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     

体外冲击波对腰肌肌筋膜疼痛综合征患者的疗效

目的观察体外冲击波治疗腰肌肌筋膜疼痛综合征的临床疗效。方法选取腰肌肌筋膜疼痛综合征患者120例,采用随机数字表法随机分为对照组与观察组,每组患者60例。2组患者均采用压痛点注射镇痛液治疗,观察组在压痛点注射治疗的基础上增加体外冲击波治疗,压痛点注射和体外冲击波均每周1次,连续治疗3周。于治疗前和治疗3周后(治疗后)对2组患者进行软组织张力(软组织位移距离)、疼痛程度[目测类比法(VAS)]、压力痛阈[压力痛阈测试(PPT)]以及功能障碍程度评估[Oswestry功能障碍指数(ODI)]。结果治疗后,2组患者的软组织位移距离值、VAS评分、PPT值和DOI评分与组内治疗前比较,差异均有统计学意义(P<0.05),且观察组治疗后的软组织位移距离值(包括施加1 kg和施加2 kg时的位移距离)、VAS评分、PPT值和DOI评分分别为施加1 kg(6.53±1.18)mm、施加2 kg(5.57±0.90)mm、(2.35±0.94)分、(63.48±14.35)N、(10.23±3.42)分,均显著优于对照组治疗后,差异均有统计学意义(P<0.05)。结论在压痛点注射的基础上增加体外冲击波,可显著增强腰肌肌筋膜疼痛综合征患者腰部的软组织张力,缓解疼痛程度,提高压力痛阈,改善功能障碍。     

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。     

超声引导下糖皮质激素注射治疗单侧慢性跖筋膜炎的临床疗效观察

目的探讨超声引导下注射糖皮质激素治疗单侧慢性跖筋膜炎的临床疗效。方法采用前瞻性研究方法,选取2019年1～10月首都医科大学附属北京友谊医院收治的单侧慢性跖筋膜炎患者63例,按照随机数字表法将患者分为对照组、压痛点注射组和超声引导下注射组,每组各21例。对照组患者使用发散式体外冲击波治疗跖筋膜炎,每3 d接受一次治疗,一共治疗5次;压痛点注射组在压痛点注射倍他米松注射液1 ml和利多卡因1 ml;超声引导下注射组在超声引导下将倍他米松注射液1 ml和利多卡因1 ml注射到跖筋膜深层。所有患者门诊随访12周。记录治疗前和末次随访时患者足部疼痛的视觉模拟评分(VAS)和足踝关节功能的美国足踝矫形协会(AOFAS)评分、末次随访患者的治疗有效率以及患者对治疗效果满意度,并进行比较。结果所有患者均得到完整随访。末次随访时对照组、超声引导下注射组和压痛点注射组的VAS分别是:4. 2±0. 4分、3. 2±0. 4分和4. 0±0. 5分,而三组AOFAS分别为48. 5±4. 7分、74. 6±7. 5分和49. 4±5. 2分。三组患者末次随访VAS评分均较治疗前显著下降,差异具有统计学意义(P 0. 05)。超声引导下注射组VAS明显低于其他两组,差异具有统计学意义(P 0. 05)。超声引导下注射组AOFAS评分明显高于其他两组,差异具有统计学意义(P 0. 05)。而压痛点注射组和对照组AOFAS评分在治疗前后差异无统计学意义(P0. 05)。末次随访治疗有效率和患者满意度方面,超声引导下注射组明显高于压痛点注射组和对照组,差异具有统计学意义(P 0. 05)。结论超声引导下注射糖皮质激素能够减轻单侧慢性跖筋膜炎疼痛,并且改善足踝功能,是治疗单侧慢性跖筋膜炎有效的非手术方法。     

胸锁乳突肌扳机点与老化的相关性研究

目的:研究胸锁乳突肌乳突部的肌筋膜扳机点压痛与年龄因素之间的相关性。方法:采用定量按压法,按乳突前、下、后三部分,对不同年龄段男女健康受试者胸锁乳突肌乳突部的扳机点进行检查,采取VAS压痛量化评分评定压痛程度。结果:中老年组VAS疼痛评分为5.358±2.309,青年组VAS疼痛评分为3.357±1.956。两组比较差异有显著性意义(P<0.001)。结论:胸锁乳突肌乳突部的肌筋膜扳机点压痛的发生率和疼痛程度与年龄因素有密切的关系,中老年组VAS压痛评分及压痛程度明显高于青年组。     

超声引导前列腺精囊筋膜局麻经直肠前列腺穿刺活检

目的　减轻前列腺穿刺活检痛苦 ,改进经直肠穿刺操作技术。方法　将 35例临床怀疑前列腺癌 (PCA) ,行多平面经直肠超声 (multi- plane TVUS)引导下前列腺穿刺活检患者分成 2组。 组 10例直接行普通经直肠穿刺活检 , 组 2 5例予 1.0 %利多卡因 10 ml 肾上腺素 1滴混合液 ,在前列腺精囊筋膜多点阻滞麻醉后进行。结果　 组平均穿刺 (1.6 1± 0 .5 1)次 ;疼痛指数 6 .90± 1.4 5。 组平均穿刺活检 (6 .4 1± 1.0 8)次 ,疼痛指数 (2 .6 4 1±0 .5 7)。 2组比较 :均 P<0 .0 5 ,差异显著。结论　前列腺精囊筋膜多点阻滞麻醉能有效减轻疼痛 ,增加对穿刺的耐受 ,作为活检操作的一部分 ,值得临床推广应用。     

颈后肌筋膜疼痛综合症射频热凝治疗

目的:总结射频热凝治疗颈后肌筋膜疼痛综合症的临床效果.方法:32例颈后肌筋膜疼痛综合症患者,以颈后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30秒,行穿刺点射频热凝;观察治疗前、治疗后1周、1月和3个月VAS评分、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月和3个月VAS评分分别是8.1±0.9、7.3±1.2、3.8±1.1、1.5±1.2;疼痛程度在治疗后1个月和3个月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个月后全部停止痛药.结论:射频热凝治疗颈肌筋膜疼痛综合症创伤微小、安全和疗效确切.     

小针刀配合封闭及手法治疗腰背肌筋膜疼痛综合征的疗效观察

目的：分析采用“扳机点”小针刀配合手法、封闭疗法治疗腰背部肌筋膜疼痛综合征的临床效果。方法：选取2019年6月至2021年5月收治的100例腰背部肌筋膜疼痛综合征患者为研究对象,采用随机数字表法分为观察组和对照组,各50例。对照组采用常规针灸治疗,观察组采用“扳机点”小针刀配合手法、封闭疗法治疗。观察比较两组治疗前后疼痛程度、功能状况及肌电图信号。结果：治疗前两组疼痛视觉模拟评分法评分（VAS）对比,差异无统计学意义（P＞0.05）;治疗后观察组VAS评分明显低于对照组（P＜0.05）。治疗前两组Oswestry功能障碍调查表（ODI）、Fugl-Meyer下肢功能量表（FM）及Barthel量表（MBI）评分对比,差异无统计学意义（P＞0.05）;治疗后观察组ODI功能障碍评分低于对照组,FM下肢功能评分、MBI评分均高于对照组（P＜0.05）。治疗前两组肌电图信号平均肌电波幅（AEMG）、平均功率频率（MPF）对比,差异无统计学意义（P＞0.05）;治疗后观察组肌电图信号AEMG、MPF均明显高于对照组（P＜0.05）。结论：采用“扳机点”小针刀配合手法、封闭疗法治疗腰背部肌筋膜疼痛综合征,能够有效改善患者腰背部肌肉肌张力、肌力以及疲劳感,从而有效缓解患者的疼痛感,改善患者腰背部及下肢功能,提升患者独立生活能力。     

甘露醇加低分子右旋糖酐治疗骨关节软组织损伤所致肢体肿胀的疗效研究与护理观察

目的:探讨甘露醇加低分子右旋糖酐(后为低右)治疗骨关节软组织损伤所致肢体肿胀的效果。方法:120例患者随机分成两组,每组60例,观察两组肢体肿胀、疼痛的消退、消失时间,张力性水泡及骨筋膜室综合征发生率,进行对比分析。结果:实验组肢体肿胀消退时间(4·0±0·7)d、疼痛消失时间为(2·5±0·8)d,张力性水泡形成率为21·7%(13/60),骨筋膜室综合征发生率为0。而对照组分别为(5·7±0·8)d、(4·3±0·9)d、40·2%(25/60)和6·7%(4/60),二者差异比较有显著意义(P<0·05)。结论:甘露醇加低右治疗骨关节组织损伤所致肢体肿胀,能有效地促进局部肿胀和疼痛的消除,显著降低局部张力性水泡的形成和防止骨筋膜室综合征的发生,促进损伤愈合。     

桡管综合征误诊为网球肘12例分析

桡管综合征 ,又称为旋后肌综合征 ,主要症状为肘外侧疼痛 ,故常与网球肘混淆 ,影响治疗效果。笔者遇误诊为网球肘的桡管综合征 12例 ,现总结如下。1　临床资料本组男 5例 ,女 7例。年龄 2 7～ 5 2岁 ,所有病例均在院内外按网球肘封闭 2～ 5次 ,疗效不明显。其中封闭 2次者 3例 ,3次者 6例 ,4次以上者 3例。本院治疗 3例 ,院外治疗 9例。笔者查体时患者均述肘外侧疼痛 ,并能指出以往封闭部位 (肱骨外上髁 ) ,检查发现桡骨头颈部位均有明显压痛点 ,部分病例肱骨外上髁处亦有轻压痛。在桡骨头颈处封闭 2～ 3次全部治愈。2　讨论2 .1　椎管的应…     

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.     

New views of myofascial trigger points: etiology and diagnosis

Simons DG. New views of myofascial trigger points: etiology and diagnosis.Two studies appearing in Archives, one by Shah and colleagues and another one by Chen and colleagues, present groundbreaking findings that can reduce some of the controversy surrounding myofascial trigger points (MTPs). Both author groups recognize the ubiquity of this disease and the importance to patients of health care professionals becoming better acquainted with the cause and identification of MTPs. The integrated hypothesis is the most credible and most complete proposed etiology of MTPs. However, the feedback loop suggested in this hypothesis has a few weak links, and studies by Shah and colleagues in particular supply a solid link for one of them. The feedback loop connects the hypothesized energy crisis with the milieu changes responsible for noxious stimulation of local nociceptors that causes the local and referred pain of MTPs. Shah’s reports quantify the presence of not just 1 noxious stimulant but 11 of them with outstanding concentrations of immune system histochemicals. The results also strongly place a solid histochemical base under the important clinical distinction between active and latent MTPs. The study by Chen on the use of magnetic resonance elastography (MRE) imaging of the taut band of an MTP in an upper trapezius muscle may open a whole new chapter in the centuries-old search for a convincing demonstration of the cause of MTP symptoms. MRE is a modification of existing magnetic resonance imaging equipment, and it images stress produced by adjacent tissues with different degrees of tension. This report seems to present an MRE image of the taut band that shows the chevron signature of the increased tension of the taut band compared with surrounding tissues.     

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.     

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。     

Are "cervicogenic" headaches due to myofascial pain and cervical spine dysfunction?

The purpose of this investigation was to evaluate whether the pain of cervicogenic headache could be due to referred symptoms from myofascial trigger points. The presence or absence of cervical spine dysfunction was also of interest. Eleven patients with cervicogenic headaches were systematically examined for myofascial trigger points and cervical spine dysfunction. All patients had at least three myofascial trigger points on the symptomatic side. In eight of these patients, trigger point palpation clearly reproduced their headache. There were 70 myofascial trigger points (35 "very tender", 35 "tender") and 17 non-myofascial tender points on the symptomatic side, compared to 22 myofascial trigger points (one "very tender", 21 "tender") and 19 non-myofascial tender points on the asymptomatic side. These differences were statistically significant [chi-square (2df) = 22.04, p less than 0.0001]. All patients had some evidence of cervical dysfunction. Ten patients (91%) had specific segmental dysfunction of occiput on atlas and/or atlas on axis. Five patients were entered into a non-invasive, interdisciplinary pain management program designed to treat cervical spine dysfunction and myofascial pain. Treated patients reported a significant decrease in the frequency and intensity of their headaches during a median two-year follow-up. It is concluded that myofascial trigger points may be an important pain producing mechanism in cervicogenic headache and that segmental cervical dysfunction is a common feature in such patients. Conservative, non-surgical treatment appears to be effective in reducing the frequency and intensity of cervicogenic headache. These data suggest that surgical approaches should be reserved only for those patients who fail conservative therapy.     

Myofascial Pain Syndrome Affecting the Quadratus Femoris

The quadratus femoris is an external rotator of the hip. Quadratus femoris injury can accompany damage to the surrounding muscles. Guided by the clinical symptoms, the injection technique described here can facilitate accurate diagnosis in selected cases.     

The Short-Term Effects of Acupuncture on Myofascial Pain Patients After Clenching

Aim: Short‐term pain reduction from acupuncture in chronic myofascial pain subjects was evaluated using an 11‐point (0 to 10) numeric rating scale, visual analog scale (VAS), and pain rating of mechanical pressure on the masseter muscle. Methods: A single‐blind, randomized, controlled, clinical trial with an independent observer was performed. Fifteen chronic myofascial pain subjects over the age of 18 were randomly assigned into groups: nine subjects received real acupuncture; six subjects received sham acupuncture. Each subject clenched his/her teeth for 2 minutes. Acupuncture or sham acupuncture was administered at the Hegu Large Intestine 4 acupoint. Sham acupuncture was conducted by lightly pricking the skin with a shortened, blunted acupuncture needle through a foam pad, without penetrating the skin. The foam pad visually conceals the needle's point of the entry, so that the subject cannot discern which technique is being used. The subjects rated their general pain on a numeric rating scale. A mechanical pain stimulus was applied with an algometer and the subject rated his/her pain on a VAS. Statistical analysis was performed using the repeated measures anova , paired t‐tests, and Fisher's exact test as appropriate. Results: There was a statistically significant difference in pain tolerance with acupuncture (P = 0.027). There was statistically significant reduction in face pain (P = 0.003), neck pain (P = 0.011), and headache (P = 0.015) with perception of real acupuncture. Conclusion: Pain tolerance in the masticatory muscles increased significantly more with acupuncture than sham acupuncture.     

A Critical Appraisal of the Evidence for Botulinum Toxin Type A in the Treatment for Cervico‐Thoracic Myofascial Pain Syndrome

Myofascial pain syndrome (MPS) is a musculoskeletal condition characterized by regional pain and muscle tenderness associated with the presence of myofascial trigger points (MTrPs). The last decade has seen an exponential increase in the use of botulinum toxin (BTX) to treat MPS. To understand the medical evidence substantiating the role of therapeutic BTX injections and to provide useful information for the medical practitioner, we applied the principles of evidence‐based medicine to the treatment for cervico‐thoracic MPS. A search was conducted through MEDLINE (PubMed, OVID, MDConsult), EMBASE, SCOPUS and the Cochrane database for the period 1966 to 2012 using the following keywords: myofascial pain, muscle pain, botulinum toxin, trigger points, and injections. A total of 7 trials satisfied our inclusion criteria and were evaluated in this review. Although the majority of studies found negative results, our analysis identified Gobel et al.'s as the highest quality study among these prospectively randomized investigations. This was due to appropriate identification of diagnostic criteria, excellent study design and objective endpoints. The 6 other identified studies had significant failings due to deficiencies in 1 or more major criteria. We conclude that higher quality, rigorously standardized studies are needed to more appropriately investigate this promising treatment modality.