National Spinal Injuries Unit, Department of Trauma and Orthopaedic Surgery, Mater Misericordiae Univeristy Hospital, Eccles Street, Dublin 7, Ireland.
Spine (Phila Pa 1976). 2010 Apr 20;35(9):955-7. doi: 10.1097/BRS.0b013e3181bccf0f.
A prospective study was undertaken over a 6-month period to determine the incidence of the inverted supinator reflex in asymptomatic, neurologically normal individuals.
The objective of our study is to assess asymptomatic patients for the presence of the inverted radial reflex and to determine its clinical relevance.
The inverted radial reflex sign is commonly used in clinical practice to assess cervical myelopathy. It is unknown whether the sign correlates with the presence or severity of myelopathy, and no consensus exists regarding the significance of a positive sign in asymptomatic individuals.
Patients attending the Trauma Clinic at our institution were invited to participate. Each patient was examined neurologically and specifically for the presence or absence of the Babinski test, Hoffman's sign, the finger escape sign, static and dynamic Romberg's test, and the inverted supinator reflex. Patients were excluded if they had any history of neck pain, any history of neurosurgical procedure or spinal surgery, any known neurologic disorder or deficit, or if there was any outstanding medicolegal case.
We examined 277 patients in 6-month period. The male to female ratio was 1.1:1. The mean age was 27 years (range, 16-78). The incidence of the inverted supinator reflex was 27.6% (75/271). Of the 75 positive patients, the inverted supinator reflex was present bilaterally in 39% (29/75). Nine of 75 patients (10%) had an associated positive Hoffman's sign but had no other signs suggestive of myelopathy. The proportion of patients with a positive inverted supinator reflex reduced with increasing age (Pearson correlation coefficient > 0.80).
This study demonstrates that an isolated, inverted supinator reflex may be a variation of normal clinical examination. We believe that an isolated inverted supinator reflex, in the absence of other clinical findings, is not a reliable sign of cervical myelopathy; however, it must be interpreted with caution in the older patient.
本前瞻性研究历时 6 个月，旨在确定无症状、神经功能正常个体中反旋前肌反射的发生率。
我们的研究目的是评估无症状患者是否存在反桡反射，并确定其临床相关性。
反桡反射征在临床实践中常用于评估颈脊髓病。目前尚不清楚该征象与脊髓病的存在或严重程度是否相关，并且对于无症状个体中阳性征象的意义尚无共识。
邀请我院创伤诊所的患者参与研究。每位患者均接受神经学检查，具体检查包括巴宾斯基征、霍夫曼征、指逃征、静态和动态罗姆伯格试验以及反旋前肌反射的存在情况。如果患者有颈部疼痛史、神经外科手术或脊柱手术史、已知的神经障碍或缺陷史，或存在未决的医疗法律案件，则将其排除在外。
在 6 个月的时间内，我们共检查了 277 例患者。男女比例为 1.1:1。平均年龄为 27 岁（范围 16-78 岁）。反旋前肌反射的发生率为 27.6%（75/271）。在 75 例阳性患者中，反旋前肌反射双侧阳性占 39%（29/75）。75 例患者中有 9 例（10%）存在阳性霍夫曼征，但无其他提示脊髓病的体征。阳性反旋前肌反射的患者比例随年龄的增加而降低（皮尔逊相关系数>0.80）。
本研究表明，孤立性反旋前肌反射可能是正常临床检查的一种变异。我们认为，孤立性反旋前肌反射在无其他临床发现的情况下，不是颈脊髓病的可靠征象；然而，在老年患者中必须谨慎解读。
