体外冲击波治疗大鼠肌筋膜疼痛及其机制初探  

A PRELIMINARY STUDY ON THE TREATMENT EFFECT AND MECHANISM OF EXTRACORPOREAL SHOCK WAVE ON THE RATS WITH MYOFASCIAL PAIN

作　　者：沃春新 徐正涛[2] 秦乐 于子龙 张忠杰 陆巍 姚旌 王林 WO Chun-Xin;XU Zheng-Tao;QIN Yue;YU Zi-Long;ZHANG Zhong-Jie;LU Wei;YAO Jing;WANG Lin(Affiliated Hospital of Guizhou Medical University,Pain Department,Guiyang 550001,China;Department of Anesthesiology,Guizhou Medical University,Guiyang 550001,China)

机构地区：[1]贵州医科大学附属医院疼痛科,贵阳550001 [2]贵州医科大学麻醉系,贵阳550001

出　　处：《中国疼痛医学杂志》2018年第8期586-592,共7页Chinese Journal of Pain Medicine

基　　金：筑科合同(20151001)社22号;黔科合SY字(2015)3043

摘　　要：目的:观察体外冲击波治疗对肌筋膜疼痛综合征(myofascial pain syndrome,MPS)大鼠脊髓水平神经递质的影响。方法:24只健康SD大鼠随机分为3组(n=8):正常组(C组),模型组(M组),冲击波组(S组)。C组大鼠不行任何刺激,M组和S组大鼠采用打击右股内侧肌结合运动疲劳建立慢性MPS模型。S组大鼠MPS模型复制成功后,行右股内侧肌冲击波治疗,每5天一次,共治疗3次。疗程结束2周后测定热痛阈值和右股内侧肌自发电活动。麻醉后处死大鼠,取右股内侧肌及脊髓L4-6节段,HE染色切片观察局部肌肉形态学变化,免疫组化法检测脊髓神经元型一氧化氮合酶(n NOS)、P物质(SP)、β内啡肽(β-EP)及5-羟色胺(5-HT)。结果:(1)肌电图:T1实验第12周,即模型复制完成时,T2:实验第16周,即S组治疗后第3周,T1时,C组的自发放电频率显著低于M组和S组(P<0.01),而S组的自发放电频率与M组相比无显著差异;T2时,与M组相比较,S组的自发放电频率显著降低(P<0.01);(2)热痛阈:T1时M组和S组热痛阈时间较C组显著缩短(P<0.01),M组和S组比较无统计学意义。T2时S组热痛阈时间延长,且显著高于M组(P<0.01);(3)脊髓组织n NOS表达:与C组比较,M组n NOS升高,差异有统计学意义(P<0.05),S组较M组明显下降(P<0.05);(4)脊髓组织SP表达:M组较C组SP显著升高(P<0.05),S组显著低于C组(P<0.05);(5)脊髓组织5-HT表达:三组大鼠脊髓5-HT阳性表达无差异;(6)脊髓组织β-EP表达:三组大鼠脊髓β-EP的表达无差异;(7)病理形态学改变:C组大鼠肌肉切片显示肌纤维紧密并规律,细胞核多分散于肌纤维膜下且规则。M组肌纤维呈现粗细不同、排列紊乱及粘连、炎性细胞浸润现象。S组肌纤维形态接近正常,有少量不同程度的肌纤维轻微萎缩及变性。结论:体外冲击波可以通过降低病变肌筋膜自发电活动、提高痛阈值以及促进损伤肌筋膜的修复发挥治疗作用,其机制可能与降低脊髓n NOS及SP水�Objective:To observe the effect of extracorporeal shock wave therapy on spinal cord level neurotransmitters in rats with myofascial pain syndrome(MPS)rats.Methods:24 healthy SD rats were randomly divided into three groups(n=8):normal group(C),model group(M),and shock wave group(S).Rats in group C were not stimulated.Group M and group S established chronic MPS models by striking right femoral medial muscles combined with exercise fatigue.After successful replication of MPS model in group S,right femur medial muscle shock wave treatment was performed every 5 days,3 times a total.After 3 weeks of treatment,heat pain threshold and spontaneous electromyographic activity of right femoral medial muscles were measured.After anesthesia,the rats were killed and the right femoral medial muscle and spinal cord(L4-6 segment)of the rats were taken.The morphological changes of local muscles were observed by HE staining.Immunohistochemical method was used to detect the spinal neuronal nitric oxide synthase(nNOS),substance P(SP),beta endorphin(β-EP)and 5-hydroxytryptamine(5-HT).Results:(1)Electromyography:At T1,the frequency of spontaneous electromyographic activity in group C was significantly lower than these in group M and group S(P<0.01),and there was no statistical difference between group M and S;At T2,the spontaneous electromyography activities were still frequent in group M and the frequency of group S was significantly lower than that of group M(P<0.01);(2)Thermal pain threshold:At T1,the thermal pain thresholds of group M and S were significantly shorter than that of group C(P<0.01),and there was no significant difference between group M and S.At T2,the thermal pain threshold of group S was prolonged and significantly longer than that of group M(P<0.01);(3)nNOS expression in spinal cord:compared with group C,nNOS in group M was significantly increased(P<0.05).The nNOS in group S was significantly lower than that in group M(P<0.05);(4)SP in spinal cord tissue:the expression of SP in group M was significantly higher than

关 键 词：肌筋膜疼痛综合征 体外冲击波 神经递质 疼痛 

分 类 号：R686.3[医药卫生—骨科学]