肩胛部深层肌筋膜痛的诊治及解剖学基础  

The diagnosis treatment and the anatomy of the myofacial pain of deep layer of scapular region

作　　者：王华军[1] 叶永亮[1] 童飞飞[1] 李义凯[1] 

机构地区：[1]南方医科大学中医药学院骨伤推拿教研室,广州510515

出　　处：《颈腰痛杂志》2007年第6期459-462,共4页The Journal of Cervicodynia and Lumbodynia

摘　　要：目的为肩胛部深层肌筋膜痛的诊断和治疗提供临床及解剖学依据。方法对30例肩胛部深层肌筋膜痛患者给予扳机点注射治疗并随访。解剖观察12具成人尸体肩胛部冈下肌、小圆肌和大圆肌的位置、走行、长度和厚度。结果肩胛部深层肌筋膜痛患者常见压痛部位为冈下窝中央及肩胛骨腋缘。扳机点注射治疗前VAS评分为7.631±2.652,治疗1周后评分为3.248±1.482,两组比较有显著性差异(P<0.001);随访一月后VAS评分为2.829±1.852,与治疗1周后比较无显著性差异(P>0.05)。冈下肌位于冈下窝内,小圆肌附着于肩胛骨腋缘距肩胛骨下角5.8～7.0cm处,大圆肌附着于肩胛骨腋缘距肩胛骨下角4.0～6.5cm处。结论冈下窝中央压痛由冈下肌筋膜痛引起;肩胛骨腋缘中段压痛由小圆肌筋膜痛引起;肩胛骨腋缘下段压痛由大圆肌筋膜痛引起。肌筋膜扳机点注射是其有效的治疗方法。Objective To provide the anatomy basis and clinical evidence for the diagnosis and treatment of the myofacial pain of deep layer of scapular region. Methods The trigger point injection and follow-up were given to 30 patients with the myofacial pain of deep layer of scapular region. The position,course,length and thickness of infraspinatus,teres minor and teres major were observed on scapular region of 12 adult cadavers. Results Common tenderness points of scapular region were located in the centre of infraspinous fossa and margo lateralis of scapula. The score by VAS was 7.631±2.652 before the trigger point injection,and 3.248±1.482 one week after the treatment,the difference was significant between them（P〈0.001）. However,the score was 2.829±1.852one month after the treatment,which was not significantly different from one week after that treatment （P〉0.05）. The centre of infraspinous fossa was infraspinatus. The distance from the origin of teres minor on the margo lateralis of scapula to inferior angle of scapula was 5.8-7.0cm and it was 4.0-6.5cm for teres major. Conclusion The tenderness of deep layer of scapular region is often caused respectively by myofacial pain of infraspinatus ,teres minor and teres major. The trigger point injection could be one of the efficient methods to treat the myofacial pain.

关 键 词：冈下肌 小圆肌 大圆肌 肌筋膜痛 扳机点注射 

分 类 号：R686.3[医药卫生—骨科学]