剪切波弹性成像在肌筋膜疼痛综合征中的临床应用价值

目的应用剪切波弹性成像观察肌筋膜疼痛综合征患者肌筋膜疼痛触发点(MTrPs)处肌肉弹性改变情况,观察其在中医手法治疗中的应用。方法收集我院收治的60例肌筋膜疼痛综合征患者(观察组)和60例健康体检者(对照组)为研究对象,均行剪切波弹性成像检测,比较观察组与对照组肌肉杨氏模量值(E)、组织剪切波速度(SWV)、上斜方肌厚度、目测类比等级(VAS)评分。以后期病理生理学检测结果为标准,绘制受试者工作特征(ROC)曲线分析剪切波弹性成像诊断MTrPs的价值。根据观察组患者定位MTrPs方式差异分为2个亚组:常规组(30例)和辅助组(30例),对比常规组与辅助组治疗前和治疗后15 d的VAS评分、疼痛分级指数(PRI)评分、现有疼痛强度(PPI)评分,以及治疗1、2、3个疗程后的疼痛缓解显效率。结果观察组MTrPs处肌肉E、SWV、上斜方肌厚度、VAS评分均高于对照组,差异均有统计学意义(均P0.05)。ROC曲线分析显示,剪切波弹性成像诊断MTrPs的曲线下面积为0.948,敏感性为95.24%,特异性为94.44%,诊断准确率为95.00%。通过对比疗效发现,辅助组1、2、3个疗程治疗后的疼痛缓解显效率均显著高于常规组,治疗后15 d的VAS评分、PRI评分、PPI评分均低于常规组,差异均有统计学意义(均P0.05)。结论剪切波弹性成像评估肌筋膜疼痛综合征患者MTrPs处肌肉弹性改变具有较高的特异性和敏感性,有助于中医手法治疗定位,具有重要的临床价值。

Evaluation of Shear Wave Elastography on the Changes of Muscle Elasticity at MTrPs in Patients with Myofascial Pain Syndrome and Its Application in Traditional Chinese Medicine Manipulation

Objective: Exploring the evaluation of shear wave elastography on the changes of muscle elasticity at MTrPs in patients with myofascial pain syndrome and its application in traditional Chinese medicine manipulation. Methods: A retrospective analysis of 60 patients with myofascial pain syndrome in the observation group and 60 healthy persons in the control group who were admitted from June 2018 to April 2020, all underwent real-time shear wave elastography detection, and real-time analysis by ROC curve The diagnostic value of shear wave elastography, and the comparison of Young"s modulus (E), tissue shear wave velocity (SWV), upper trapezius muscle thickness, and visual analog scale (VAS) scores between the two groups. At the same time, patients in the observation group were divided into two groups according to the treatment methods, namely the conventional group (30 groups) and the auxiliary group (30 groups). The pain relief rate and simplified McGill pain (simplified SF-MPQ) score of the two were compared.. Results: The E, SWV, upper trapezius thickness, and VAS scores of the observation group were higher than those of the control group (P<0.05). After ROC curve analysis, SWE"s AUC is 0.948, sensitivity is 95.24, specificity is 94.44, and it has a certain accuracy. When comparing the effects of the two groups at the same time, the pain relief rate of 1 course, 2 courses, and 3 courses of the auxiliary group was significantly higher than that of the conventional group, and the VAS score, PPI score, and PRI score of 15 days after treatment were lower than those of the conventional group (P< 0.05). Conclusion: Shear wave elastography has high specificity and sensitivity in assessing and diagnosing changes in muscle elasticity at MTrPs in patients with myofascial pain syndrome. It is assisted in the treatment of traditional Chinese medicine to better relieve pain.