肌筋膜疼痛综合征的现状与展望

<正> 近年来临床和研究工作中对扳机点引起的肌筋膜疼痛综合征(MPS)很感兴趣。本文总结了在这方面已发表和将要发表的一些研究成果。肌筋膜疼痛综合征Travell 在总结扳机点所致MPS 的鉴别特征时指出:肌筋膜扳机点是位于骨骼肌或其相关联的筋膜中的,单独持续存在的过度激惹灶,在其他结构中(如皮肤、瘢痕、关节囊、韧带、骨膜等)可以有其他种类的扳机点,如果在压痛点上施加压力时不产生牵     

肌筋膜疼痛综合征的诊治与康复

肌筋膜疼痛综合征（myofascial pain syndrom,MPS）是一种较为复杂的疾病，发生于人体的很多部位，是腰背痛、颈肩痛以及关节周围痛的常见病因。以下从不同方面探讨及分析了MPS的常见病因和病理表现，并对颈后部、腰背部、前臂及手部等3个常见部位MPS的致病原因、诊断、治疗及康复进行论述，同时对今后的发展及研究方向提出展望。     

肌筋膜疼痛综合征的研究进展

肌筋膜疼痛综合征(myofascial pain syndrome,MPS)是一种局部疼痛综合征,以激痛点为主要临床特征。临床医师越来越关注此病,因其发病形式多样、发病部位不定、症状轻重程度不一,故易出现误诊,为让更多医师掌握此病,本文对流行病学、激痛点、临床特点、临床检查、诊断标准及临床治疗等方面的国内外相关文献进行综述,为MPS的诊断及临床治疗提供依据。     

运动员肌筋膜疼痛综合征诊治进展

肌筋膜疼痛综合征是临床常见的疼痛性疾患,尤其常见于运动员,虽然概念的提出已有数十年之久,但尚未被医务工作者广泛认识。近十年来,对其研究逐渐深入,诊断和治疗手段也已日趋成熟,推动了国内肌筋膜疼痛综合征的临床诊治与科研工作。     

毁损疗法治疗顽固性肌筋膜疼痛综合征

对局部2～4个"激痛点"标记消毒,用11号手术尖刀片挑开皮肤3～5mm,然后用经改进的牙科调刀由创面插入疼痛点,对肌肉、肌筋膜进行纵行切割及左右摇摆分离,术毕无菌纱布包扎及抗炎治疗。结果运用毁损疗法治疗顽固性肌筋膜疼痛综合征68例,经0.5~2年随访,治愈59例(86.8%);有效6例(8.8%);无效3例(4.4%);总有效率95.6%。毁损疗法治疗顽固性肌筋膜疼痛综合征疗效肯定、操作简便、安全性高、值得推广。     

胸部肌筋膜疼痛综合征的理疗

临床上肌筋膜疼痛在胸廓反射性综合征中占主要地位 ,多见于劳动年龄 (30～ 5 0岁 )者 ,常常发作 ,使活动受限 ,原因多样 ,尚无根治疗法。近来倾向于应用联合理疗法———超声脉冲电联合疗法 ,可以增强疗效。作者观察了 1 2 6例胸部肌筋膜疼痛综合征患者 ,年龄 30～ 6 0岁 ,男女     

射频热凝治疗肌筋膜疼痛综合征32例疗效观察

【目的】探讨射频热凝治疗肌筋膜疼痛综合征的临床疗效。【方法】32例肌筋膜疼痛综合征患者,以肌群压痛点为穿刺点,穿刺针抵达骨质后,调节热凝温度为75℃,时间为30s,行穿刺点射频热凝;观察治疗前、治疗后1周、1个月和3个月视觉模拟评分（VAS）、疼痛缓解优良率和镇痛药使用情况。【结果】治疗前、治疗后1周、1个月和3个月VAS评分分别是8．0±0．9、7．3土1．1、3．8±1．0、1．4士1．2;疼痛程度在治疗后1个月和3个月分别均较治疗前有明显缓解（P〈0．01）;治疗后1周内使用止痛药人次为85％,1个月后为10％（P〈0．05）;3个月后全部停用止痛药。【结论】射频热凝治疗肌筋膜疼痛综合征创伤微小、安全,疗效确切。     

肌筋膜疼痛综合征的治疗进展

肌筋膜疼痛综合征的干预和康复手段在过去十余年中有着重大的发展和变化。本文综述最新的肌筋膜疼痛综合征的治疗方法及相关研究证据。     

肌筋膜疼痛综合征的诊治与康复

肌筋膜疼痛综合征(myofascialpainsyndrom,MPS)是一种较为复杂的疾病,发生于人体的很多部位,是腰背痛、颈肩痛以及关节周围痛的常见病因。以下从不同方面探讨及分析了MPS的常见病因和病理表现,并对颈后部、腰背部、前臂及手部等3个常见部位MPS的致病原因、诊断、治疗及康复进行论述,同时对今后的发展及研究方向提出展望。     

肌筋膜触发点疼痛特征的要点分析

介绍肌筋膜触发点疼痛的病理和临床特点及怎样理解其诊断和治疗方法。肌筋膜触发点是受累骨骼肌上能够激惹疼痛的局限小区，挤压时疼痛和拉紧的带，引起牵涉痛和交感现象。静息下运动终板神经末梢处乙酰胆碱浓度增高，引起肌后连接持续去极化和持续性肌节缩短和收缩结节。慢性持续肌节缩短增加局部能量的消耗和血循环的减少，神经血管反应物质释放，致敏传入神经引起触发点疼痛。触发点诊断常依赖病理生理学的诊断标准。触发点治疗的可能原则是对受累肌的牵张，其次是想法刺激或破坏触发点。常用的方法有肌疗法、肌肉牵张和冷喷雾疗法、针刺法加肌肉牵张法、肉毒素注射加肌肉牵张法。同时，常需要辅以补充各种维生素和改善周围循环和提高免疫功能的药物。     

Effect of dry needling on myofascial pain syndrome of the quadratus femoris: A case report

This case report describes a 40-year-old male who presented with posterior thigh pain managed unsuccessfully with massage therapy, chiropractic adjustments, and physical therapy. The diagnosis of myofascial pain syndrome (MPS) involving the quadratus femoris (QF) was purely clinical, based on palpatory findings and ruling out other conditions through deductive reasoning. This is potentially a first time report, describing the successful management of MPS of the QF with dry needling (DN) using a recently published DN grading system. Immediate improvements were noted in all the outcome measures after the first treatment, with complete pain-resolution maintained at a 4-month follow-up.     

实时剪切波弹性成像对颈肩部肌筋膜疼痛综合征阿是穴针刺疗效评估

目的 探讨实时剪切波弹性成像（SWE）对颈肩部肌筋膜疼痛综合征（MPS）患者经阿是穴针刺治疗后的效果评估价值。方法 应用SWE技术定量测量30例颈肩部肌筋膜疼痛综合征（MPS）患者经阿是穴针刺治疗前后斜方肌疼痛触发点的弹性模量值及弹性评分,并且测量患者治疗前后的疼痛视觉模拟评分（VAS）。结果 针刺治疗前患者VAS评分与斜方肌MTrPs杨氏模量值及弹性评分均呈明显正相关(r=0.572, P<0.001;r=0.474, P=0.008),经阿是穴针刺治疗后,MPS患者VAS评分较治疗前减低(t=10.02, P<0.001),斜方肌MTrPs超声弹性成像评分 (t=6.34, P<0.001)及杨氏模量值(t=33.36,P<0.001)明显降低,差异均具有统计学意义;经针刺治疗后?VAS、?杨氏模量值与?弹性评分均呈明显正相关(r=0.611, P<0.001;r=0.561, P=0.001)。 结论 实时剪切波弹性成像能客观有效评估颈肩部肌筋膜膜疼痛综合征阿是穴针刺疗效。     

Shock waves as treatment of mouse myofascial trigger points

Introduction

An abnormal increase in spontaneous neurotransmission can induce subsynaptic knots in the myocyte called myofascial trigger points. The treatment of choice is to destroy these trigger points by inserting needles. However, 10% of the population has a phobia of needles, blood, or injuries. Therefore, the objective of this study is to verify the usefulness of shock waves in the treatment of myofascial trigger points.

Methods

Two groups of mice have been developed for this: healthy muscles treated with shock waves; trigger points affected muscles artificially generated with neostigmine and subsequently treated with shock waves. Muscles were stained with methylene blue, PAS-Alcian Blue, and labeling the axons with fluorescein and the acetylcholine receptors with rhodamine. Using intracellular recording the frequency of miniature endplate potentials (mEPPs) was recorded and endplate noise was recorded with electromyography.

Results

No healthy muscles treated with shock waves showed injury. Twitch knots in mice previously treated with neostigmine disappeared after shock wave treatment. Several motor axonal branches were retracted. On the other hand, shock wave treatment reduces the frequency of mEPPs and the number of areas with endplate noise.

Discussion

Shock waves seem to be a suitable treatment for myofascial trigger points. In the present study, with a single session of shock waves, very relevant results have been obtained, both functional (normalization of spontaneous neurotransmission) and morphological (disappearance of myofascial trigger points). Patients with a phobia of needles, blood, or injuries who cannot benefit from dry needling may turn to noninvasive radial shock wave treatment.     

节段性神经肌肉疗法阻滞治疗肌筋膜痛综合征的疗效分析

目的:观察节段性神经肌肉疗法(SNMT)阻滞治疗用于肌筋膜痛综合征治疗的疗效及对患者运动功能恢复的影响。方法:选取32例肌筋膜痛综合征患者,其中12例患者的疼痛与膝关节活动相关且影响了关节活动度训练的进度。所有患者进行SNMT治疗。SNMT治疗是对患者进行椎旁阻滞,有的患者加局部浸润。SNMT治疗后进行运动功能康复训练。每例患者在SNMT治疗前、后及治疗后1周、4周、3个月及6个月进行0—10数字分级量表(NRS)评定;与疼痛相关膝关节活动受限的患者,在SNMT治疗前、后及治疗后6个月进行关节的被动关节活动度(PROM)评定。结果:SNMT治疗前NRS评分平均为(7.57±1.18)分,治疗后即刻降至(3.75±1.93)分,与治疗前比有显著性差异(P=0.000);治疗后1周、4周、3个月及6个月的平均NRS评分分别为3.68±1.86,3.48±2.03,3.20±1.64及2.55±1.70分,与治疗前比均有显著性差异(P=0.000);与疼痛相关膝关节活动受限的患者在SNMT治疗前PROM平均为97.50°±30.11°,治疗后即刻即增加为107.92°±29.11°,与治疗前相比有显著性差异(P=0.001);治疗后6个月时为135.83°±7.02°,与治疗前比有显著性差异(P=0.000)。结论:SNMT对肌筋膜痛综合征所致神经肌肉骨骼性疼痛具有迅速且较持久的疗效;对疼痛所致膝关节活动受限具有明显改善作用。     

Trigger points and myofascial pain: toward understanding how they affect headaches

Myofascial pain, referred from hyperalgesic trigger points located in skeletal muscle and its associated fascia, is a common cause of persistent regional pain. Clinical and experimental literature on manifestations, pathophysiology, and management of pain from myofascial trigger points is reviewed with priority given to how pain referred from trigger points generates, triggers, and maintains headaches—especially chronic and recurrent ones. Because treating myofascial problems may be the only way to offer complete relief from certain types of headache, clinicians must learn to diagnose and manage trigger points in neck, shoulder, and head muscles.     

Effects of dry needling on pain,pressure pain threshold and psychological distress in patients with mild to moderate hip osteoarthritis: Secondary analysis of a randomized controlled trial

ObjectiveTo determine the changes produced by dry needling in active myofascial trigger points in hip muscles compared to a sham needling on pain intensity, main pain area, pressure pain threshold and psychological distress in patients with hip osteoarthritis.DesignSecondary analysis of a single-centre, randomized, double-blinded, clinical trial.Intervention30 participants with mild to moderate hip osteoarthritis were randomly assigned to DN group (n = 15) or sham DN group (n = 15). DN group received three sessions of penetrating DN, and sham DN group received three sessions of non-penetrating DN in hip muscles.Main outcome measures: Pain intensity (Visual Analogue Scale), main pain area (body chart), pressure pain threshold (algometry), psychological distress (Hospital Anxiety and Depression Scale) and self-reported improvement (Global Rate of Change) were measured before and after treatment.ResultsDN group showed statistically significant improvements with large effect sizes for pain intensity (p < 0.001; E.S: 2.7), pressure pain thresholds (p < 0.05; E.S: 1.3-1.8) and psychological distress (p = 0.002; E.S: 1.5) compared to sham DN group. The DN group described a self-reported improvement categorised as quite a bit, great or very great deal better (n = 12, 80%). No statistically significant differences were found between baseline and postintervention in the sham DN group in any variable (p > 0.05).ConclusionsThree sessions of dry needling were more effective than sham dry needling for improving pain intensity, pressure pain threshold and psychological distress in patients with mild to moderate hip osteoarthritis in the short term.     

Expert consensus on the diagnosis and treatment of myofascial pain syndrome

Myofascial pain syndrome (MPS) is characterized by myofascial trigger points and fascial constrictions. At present, domestic and foreign scholars have not reached a consensus on the etiology and pathogenesis of MPS. Due to the lack of specific laboratory indicators and imaging evidence, there is no unified diagnostic criteria for MPS, making it easy to confuse with other diseases. The Chinese Association for the Study of Pain organized domestic experts to formulate this Chinese Pain Specialist Consensus on the diagnosis and treatment of MPS. This article reviews relevant domestic and foreign literature on the definition, epidemiology, pathogenesis, clinical manifestation, diagnostic criteria and treatments of MPS. The consensus is intended to normalize the diagnosis and treatment of MPS and be used by first-line doctors, including pain physicians to manage patients with MPS.     

Thermographic evaluation of occlusal splint and low level laser therapy in myofascial pain syndrome

ObjectiveThe purpose of this study was to compare and evaluate the effects of occlusal splint and low dose laser treatments clinically and thermographically in patients with myofascial pain syndrome.MethodsTwenty patients aged 18–45 with myofascial pain syndrome were involved into this study. Patients were examined by clinically and Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) was used for the diagnosis of TMD. Patients divided into two groups. First group treated with stabilisation splint, while the other one with low level laser therapy (LLLT). Pre- and post-treatment pain intensity, muscle sensitivity and the superficial skin temperature differences over the masseter and anterior temporal muscle were assessed, and comparison was made within and between the groups pre- and post-operatively.ResultsIn both groups, there was a significant decrease in temperature values, especially in the masseter region (p < 0.05) and post-treatment pain intensity and muscle sensitivity values were lower than the pre-treatment values (p < 0.05). In addition, the heat values in certain regions of the masseter were lower in the LLLT group than in the splint group and there was a statistical difference in these regions between two groups (p < 0.05). However, there was no statistical difference in the pain intensity and muscle sensitivity between both groups (p > 0.05).ConclusionIt was concluded that both occlusal splint therapy and low level laser therapy were effective in the treatment of MPS, and when thermographic data were taken into account, LLLT treatments could provide more advantageous results in these patients.     

灰阶超声联合剪切波弹性成像评估肌筋膜疼痛综合征患者肌筋膜疼痛触发点

目的 探讨灰阶超声联合剪切波弹性成像（SWE）技术评估肌筋膜疼痛综合征（MPS）患者肌筋膜疼痛触发点（MTrPs）处肌肉形态及组织学特性的价值。方法 以28例MPS患者（36个MTrPs）为病例组,33名健康志愿者（33个正常肌肉点）为对照组。由2名检查者分别测量病例组MTrPs （上斜方肌）厚度、剪切波传播速度（SWV）及杨氏模量值（E）,1名检查者测量对照组上述参数,1周后2组均重复测量。采用组内相关系数（ICC）评价2名检查者检测结果的一致性,以Pearson检验分析MPS患者疼痛视觉模拟量表（VAS）评分与上斜方肌厚度、SWV及E的相关性。结果 2名检查者重复测量一致性、时间一致性及检查者间一致性均好或优（ICC 0.73~0.98）。病例组MPS患者上斜方肌厚度、SWV及E均高于对照组,差异均有统计学意义（P均<0.05）。MPS患者VAS评分与上斜方肌厚度无相关性（r=0.016,P=0.945）,与SWV （r=0.709,P<0.001）、E （r=0.653,P=0.002）均呈正相关。结论 灰阶超声联合SWE可定量评估MPS患者MTrPs处肌肉形态及组织学特性。     

Myofascial Pain Syndrome: An Overview

Over the last few decades, advances have been made in the understanding of myofascial pain syndromes (MPSs). In spite of its high prevalence in the society, it is not a commonly established diagnosis. MPS is said to be the great imitator. This article puts some light on the various clinical presentations of the syndrome, on the various tools to reach to a diagnosis for commencing the treatment and on the treatment modalities that have been used so far.