超声引导下小针刀治疗颈肩部肌筋膜疼痛综合征的临床研究  

Clinical Study of Ultrasound-guided Small Needle Knife in the Treatment of Cervical Shoulder Myofascial Pain Syndrome

作　　者：胡文文 付志远 刘亮[1] 夏晓辉[1] 陈红天[1] HU Wen-wen;FU Zhi-yuan;LIU Liang(Hunan Provincial People's Hospital/The First Affiliated Hospital of Hunan Normal University,Changsha,Hunan,410005)

机构地区：[1]湖南省人民医院暨湖南师范大学附属第一医院,湖南长沙410005

出　　处：《医学临床研究》2021年第6期838-842,共5页Journal of Clinical Research

基　　金：湖南省科技创新计划项目(编号:2017SK50505)。

摘　　要：【目的】探讨超声引导小针刀治疗颈肩部肌筋膜疼痛综合征(Myofascial pain syndrome,MPS)的疗效及安全性。【方法】前瞻性收集2019年12月至2021年1月因颈肩部疼痛在湖南省人民医院(湖南师范大学附属第一医院)肩痛门诊就诊并诊断为MPS的患者并最终纳入研究73例,采用随机数字表法将研究对象分为试验组(n=37)和对照组(n=36)。试验组接受可视化超声引导小针刀治疗,对照组接受传统小针刀治疗;分别记录两组肌筋膜疼痛触发点(Myofascial trigger points,MTrPs)灰阶声像图表现,MTrPs与邻近区治疗前、后杨氏模量值,两组治疗前、治疗中、治疗后的视觉模拟评分(Visual Analogue Scale,VAS),并记录两组整个治疗过程中是否有晕针、气胸、出血、神经受损等不良事件发生。【结果】MTrPs在灰阶声像图特点主要表现为低回声区,其杨氏模量值高于邻近区(P<0.05)。两组治疗中、治疗后的VAS均低于治疗前;治疗后杨氏模量值均低于治疗前(P<0.05)。两组间比较,患者治疗前VAS、杨氏模量值均无显著差异(P>0.05),但试验组治疗中、治疗后的VAS及治疗后的杨氏模量值均较对照组降低更明显(P<0.05)。Pearson相关分析表明,MTrPs、杨氏模量值与VAS呈正相关(r=0.8,P<0.01)。对照组有3例患者发生不良事件,均表现为治疗区域局部血肿形成,试验组无明显出血情况,两组患者均无晕针、气胸、神经受损等不良事件发生。【结论】与传统小针刀比较,超声引导下小针刀治疗颈肩部MPS的疗效更好、安全性更高,值得临床应用推广。【Objective】To explore the efficacy and safety of ultrasound-guided small needle knife in the treatment of myofascial pain syndrome(MPS).【Methods】From December 2019 to January 2021,73 patients diagnosed as MPS in the shoulder pain clinic of Hunan Provincial People's Hospital(the First Affiliated Hospital of Hunan Normal University)with neck and shoulder pain were prospectively collected.The subjects were randomly divided into experimental group(n=37)and control group(n=36).The experimental group was treated with small needle knife guided by visual ultrasound,and the control group was treated with traditional needle knife;The gray-scale ultrasonographic manifestations of myofascial trigger points(MTrPs),Young's modulus values of MTrPs and adjacent areas before and after treatment,visual analogue scale(VAS)before,during and after treatment of the two groups were recorded respectively,and whether there were needle syncope,pneumothorax,bleeding,pain,etc.in the whole treatment process of the two groups were recorded Nerve damage and other adverse events occurred.【Results】The characteristics of MTrPs in gray-scale sonogram were mainly low echo area,and the young's modulus of MTrPs was higher than that of adjacent areas(P<0.05).The VAS of the two groups during and after treatment were lower than before treatment;The young's modulus after treatment was lower than that before treatment(P<0.05).There was no significant difference in VAS and Young's modulus before treatment between the two groups(P>0.05),but the VAS and Young's modulus after treatment in the experimental group were significantly lower than those in the control group(P<0.05).Pearson correlation analysis showed that MTrPs and Young's modulus were positively correlated with VAS(r=0.8,P<0.01).There were 3 cases of adverse events in the control group,which were manifested as the formation of local hematoma in the treatment area.There was no obvious bleeding in the experimental group,and there were no adverse events such as needle syncope,pneumothorax

关 键 词：肌筋膜疼痛综合征/中西医结合疗法 颈痛 肩痛 超声检查 

分 类 号：R244.152[医药卫生—针灸推拿学]