经皮病变肌筋膜离断术结合药物治疗肌筋膜疼痛综合征40例疗效观察

目的：探讨经皮病变肌筋膜离断术结合药物治疗肌筋膜疼痛综合征(MPS)的临床疗效。方法选择2014年5月至2015年5月期间我院疼痛科和康复医学科收治的80例MPS患者，按照数字随机法分成观察组和对照组各40例，对照组给予小针刀结合曲安奈德、维生素B12及利多卡因注射治疗，观察组给予经皮病变肌筋膜离断术结合曲安奈德、维生素B12及利多卡因注射治疗，疗程均为15 d，观察治疗前、治疗3个月时的视觉模拟评分(VAS)、临床疗效评分(JOA)变化及压痛点个数改变情况。结果治疗前观察组VAS评分为(6.68±1.38)分，对照组为(6.42±1.43)分，两组比较差异无统计学意义(P>0.05)，治疗后3个月后两组患者VAS评分均显著降低，观察组患者VAS评分明显低于对照组(2.23±1.43)分vs (3.81±2.12)分]，差异有统计学意义(P<0.05)；治疗前观察组临床症状、体征、日常生活和总分分别为(5.02±1.23)分、(2.07±0.95)分、(10.48±2.41)分、(17.57±2.87)分，对照组分别为(4.96±1.18)分、(2.08±1.02)分、(10.41±2.54)分、(17.45±2.97)分，两组比较差异均无统计学意义(P>0.05)，治疗后3个月后，观察组临床症状、体征、日常生活和总分分别为(2.02±1.01)分、(1.67±0.78)分、(5.12±1.76)分、(8.81±1.78)分，对照组分别为(2.87±1.02)分、(1.86±0.85)分、(6.89±1.89)分、(11.62±2.06)分，组间比较差异均有统计学意义(P<0.05)，治疗后观察组JOA各项评分及总分明显低于对照组，两组比较差异有统计学意义(P<0.05)。治疗前观察组患者腰部压痛点为(4.31±0.53)分，对照组为(4.27±0.48)分，差异无统计学意义(P>0.05)；治疗后3个月两组患者腰部压痛点均明显减少，组间比较差异有统计学意义(2.45±1.33)分vs (2.87±1.08)分，P<0.05]，观察组患者腰部压痛点少于对照组，两组比较差异有统计学意义(P<0.05)。结论经皮病变肌筋膜离断术结合曲安奈德、维生素B12及利多卡因注射治疗MPS较小针刀疗效更佳，值得在临床上进行推广应用。

Curative effect of percutaneous myofascial disconnection combined with drug for the treatment of myofascial pain syndrome

Objective To investigate the pathological changes of percutaneous myofascial disconnection com-bined with drug for the treatment of myofascial pain syndrome (MPS). Methods A total of 80 patients with MPS, who admitted to our hospital from May 2014 to May 2015, were selected and randomly divided into observation group and control group according to digital random method, with 40 cases in each. Patients in control group were treated by small needle knife combined with triamcinolone acetonide, vitamin B12 and lidocaine injection therapy, and the observation group received the skin lesion muscle fascia disconnection combined with triamcinolone acetonide, vitamin B12 and li-docaine injection therapy. The treatment lasted for 15 days, and the visual simulate different score (VAS), clinical score (JOA) changes and tenderness point number of two groups before treatment and 3 months after treatment were recorded. Results There was no significant difference between the observation group (6.68 ± 1.38) points] and control group (6.42 ± 1.43) points] in VAS scores before the treatment (P>0.05). After 3 months treatment, the VAS scores of the two groups decreased significantly, and VAS scores of the observation group (2.23 ± 1.43) points] was significantly lower than that of the control group (3.81±2.12) points] (P<0.05). Before the treatment, in the term of JOA score, sign score, daily score and total score, there were no significant differences between the observation group (5.02 ± 1.23) points, (2.07 ± 0.95) points, (10.48 ± 2.41) points, (17.57 ± 2.87) points] and control group (4.96 ± 1.18) points, (2.08 ± 1.02) points, (10.41 ± 2.54) points, (17.45 ± 2.97) points] (P>0.05). After 3 months treatment, in the term of JOA score, sign score, daily score and total score, there were significant differences between the observation group (2.02 ± 1.01) points, (1.67±0.78) points, (5.12±1.76) points, (8.81±1.78) points] and control group (2.87±1.02) points, (1.86±0.85) points, (6.89 ± 1.89) points, (11.62 ± 2.06) points] (P<0.05). The JOA score and total score of observation group were signifi-cantly lower than those of control group (P<0.05). Before the treatment, there was no significant difference between the observation group (4.31±0.53) points] and control group (4.27±0.48) points] in tenderness point number (P>0.05). After 3 months treatment, the lumbar tenderness number were significantly reduced, and the lumbar tenderness number of observation group (2.45±1.33) points] was significantly less than that of control group (2.87±1.08) points] (P<0.05). Conclusion The Percutaneous lesion myofascial disconnection surgery combined with triamcinolone acetonide, vita-min B12 and lidocaine injection for the treatment of muscle fasciitis pain treatment is better than acupotomy therapy, which is worthy of clinical application.