颈肩部肌筋膜疼痛综合征患者预后影响因素及与超声弹性成像指标及上斜方肌厚度的相关性  

Prognostic Factors in Patients with Neck and Shoulder Myofascial Pain Syndrome and Their Correlation with Shear Wave Elastography and Thickness of Upper Trapezius Muscle

作　　者：曾佳 胡桂嫦 高杨 ZENG Jia;HU Guichang;GAO Yang(Department of Ultrasound Medicine,the First People′s Hospital of Shuangliu District/West China Airport Hospital of Sichuan University,Chengdu 610200,China)

机构地区：[1]成都市双流区第一人民医院,四川大学华西空港医院超声医学科,成都610200

出　　处：《医学综述》2023年第20期4404-4408,F0003,共6页Medical Recapitulate

摘　　要：目的分析颈肩部肌筋膜疼痛综合征(MPS)患者预后的相关影响因素及与超声弹性成像(SWE)指标及上斜方肌厚度的相关性。方法选择2021年1月至2022年1月四川大学华西空港医院收治的颈肩部MPS患者368例,患者均经深层肌肉刺激(DMS)联合运动疗法进行治疗,采用视觉模拟评分法(VAS)评估患者疼痛程度,采用SWE检查患者SWE指标[杨氏模量值(E值)、组织弹性评分、组织剪切波速度(SWV)]及上斜方肌厚度。随访1年,根据患者是否再发MPS分为预后良好组和预后不良组。收集可能影响患者预后的相关临床资料,采用Logistic回归分析患者预后的影响因素。采用Spearman相关性分析SWE指标及上斜方肌厚度与患者预后的相关性。结果随访1年后368例中失访30例,余338例经DMS联合运动疗法治疗后90例(26.63%)患者出现颈肩部MPS复发。预后不良组病程长于预后良好组[(17±4)个月比(15±4)个月](P<0.01),无经常运动占比高于预后良好组[66.67%(60/90)比45.16%(112/248)](P<0.01),VAS评分、E值、组织弹性评分、SWV值高于预后良好组[(5.34±0.86)分比(2.38±0.76)分、(42.6±3.6)kPa比(30.5±2.4)kPa、(4.8±1.6)分比(3.5±1.5)分、(4.77±0.35)m/s比(2.62±0.25)m/s](P<0.01),上斜方肌厚度(左侧和右侧)大于预后良好组[(10.3±3.1)mm比(8.2±2.1)mm、(10.7±3.2)mm比(8.1±2.2)mm](P<0.01)。多因素Logistic回归分析结果显示,E值、组织弹性评分、SWV及上斜方肌厚度(左侧和右侧)是颈肩部MPS患者预后的影响因素(OR=1.844,95%CI 0.932~2.756;OR=2.061,95%CI 0.696~3.425;OR=1.740,95%CI 0.535~2.945;OR=1.912,95%CI 1.146~2.677;OR=1.970,95%CI 1.046~2.894)(均P<0.01)。Spearman相关性分析显示,E值、组织弹性评分、SWV、上斜方肌厚度(左侧和右侧)与颈肩部MPS患者预后呈正相关(均P<0.01)。结论E值、组织弹性评分、SWV、上斜方肌厚度(左侧和右侧)是影响患者预后的相关因素,与患者预后具有一定相关性。Objective To analyze the prognostic factors of patients with neck and shoulder myofascial pain syndrome(MPS)and their correlation with shear wave elastography(SWE)and the thickness of the upper trapezius muscle.Methods A total of 368 patients with neck and shoulder MPS admitted to West China Airport Hospital of Sichuan University from Jan.2021 to Jan.2022 were included.All patients were treated with deep muscle stimulation(DMS)combined with exercise therapy.Visual analogue scale(VAS)was used to assess the pain degree of the patients.The SWE indexes[Young′s modulus value(E value),tissue elasticity score,tissue shear wave velocity(SWV)]and the thickness of the superior trapezius muscle were examined by SWE.After 1 year of follow-up,the patients were divided into a good prognosis group and a poor prognosis group according to whether they had recurrent MPS.The relevant clinical data that may affect the prognosis were collected,and the influencing factors of the prognosi were analyzed by Logistic regression.Spearman correlation analysis was used to analyze the correlation between SWE index and upper trapezius muscle thickness and the prognosis of the patients.Results Among the 368 patients after 1 year of follow-up,30 were lost to follow-up,and among the remaining 338 patients treated with DMS combined with exercise therapy,90(26.63%)had neck and shoulder MPS recurrence.The disease duration in the poor prognosis group was longer than that in the good prognosis group[(17±4)months vs(15±4)months](P<0.01),the proportion of no regular exercise was higher than that of the good prognosis group[66.67%(60/90)vs 45.16%(112/248)](P<0.01),VAS score,E value,tissue elasticity score,SWV value were higher than those of the good prognosis group[(5.34±0.86)vs(2.38±0.76),(42.6±3.6)kPa vs(30.5±2.4)kPa,(4.8±1.6)vs(3.5±1.5),(4.77±0.35)m/s vs(2.62±0.25)m/s](P<0.01),the upper trapezius thickness(left and right)was greater than that of the good prognosis group[(10.3±3.1)mm vs(8.2±2.1)mm,(10.7±3.2)mm vs(8.1±2.2)mm](P<0.01).The

关 键 词：颈肩部肌筋膜疼痛综合征 超声弹性成像 上斜方肌厚度 

分 类 号：R445.1[医药卫生—影像医学与核医学]