针刺MTrPs治疗膝骨关节炎的效果及形态学变化研究  

A study on effects and morphological changes of acupuncture at MTrPs in treatment of knee osteoarthritis

作　　者：吕迪 宁秀娟 马彦韬 郑拥军 Lyu Di;Ning Xiujuan;Ma Yantao;Zheng Yongjun(Surgical Intensive Care Unit,Public Health Clinical Center of Shanghai City,Shanghai,201508,P.R.China;Emergency Intensive Care Unit,Tenth People's Hospital of Shanghai City,Shanghai,200072,P.R.China;Department of Pain Medicine,Huadong Hospital Affiliated to Fudan University,Shanghai,200040,P.R.China)

机构地区：[1]上海市公共卫生临床中心外科监护室,上海201508 [2]上海市第十人民医院EICU,上海200072 [3]复旦大学附属华东医院疼痛科,上海200040

出　　处：《老年医学与保健》2024年第6期1747-1753,共7页Geriatrics & Health Care

基　　金：上海市科委项目22Y31900200。

摘　　要：目的观察针刺肌筋膜触发点对膝骨关节炎患者的治疗效果。方法将2023年1月—2023年12月就诊于复旦大学附属华东医院疼痛科的70例KOA患者(平均年龄70.3±6.4岁)随机分为试验组(平均年龄71.6±8.8岁)和对照组(平均年龄70.7±7.2岁),试验组进行针刺肌筋膜触发点+肌肉拉伸练习;对照组采用假针刺+肌肉拉伸练习。6周为1疗程,观察并比较2组NRS、ROM、KOOS、超声下MTrPs厚度变化。结果2组均能改善患者疼痛、增强关节活动范围和改善KOOS评分,且具有统计学意义(P<0.05),其中试验组在治疗1周后具有统计学意义,且在治疗1周后、6周后较对照组均具有统计学意义。超声下肌筋膜触发点表现为局部变厚的低回声信号,针刺治疗6周后厚度变小,但并未消失。相关性分析显示超声下肌筋膜触发点的形态学变化与膝骨关节炎患者的疼痛改善具有相关性,且呈正相关(试验组治疗后疼痛改善与股内侧肌近端肌筋膜触发点厚度变化具有相关性,呈正相关,r=0.463;与股内侧肌远端肌筋膜触发点厚度变化具有相关性,呈正相关,r=0.41。对照组中P>0.05,不具有相关性)。结论针刺肌筋膜触发点可以改善形态,治疗膝骨关节炎,且触发点形态变化与患者疼痛症状具有相关性。Objective To observe the therapeutic effects of acupuncture at myofascial trigger points(MTrPs)on patients with knee osteoarthritis(KOA).Methods 70 patients with KOA(mean age 70.3±6.4 years)admitted to Department of Pain Medicine of Huadong Hospital from January 2023 to December 2023 were randomly divided into experimental group(mean age 71.6±8.8 years)and control group(mean age 70.7±7.2 years).The experimental group was treated with acupuncture at MTrPs+muscle stretching exercise.The control group was treated with sham acupuncture+muscle stretching exercises.6 weeks was one course of treatment.The changes of NRS,ROM,KOOS and thickness of MTrPs under ultrasound were observed and compared between the two groups.Results Both groups could reduce pain degree,enhance range of joint motion and improve KOOS score,with statistical significance(P<0.05).However,the improvement of the experimental group was statistically significant after 1 week of treatment,and was statistically different from that of the control group after 1 week and 6 weeks of treatment.The MTrPs showed a locally thickened low echo signal under ultrasound.After 6 weeks of acupuncture treatment,the thickness decreased but did not disappear.Correlation analysis showed that the morphological changes of MTrPs under ultrasound were positively correlated with pain improvement in patients with KOA[The improvement of pain after treatment in the experimental group was positively correlated with the thickness change of proximal MTrPs of the vastus medialis(r=0.463);it was positively correlated with the thickness change of distal MTrPs of the vastus medialis(r=0.41).However,in the control group,the above improvement had no statistical significance(P>0.05),indicating no correlation].Conclusion Acupuncture at MTrPs can improve morphology and treat KOA,and the changes in the morphology of MTrPs are correlated with pain symptoms of patients.

关 键 词：老年 膝骨关节炎 肌筋膜触发点 针刺 疼痛 关节活动范围 超声 

分 类 号：R68[医药卫生—骨科学]