-0002-0427-0601ХодулевВ. И.KhodulevV. I.

Ходулев Василий Иосифович – д-р мед. наук, заведующий отделением

ул. Скорины, 24, 220114, г. Минск

Vasily I. Khodulev – D. Sc. (Med.), Head of the Depart- ment

24, F. Skoriny, 220114, Minsk

khodulev@tut.byКобылкоО. В.KabylkaA. V.

Кобылко Олег Викторович – врач-невролог

ул. Братьев  Лизюковых, 5, г. Гомель

Aleh V. Kabylka ‒ neurologist

5, Brothers Lizyukov Str., Gomel

kobylko-ol@mail.ruКовалевА. А.KovalevA. A.

Ковалев Алексей Алексеевич ‒ ст. преподаватель

ул. Ланге, 5, 246000, г. Гомель

Aleksey A. Kovalev ‒ Senior Lecturer

5, Lange Str., 246000, Gomel

kovalev.data.analysis.gsmu@yandex.byРеспубликанский научно-практический центр неврологии и нейрохирургииRepublican Research and Clinical Center of Neurology and NeurosurgeryГомельская областная клиническая больницаGomel Regional Clinical HospitalГомельский государственный медицинский университетGomel State Medical University202430112024214316325Copyright © Ходулев В.И., Кобылко О.В., Ковалев А.А., 20242024Ходулев В.И., Кобылко О.В., Ковалев А.А.Khodulev V.I., Kabylka A.V., Kovalev A.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://vestimed.belnauka.by/jour/article/view/1000

Электрофизиологические методы исследования, в частности поздние ответы нервной проводимости, играют важную роль в диагностике ряда нейрогенных расстройств, в том числе при пояснично-крестцовой радикулопатии. К поздним ответам относятся F-волна, Н-рефлекс и А-волна.

Цель данного исследования ‒ установить диагностическую значимость поздних ответов при стимуляции большеберцового нерва у пациентов с изолированной радикулопатией S1 в сопоставлении с клиническими данными.

Всего было обследовано 32 пациента с изолированной радикулопатией S1 (16 женщин, 16 мужчин), средний возраст которых составил 43,5 ± 9,3 года. При электронейромиографическом исследовании большеберцового нерва  на поврежденной стороне выявлено наличие А-волны у 20 пациентов (62,5 %, p < 0,001). Она достоверно чаще сочеталась с тестами на раздражение спинномозгового корешка, а ее локализация перед F-волной являлась отличительной чертой этой патологии. Анализ параметров F-волны показал, что ее длительность была больше (р = 0,001), чем на неповрежденной стороне, а в контрольной группе отмечалось пролонгирование как длительности, так и латентности (р < 0,001). Пациенты с наличием А-волны имели более выраженные изменения длительности и латентности F-волны на поврежденной и неповрежденной сторонах. При анализе Н-рефлекса установлено его отсутствие  у 14 (43,8 %) пациентов и снижение его амплитуды на стороне повреждения у 9 (28,1 %) человек. Отсутствие Н-рефлекса достоверно чаще выявлялось у пациентов с отсутствием ахиллова рефлекса (р < 0,05). Количество  пациентов с наличием А-волны не отличалось от количества пациентов с увеличенной длительностью F-волны  или со снижением амплитуды Н-рефлекса (p > 0,05).

Electrophysiological research methods, in particular late nerve conduction responses, play an important role  n the diagnosis of a number of neurogenic disorders and, in particular in lumbosacral radiculopathy. Late responses include the F-wave, H-reflex, and A-wave.

The purpose of this study was to determine the diagnostic value of late responses to tibial nerve stimulation in patients with isolated S1 radiculopathy in comparison with clinical findings. We examined 32 patients with isolated S1 radiculopathy (16 women, 16 men), their average age was 43.5 ± 9.3 years.

An electroneuromyographic study of the tibial nerve on the injured side revealed the presence of an A-wave in 20 patients (62.5 %, p < 0.001). It was significantly more often combined with tests for spinal root irritation, and its localization before the F-wave was a characteristic feature of this pathology. The analysis of the F-wave parameters showed an increase  in its duration (p = 0.001) compared to the uninjured side, and compared to the control group there was a prolongation of both duration and latency (p < 0.001). Patients with the presence of an A-wave had more pronounced changes in the duration  and latency of the F-wave on the injured and uninjured sides. When analyzing the H-reflex, it was found to be absent  in 14 (43.8 %) and decreased in amplitude in 9 (28.1 %) patients on the injured side. The absence of the H-reflex was significantly more often detected in patients with the absence of the Achilles reflex (p < 0.05). The number of patients with the presence of an A-wave did not differ from that of patients with an increased duration of the F-wave or a decrease in the amplitude of the H-reflex (p > 0.05).

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The authors declare that there are no conflicts of interest present.