高能震波治疗肌肉骨关节的慢性疼痛

背景：目前有关用高能震波治疗肌肉骨关节慢性疼痛的报道不少，但其治疗的确切效果及作用机制不明确，有待进一步探讨。目的：探讨高能震波对骨关节肌筋膜炎的治疗效果、作用机制及临床应用效应。设计：以诊断为依据的非随机化同期对照研究。单位：中山大学附属第一医院康复医学科。对象：2001—07／2002—04中山大学第一附属医院康复科门诊救治的肌肉骨关节慢性疼痛患者90例，按就诊次序分为治疗组45例，男17例，女28例；平均年龄54岁；对照组45例，男15例，女30例，平均年龄63岁。方法：治疗组采用体外冲击波治疗；对照组采用常规物理因子治疗。用简式McGill疼痛问卷(MPQ)评估患者对疼痛的综合反应，并对肩关节活动范围及临床疗效进行评定。主要观察指标：①两组治疗前后疼痛改善程度。②关节活动度的变化。③综合临床疗效。结果：治疗组在治疗后感觉类，情感类，疼痛总分，目测类比定级(VAS)，现有痛强度(PPI)方面与治疗前比较差异有显著性意义(t=5，69，5．67，7．06，8．37，6．21，P&;lt;0．01)。在感觉类，疼痛总分，VAS方面与对照组比较差异也有显著性意义(t=4．66，P&;lt;0．01；t=2．52，3．40，P&;lt;0．05)。结论：体外高能震波对骨关节肌筋膜炎等慢性疼痛疗效确切，临床应用上具有高效、快速、安全的特点。     

高能震波治疗肌肉骨关节慢性疼痛性疾病的临床研究

目的　观察高能震波对肩周炎等肌肉骨关节疾病引起的慢性疼痛的治疗效果 ,探讨其作用机制及临床应用。方法　选择 90例门诊患者 ,随机分为治疗组和对照组 ,治疗组采用ESWO AJ体外冲击波治疗机进行治疗 ,工作电压为 7～ 10kV ,冲击波频率为 60次 /min ;对照组按照病种选用相应常规物理因子疗法。采用简式McGill疼痛问卷 (MPQ)等方法进行疗效评估并比较。结果　治疗组治疗后功能明显改善 ,治愈率71.1% ,明显高于对照组 ( 4 0 .0 % ) (P <0 .0 1)。在治疗后情感类 (A)、疼痛总分 (T)与目测类比量表 (VAS)评分中 ,治疗组明显优于对照组 (P <0 .0 1或P <0 .0 5 )。且两组在治疗次数上差异有非常显著性意义 (P <0 .0 0 1)。结论　体外高能震波对肌肉骨关节疾病的慢性疼痛疗效确切 ,应用于临床具有高效、快速和安全的特点。     

高能体外冲击波治疗慢性足底筋膜炎

目的:观察高能体外冲击波对慢性足底筋膜炎的临床治疗效果。方法:选择2004-12/2005-12在深圳市第六人民医院疼痛科门诊就诊的足底筋膜炎患者167例,均自愿参加观察。按奇偶序列随机分为2组,治疗组84例,对照组83例。①治疗组采用HKSW-O冲击波治疗机进行标准治疗,工作电压7～10V,冲击波频率60次/min,治疗时间15min。②对照组除机器探头未与治疗部位充分有效接触外,定位及治疗参数设置同治疗组。两组患者均治疗3次,间隔5d治疗1次。①治疗前及治疗结束3个月后对两组患者进行简式McGill疼痛问卷测评:包括感觉类评分(0～33分)、情感类评分(0～12分)、疼痛总分(0～45分)、目测类比疼痛评分(0～10分)及现有疼痛强度评分(0～5分),以上各项分值越高,表示疼痛强度越大。②治疗后3个月对两组患者进行疗效评估:显效为疼痛明显减轻;好转为疼痛略减轻;无效为症状较治疗前无改变或加重。③患者治疗后第3天复诊时进行副作用观察,包括皮肤发红、疼痛、肿胀及其他(如恶心、眩晕、异感等)。结果:167例足底筋膜炎患者全部进入结果分析,无脱落。①两组患者治疗前及治疗3个月后简式McGill疼痛问卷评分比较:治疗3个月后,治疗组感觉类、情感类、疼痛总分、目测类比疼痛评分及现有疼痛强度评分均显著低于治疗前(t=2.639～3.416,P<0.01)。除现有疼痛强度评分外,治疗3个月后治疗组患者的感觉类、情感类、疼痛总分及目测类比疼痛评分均显著低于对照组(t=2.467～3.487,P<0.01)。②治疗3个月后两组患者的临床疗效比较:治疗组患者的显效率显著高于对照组(χ2=112.33,P<0.01)。③治疗后第3天复诊时治疗组患者的副作用发生情况:治疗组患者有少部分病例会出现皮肤发红和局部疼痛,而肿胀和其他副作用几乎不出现。结论:高能体外冲击波对慢性足底筋膜炎的临床治疗效果确切,具有安全、有效、简易和快速等特点。     

深层肌肉刺激治疗足底筋膜炎的疗效观察

目的 观察深层肌肉刺激（DMS）治疗足底筋膜炎的临床疗效。 方法 采用随机数字表法将56例足底筋膜炎患者分为观察组及对照组,每组28例。2组患者均给予传统康复干预(包括足底按摩手法及超声波治疗),观察组还同时辅以DMS治疗。每周治疗5 d,连续治疗4周。于治疗前、治疗4周后分别采用疼痛视觉模拟评分法（VAS）、足底超声检查及改良Barthel指数(MBI)评价患者疼痛、足底筋膜厚度及日常生活活动（ADL）能力改善情况。 结果 治疗后2组患者疼痛VAS评分、足底筋膜厚度及MBI评分均较治疗前明显改善（P<0.05）;并且观察组治疗后疼痛VAS评分［（2.9±1.9）分］、足底筋膜厚度［（2.84±0.71）mm］及MBI评分［（74.9±9.2）分］亦显著优于对照组水平（P<0.05）。 结论 DMS治疗足底筋膜炎的疗效明显优于传统康复干预,能进一步缓解疼痛,促进患部炎症水肿消散及生活质量提高,该疗法值得临床推广、应用。     

高能震波治疗四肢长骨骨不连接

目的 观察高能震波 (high energy shock waves,HESW)治疗骨折不愈合的疗效及安全性。方法 应用体外震波碎石机所产生的 HESW治疗 19例骨折不愈合病例。术后根据病情选用石膏、夹板或外固定支架固定。观测指标：定期 X线摄片、血碱性磷酸酶 (AKP)和骨钙素 (BGP)测定。结果 84.2％ (16/19)病例获得了骨愈合。骨折愈合时间为 8～ 18周,平均 12周。血 AKP、 BGP术后 2周明显升高 (P     

体外冲击波治疗肌肉骨骼疼痛的研究进展

体外冲击波疗法(ESWT)由于其安全有效、损伤小等特点近年来逐渐成为康复治疗的一种新方法,在临床中广泛应用。本文主要对ESWT的作用机制以及治疗肌肉骨骼疼痛的研究进展和应用前景进行综述。     

肌肉骨骼超声在评估慢性足底筋膜炎中的临床应用

目的:观察肌肉骨骼超声在评估慢性足底筋膜炎中的临床应用。方法:应用肌肉骨骼超声对21例单侧足底筋膜炎患者进行足底筋膜厚度的评估,由一位有经验的超声医生分别对患侧和健侧的足底筋膜厚度进行测量,测量2次,时间间隔为2～3d。结果:应用肌肉骨骼超声测量健侧和患侧足底筋膜厚度重复性测量信度分别为0.92和0.87,对比健侧与患侧足底筋膜厚度,患侧明显高于健侧(P<0.05)。结论:肌肉骨骼超声可有效可靠地评估足底筋膜厚度,对于诊断慢性足底筋膜炎及评估治疗效果有着重要的意义。     

肌内效贴辅助物理疗法治疗足底筋膜炎的短期疗效观察

目的:观察研究肌内效贴辅助物理疗法治疗足底筋膜炎的短期疗效。方法:选取42例足底筋膜炎患者随机分为治疗组与对照组,两组患者均予以体外冲击波(ESWT)及牵伸训练,治疗组在此基础上辅以肌内效贴贴扎。治疗前、治疗后1周、治疗后2周分别采用疼痛视觉模拟评分(VAS)、肌骨超声、美国矫形足踝协会(AOFAS)踝与后足功能评分表评估患者的疼痛程度、足底筋膜厚度及足的功能状态。结果:治疗前两组患者各项指标差异无显著性意义(P0.05)。治疗后1周,一天结束时的疼痛程度及AOFAS评分治疗组均较对照组显著改善,差异具有显著性意义(P0.05,P0.01),治疗后2周晨起第一步、一天结束时的疼痛程度及AOFAS评分治疗组均较对照组显著改善,治疗组足底筋膜变薄,与对照组比较差异具有显著性意义(P0.01)。除对照组治疗后1周一天结束时的疼痛程度较治疗前无显著改善(P0.05),两组患者治疗后1周和2周,晨起第一步、一天结束时的疼痛程度及AOFAS评分均较治疗前改善,差异具有显著性意义(P0.01)。治疗组治疗后2周足底筋膜厚度较治疗前差异有显著性意义(P0.01)。结论:在冲击波和牵伸训练基础上辅以肌内效贴可更好地缓解足底筋膜炎患者的疼痛,改善功能。     

体外冲击波联合核心稳定性训练对产后骶髂关节疼痛的临床研究

目的:本研究通过观察体外冲击波疗法联合核心稳定性训练治疗产后骶髂关节疼痛的临床疗效,评估该康复方案的有效性和可行性。方法:选取产后骶髂关节疼痛的患者91例,随机分为3组：基础组(31例)、观察组A和观察组B各30例。基础组采取常规康复治疗,观察组A在基础组基础上采用体外冲击波疗法,观察组B在基础组基础上采用体外冲击波疗法联合核心稳定性训练。比较3组治疗前、治疗4周后的视觉模拟疼痛评分(VAS)、Oswestry功能障碍指数问卷表(ODI)、SF-36简明健康调查简表(SF-36)、MRI腰5-骶1椎间盘水平竖脊肌横截面积。结果:治疗前,3组VAS评分、ODI评分、SF-36评分、MRI腰5-骶1椎间盘水平竖脊肌横截面积比较差异无统计学意义。治疗4周后,3组VAS评分、ODI评分均较治疗前降低(均P<0.05),观察组A、观察组B的VAS评分、ODI评分均低于基础组(P<0.05),且观察组B较观察组A明显降低(P<0.05)。治疗4周后,3组SF-36评分较治疗前均提高(均P<0.05),观察组A、观察组B的SF-36评分高于基础组(均P<0.05),且观...     

The effect of catastrophizing and depression on chronic pain--a prospective cohort study of temporomandibular muscle and joint pain disorders

Although most cases of temporomandibular muscle and joint disorders (TMJD) are mild and self-limiting, about 10% of TMJD patients develop severe disorders associated with chronic pain and disability. It has been suggested that depression and catastrophizing contributes to TMJD chronicity. This article assesses the effects of catastrophizing and depression on clinically significant TMJD pain (Graded Chronic Pain Scale [GCPS] II-IV). Four hundred eighty participants, recruited from the Minneapolis/St. Paul area through media advertisements and local dentists, received examinations and completed the GCPS at baseline and at 18-month follow-up. In a multivariable analysis including gender, age, and worst pain intensity, baseline catastrophizing (β 3.79, P < 0.0001) and pain intensity at baseline (β 0.39, P < 0.0001) were positively associated with characteristic of pain intensity at the 18th month. Disability at the 18-month follow-up was positively related to catastrophizing (β 0.38, P < 0.0001) and depression (β 0.17, P = 0.02). In addition, in the multivariable analysis adjusted by the same covariates previously described, the onset of clinically significant pain (GCPS II-IV) at the 18-month follow-up was associated with catastrophizing (odds ratio [OR] 1.72, P = 0.02). Progression of clinically significant pain was related to catastrophizing (OR 2.16, P < 0.0001) and widespread pain at baseline (OR 1.78, P = 0.048). Results indicate that catastrophizing and depression contribute to the progression of chronic TMJD pain and disability, and therefore should be considered as important factors when evaluating and developing treatment plans for patients with TMJD.     

整骨理筋疗法治疗慢性膝关节痛症的效果评估

目的：观察整骨理筋疗法对慢性膝关节疼痛的改善效果。方法：2002-07／2005-07解放军总医院康复医学科门诊收治慢性膝关节疼痛患者随机选择100例，通过病史及影像学检查无腰椎间盘突出症、下肢血管性疾病、肿瘤等疾病，作为膝关节疼痛治疗组，采用整骨理筋疗法进行治疗，2次／周，治疗3周。整骨理筋的同时患者不接受其他治疗。另随机选择同期30例同类患者作为对照，对照组不行整骨理筋疗法，只进行常规理疗。两组分别于治疗前、治疗后3个月、12个月分别进行1次随访，对患者慢性膝关节痛采用目测类比评分法评估疼痛改善情况（10分为严重，0分为无痛），并对患者进行自觉症状改善情况评分。每次就诊时的症状及其出现频率及程度分为0—45级评价自觉症状改善情况，提高2级为症状改善。症状改善率：（治疗前级别一治疗后级别）／治疗前级别&;#215;100％。 结果：按实际处理分析，治疗组治疗后3个月随访89例，12个月随访78例，对照组3个月随访30例。①治疗前治疗组与对照组目测类比评分无显著性差异[（6．7&;#177;0.9），（7．1&;#177;0．8）分，t=78．2，P＞0.051。②治疗组3个月后目测类比评分较治疗前显著减低，与对照组比较显著减低[治疗组3个月后为（3.5&;#177;0．4）分，治疗前为（6、7&;#177;0．9）分；对照组为（6．9&;#177;0.7）分，t=54．9，t=68。8，P＜0．001]。③治疗组症状改善率较对照组显著提高[（45.8&;#177;0．86）％，（0．28&;#177;0．01）％，t=67.7，P＜0001]。④治疗组12个月目测类比评分与治疗前相比显著减低[（3．9&;#177;0．1），（6．7&;#177;0．9）分，t=47．9，P＜0.001]，症状改善评分与治疗前比显著提高（t=52。2，P＜0．001）。 结论：整骨理筋疗法能解除肌痉挛和肌挛缩，消除压痛点、改善患者疼痛和不适的自觉症状，效果确切。     

整骨理筋疗法治疗慢性膝关节痛症的效果评估

目的:观察整骨理筋疗法对慢性膝关节疼痛的改善效果。方法:2002-07/2005-07解放军总医院康复医学科门诊收治慢性膝关节疼痛患者随机选择100例,通过病史及影像学检查无腰椎间盘突出症、下肢血管性疾病、肿瘤等疾病,作为膝关节疼痛治疗组,采用整骨理筋疗法进行治疗,2次/周,治疗3周。整骨理筋的同时患者不接受其他治疗。另随机选择同期30例同类患者作为对照,对照组不行整骨理筋疗法,只进行常规理疗。两组分别于治疗前、治疗后3个月、12个月分别进行1次随访,对患者慢性膝关节痛采用目测类比评分法评估疼痛改善情况(10分为严重,0分为无痛),并对患者进行自觉症状改善情况评分。每次就诊时的症状及其出现频率及程度分为0～45级评价自觉症状改善情况,提高2级为症状改善。症状改善率=(治疗前级别-治疗后级别)/治疗前级别×100%。结果:按实际处理分析,治疗组治疗后3个月随访89例,12个月随访78例,对照组3个月随访30例。①治疗前治疗组与对照组目测类比评分无显著性差异[(6.7±0.9),(7.1±0.8)分,t=78.2,P>0.05]。②治疗组3个月后目测类比评分较治疗前显著减低,与对照组比较显著减低[治疗组3个月后为(3.5±0.4)分,治疗前为(6.7±0.9)分;对照组为(6.9±0.7)分,t=54.9,t=68.8,P<0.001]。③治疗组症状改善率较对照组显著提高[(45.8±0.86)%,(0.28±0.01)%,t=67.7,P<0.001]。④治疗组12个月目测类比评分与治疗前相比显著减低[(3.9±0.1),(6.7±0.9)分,t=47.9,P<0.001],症状改善评分与治疗前比显著提高(t=52.2,P<0.001)。结论:整骨理筋疗法能解除肌痉挛和肌挛缩,消除压痛点、改善患者疼痛和不适的自觉症状,效果确切。     

Palmitoylethanolamide and stearoylethanolamide levels in the interstitium of the trapezius muscle of women with chronic widespread pain and chronic neck-shoulder pain correlate with pain intensity and sensitivity

Chronic widespread pain (CWP) is a complex condition characterized by central hyperexcitability and altered descending control of nociception. However, nociceptive input from deep tissues is suggested to be an important drive. N-Acylethanolamines (NAEs) are endogenous lipid mediators involved in regulation of inflammation and pain. Previously we have reported elevated levels of the 2 NAEs, the peroxisome proliferator-activated receptor type-α ligand N-palmitoylethanolamine (PEA) and N-stearoylethanolamine (SEA) in chronic neck/shoulder pain (CNSP). In the present study, the levels of PEA and SEA in women with CWP (n = 18), CNSP (n = 34) and healthy controls (CON, n = 24) were investigated. All subjects went through clinical examination, pressure pain threshold measurements and induction of experimental pain in the tibialis anterior muscle. Microdialysis dialysate of the trapezius was collected before and after subjects performed a repetitive low-force exercise and analyzed by mass spectrometry. The levels of PEA and SEA in CNSP were significantly higher post exercise compared with CWP, and both pre and post exercise compared with CON. Levels of both NAEs decreased significantly pre to post exercise in CWP. Intercorrelations existed between aspects of pain intensity and sensitivity and the level of the 2 NAEs in CWP and CNSP. This is the first study demonstrating that CNSP and CWP differ in levels of NAEs in response to a low-force exercise which induces pain. Increases in pain intensity as a consequence of low-force exercise were associated with low levels of PEA and SEA in CNSP and CWP. These results indicate that PEA and SEA have antinociceptive roles in humans.     

Paralumbar muscle activity in chronic low back pain

Muscle spasm is often considered to be a prominent feature operating in chronic low back spin syndrome (LBP). The present study compared levels of paralumbar muscle activity, determined by an electromyogram (EMG), for LBP patients and normal subjects during periods of rest and voluntary muscular contraction. The resting state EMG measure did not differ in the 2 groups. However, when attempting to relax the low back while contracting other muscle groups, LBP patients exhibited higher mean levels of low back muscle activity as compared to the non-pain group. These results would suggest that such "cocontraction relaxation" procedures may provide a viable behavioral technique for assessing and possibly treating functional backache thought to be symptomatic of muscle spasm. Previous studies employing feedback and progressive relaxation techniques have trained subjects to reduce muscle tension in the resting state. Results of the present study suggest that the acquisition of "resting level" relaxation may be of little benefit to patients who exhibit excessive muscular tension while performing daily tasks. Rather, to maximize the likelihood of beneficial results, training would be better directed at relaxation of the low back during activity of other muscle groups.