超声引导针刺对颈肩激痛点面积、周长、硬度及疼痛程度的影响研究

摘要:

目的:比较超声引导针刺与常规针刺对颈肩肌筋膜疼痛综合征患者(MPS)颈肩的激痛点面积、周长、硬度及疼痛症状的改善程度。方法:根据样本量估算选取颈肩MPS患者70例,纳入的患者在体外冲击波的基础治疗上随机分为两组各35例。其中引导针刺组在超声引导下对颈肩激痛点进行针刺,常规针刺组选取颈夹脊、风府、风池、肩井等穴进行针刺干预,两组患者每3天治疗1次,治疗2次后休息1天即为一个疗程,均治疗两个疗程。分别于治疗前后比较两组患者的视觉疼痛模拟(VAS)评分、压力疼痛阈值(PPT)、激痛点病灶区的面积、周长及弹性模量值。结果:①疼痛程度评估。治疗前,两组患者视觉疼痛模拟VAS评分、压力疼痛阈值PPT评分比较无显著差异(t=0.206,P=0.838；t=-1.123,P=0.265)；治疗后,两组患者VAS评分低于治疗前[(6.20±1.18),(1.94±0.84),t=17.467,P=0.000；(6.14±1.14),(2.63±0.77),t=15.555,P=0.000]、压力疼痛阈值PPT评分高于治疗前[((17.93±6.45),(43.66±9.00),t=-42.495,P=0.000；(19.77±7.19),(35.47±9.72),t=-29.289,P=0.000],其中引导针刺组VAS评分低于常规针刺组、PPT评分高于常规针刺组(t=-3.564,P=0.001；t=3.653,P=0.001)。②激痛点面积、周长、硬度评估。治疗前,两组患者激痛点面积、周长、硬度比较无显著差异(t=-0.085,P=0.933；t=-0.663,P=0.509；t=0.120,P=0.905)；治疗后,两组患者激痛点面积低于治疗前[(0.78±0.41),(0.38±0.19),t=6.372,P=0.000；(0.79±0.57),(0.61±0.38),t=2.714,P=0.000]、激痛点周长低于治疗前[(40.49±16.29),(28.24±9.65),t=5.146,P=0.000；(43.17±17.49),(37.06±15.21),t=4.144,P=0.000]、激痛点弹性模量值低于治疗前[(41.09±15.55),(26.67±9.12),t=5.821,P=0.000；(40.66±14.17),(33.41±14.30),t=3.113,P=0.004],其中引导针刺组激痛点面积、周长、弹性模量值均低于常规针刺组(t=-3.282,P=0.002；t=-2.898,P=0.005；t=-2.352,P=0.022)。结论:超声引导针刺治疗颈肩MPS患者镇痛疗效优于常规针刺,其治疗机制可能与靶向激痛点针刺减压释放其病灶组织内压,从而减小病灶面积、周长,降低病灶硬度有关。

Abstract:

Objective: To compare the improvement of pain point area, circumference, hardness, and pain symptoms in patients with neck shoulder myofascial pain syndrome (MPS) treated with ultrasound guided acupuncture and conventional acupuncture. Method: 70 patients with neck and shoulder MPS were selected based on sample size estimation. The included patients were randomly divided into two groups with 35 patients in each group on the basis of extracorporeal shock wave therapy. Among them, the guided acupuncture group performed acupuncture on the neck and shoulder pain points under ultrasound guidance, while the conventional acupuncture group selected acupoints such as neck Jiaji, Fengfu, Fengchi, and Jianjing for acupuncture intervention. The two groups of patients received treatment once every three days, and after two treatments, they rested for one day to form a course of treatment. Both groups received treatment for two courses. Compare the visual pain simulation (VAS) score, pressure pain threshold (PPT), area, perimeter, and elastic modulus values of the pain point lesion area between the two groups of patients before and after treatment. Result: ① Assessment of pain level. Before treatment, there was no significant difference in visual pain simulation VAS score and pressure pain threshold PPT score between the two groups of patients (t=0.206, P=0.838; t=-1.123, P=0.265); After treatment, the VAS scores of both groups of patients were lower than before treatment [(6.20 ± 1.18), (1.94 ± 0.84), t=17.467, P=0.000; (6.14 ± 1.14), (2.63 ± 0.77), t=15.555, P=0.000], and the pressure pain threshold PPT scores were higher than before treatment [(17.93 ± 6.45), (43.66 ± 9.00), t=-42.495, P=0.000; (19.77 ± 7.19), (35.47 ± 9.72), t=-29.289, P=0.000]. Among them, the VAS scores of the guided acupuncture group were lower than those of the conventional acupuncture group The PPT score was higher than that of the conventional acupuncture group (t=-3.564, P=0.001; t=3.653, P=0.001) Assess the area, perimeter, and hardness of pain points. Before treatment, there was no significant difference in the area, circumference, and hardness of pain points between the two groups of patients (t=-0.085, P=0.933; t=-0.663, P=0.509; t=0.120, P=0.905); After treatment, the area of pain points in both groups of patients was lower than before treatment [(0.78 ± 0.41), (0.38 ± 0.19), t=6.372, P=0.000; (0.79 ± 0.57), (0.61 ± 0.38), t=2.714, P=0.000], and the circumference of pain points was lower than before treatment [(40.49 ± 16.29), (28.24 ± 9.65), t=5.146, P=0.000; (43.17 ± 17.49), (37.06 ± 15.21), t=4.144, P=0.000] The elastic modulus value of the pain point was lower than before treatment [(41.09 ± 15.55), (26.67 ± 9.12), t=5.821, P=0.000; (40.66 ± 14.17), (33.41 ± 14.30), t=3.113, P=0.004], among which the area, perimeter, and elastic modulus value of the pain point in the guided acupuncture group were lower than those in the conventional acupuncture group (t=-3.282, P=0.002; t=-2.898, P=0.005; t=-2.352, P=0.022). Conclusion: Ultrasound guided acupuncture has a better analgesic effect than conventional acupuncture in the treatment of neck and shoulder MPS patients. Its therapeutic mechanism may be related to the release of internal pressure in the lesion tissue by targeted pain point acupuncture, thereby reducing the area and circumference of the lesion and reducing the hardness of the lesion.