Cramer G D, Humphreys C R, Hondras M A, McGregor M, Triano J J
Department of Anatomy, National College of Chiropractic, Lombard, IL 60148-4583.
J Manipulative Physiol Ther. 1993 Jan;16(1):7-13.
To evaluate the use of the Hmax/Mmax (H/M) ratio as an outcome measure for acute low back pain and to determine the change of this ratio in acute low back pain patients treated with spinal manipulation.
Randomized clinical trial.
Chiropractic college teaching clinic.
Thirty-six patients with acute low back pain (pain of less than 2 wk duration) were referred by clinicians of the teaching clinic. Eligibility criteria for inclusion into the study consisted of the following: a score of eight or more on the Oswestry questionnaire, 33 mm or greater on a 100-mm visual analog scale, no involvement in litigation related to the low back pain complaint, patient not pregnant and no physical or electrodiagnostic signs of nerve root entrapment.
The patients were randomly assigned to either a treatment or control group. The treatment group (n = 17) received treatment deemed appropriate by the clinician as long as it included a side-lying manipulation to the appropriate level. The control group (n = 19) received detuned ultrasound, application of a cold pack and 15-30 sec of very gentle soft tissue massage. Patients were treated three to five times over a period of 10 days and were subsequently reevaluated.
The Hmax/Mmax ratio was calculated from the results of electrodiagnostic testing of the posterior tibial nerve. Extension/flexion ratio of the trunk musculature, Oswestry score and Visual Analog Scale score were also measured.
The mean difference between H/M ratios pre- and postintervention for the group treated by chiropractic methods was -0.101 on the left and -0.117 on the right. The mean difference for the control group was 0.038 on the left and 0.036 on the right. Although not statistically significant, trends suggest that at the time of final assessment, the group receiving chiropractic care had improved more than the control group.
The H/M ratio was found to be within normal limits in subjects with acute low back pain. The H/M ratio showed greater change in the group which received spinal manipulation, but the change was subtle. The results indicate that the H/M ratio may be of limited value in clinical practice.
评估Hmax/Mmax（H/M）比值作为急性下腰痛疗效指标的应用，并确定接受脊柱推拿治疗的急性下腰痛患者该比值的变化。
随机临床试验。
脊椎按摩疗法学院教学诊所。
教学诊所的临床医生转诊了36例急性下腰痛患者（疼痛持续时间少于2周）。纳入本研究的合格标准包括以下内容：奥斯威斯利问卷得分8分或更高，100毫米视觉模拟量表上得分为33毫米或更高，未参与与下腰痛投诉相关的诉讼，患者未怀孕且无神经根受压的体格检查或电诊断体征。
患者被随机分为治疗组或对照组。治疗组（n = 17）接受临床医生认为合适的治疗，只要其中包括对相应节段的侧卧推拿。对照组（n = 19）接受失谐超声、冷敷袋应用以及15 - 30秒非常轻柔的软组织按摩。患者在10天内接受3至5次治疗，随后进行重新评估。
根据胫后神经电诊断测试结果计算Hmax/Mmax比值。还测量了躯干肌肉的伸展/屈曲比值、奥斯威斯利评分和视觉模拟量表评分。
接受脊椎按摩疗法治疗的组干预前后H/M比值的平均差异在左侧为 -0.101，右侧为 -0.117。对照组的平均差异在左侧为0.038，右侧为0.036。尽管无统计学意义，但趋势表明在最终评估时，接受脊椎按摩治疗的组比对照组改善得更多。
发现急性下腰痛患者的H/M比值在正常范围内。接受脊柱推拿的组中H/M比值变化更大，但变化不明显。结果表明H/M比值在临床实践中的价值可能有限。
