超声引导下体外冲击波治疗颈肩肌筋膜疼痛综合征的疗效观察

目的探讨超声引导下体外冲击波治疗颈肩肌筋膜疼痛综合征的临床疗效和安全性。 方法前瞻性收集2017年1月至2018年6月在江苏省苏北人民医院和苏州大学附属第一医院门诊收治的颈肩肌筋膜疼痛综合征患者共计60例，按随机数字表法分为治疗组和对照组，每组各30例，对照组予以红外线、经皮神经电刺激、推拿等常规康复训练，治疗组在对照组基础上行超声引导下冲击波治疗，每周2次，连续治疗3 w。于治疗前、首次治疗后、3 w后分别对两组患者采用McGill疼痛问卷（McGill pain questionnaire，MPQ），颈椎功能障碍指数（neck disability index，NDI）进行功能评估；治疗前、治疗3 w后采用剪切波超声弹性成像技术评估颈肩部筋膜硬度（Emean值）及厚度（mm）。 结果两组患者治疗前、首次治疗后、治疗3 w后PRI-T评分分别为：（8.1±3.2）/（7.9±3.3）、（4.3±2.6）/（5.2±2.5）、（1.1±1.3）/（3.3±1.4）分，治疗前后比较，两组差异均有统计学意义（F=2.368，F=1.985，P<0.05）；组间比较，差异有统计学意义（t=1.985，P<0.05）。VAS评分分别为：（6.2±2.3）/（6.4±2.4）、（4.4±2.1）/（4.9±2.3）、（2.6±1.3）/（3.2±1.7）分，治疗前后比较，两组差异均有统计学意义（F=2.315，F=1.876，P<0.05）；组间比较，差异有统计学意义（t=1.752，P<0.05）。PPI评分分别为：（2.6±0.8）/（2.5±0.7）、（1.3±0.6）/（1.6±0.4）、（0.4±0.3）/（0.9±0.6）分，治疗前后比较，两组差异均有统计学意义（F=2.056，F=1.988，P<0.05）；组间比较，差异有统计学意义（t=1.680，P<0.05）。NDI分别为：（43.2±2.9）/（42.9±2.8）、（26.7±3.4）/（31.1±3.3）、（11.4±3.2）/（23.3±3.4）分，两组治疗前后比较，差异均有统计学意义（F=3.689，F=3.002，P<0.05）；组间比较，差异有统计学意义（t=1.680，P<0.05）。治疗3 w后，两组患者斜方肌筋膜硬度及厚度分别由治疗前的（18.4±4.3）/（17.9±4.4）kPa和（7.9±0.8）/（7.8±0.8）mm改善至（6.5±2.8）/（9.7±3.2）kPa和（4.6±0.5）/（5.4±0.7）mm，差异有统计学意义（t=6.325，t=5.256，t=2.589，t=2.014，P<0.05）；且治疗组改善优于对照组，差异有统计学意义（t=2.652，t=1.801，P<0.05）。两组患者肩胛提肌筋膜硬度及厚度分别由治疗前的（14.7±3.4）/（14.9±3.1）kPa和（6.7±0.6）/（6.8±0.5）mm改善至（5.9±2.4）/（8.1±3.7）kPa和（4.8±0.6）/（5.1±0.6）mm，差异有统计学意义（t=4.585，t=3.652，t=1.982，t=1.710，P<0.05）；且治疗组改善优于对照组，差异有统计学意义（t=2.655，t=1.699，P<0.05）。两组患者菱形肌筋膜硬度及厚度分别由治疗前的（10.3±4.2）/（11.1±3.8）kPa和（6.0±0.7）/（6.4±0.6）mm改善至（4.2±1.3）/（6.4±2.8）kPa和（4.7±0.3）/（5.6±0.6）mm，差异有统计学意义（t=4.602，t=4.055，t=2.621，t=1.986，P<0.05）；且治疗组改善优于对照组，差异有统计学意义（t=2.540，t=1.729，P<0.05）。 结论通过超声引导体外冲击波可有效缓解颈肩肌筋膜疼痛综合征疼痛症状，改善颈肩部活动功能，同时应用剪切波超声弹性成像技术可以提供精准诊疗，值得临床应用推广。

Effect of ultrasound-guided extracorporeal shock wave on neck-shoulder myofascial pain syndrome

ObjectiveTo explore the clinical efficacy and safety of ultrasound-guided extracorporeal shock wave in the treatment of the neck-shoulder myofascial pain syndrome. MethodsA total of 60 patients with neck and shoulder muscle fascia pain syndrome admitted to the outpatient department of Jiangsu Subei People's Hospital and the First Affiliated Hospital of Suzhou University from January 2017 to June 2018 were prospectively divided into treatment group and the control group according to the random number table, each group had 30 cases, the control group received infrared, transcutaneous electrical nerve stimulation, massage and other routine rehabilitation training, the treatment group had additional ultrasound guided guided shock wave treatment, 2 times a week, continuous treatment for 3 week under the basis of the control group. The McGill pain questionnaire (MQG) and the neck disability index (NDI) were used to evaluate the function of the two groups before and after the first treatment and after 3 weeks. The hardness of the neck and shoulder fascia (Emean value) and thickness (mm) were evaluated by shear wave ultrasound elastography. ResultsThe PRI-T scores of the two groups before treatment, after the first treatment, and after 3 weeks of treatment were (8.1±3.2)/(7.9±3.3), (4.3 ±2.6)/(5.2±2.5), (1.1±1.3)/(3.3±1.4) points, the difference between the two groups was statistically significant (F=2.368, F=1.985, P<0.05). There was significant difference between the groups (t=1.985, P<0.05). The VAS scores were: (6.2±2.3)/(6.4±2.4), (4.4±2.1)/(4.9±2.3), (2.6±1.3)/(3.2±1.7) points, before and after treatment, the differences between the two groups were statistically significant (F=2.315, F=1.876, P<0.05). The difference between the groups was statistically significant (t=1.752, P<0.05). The PPI scores were (2.6±0.8)/(2.5±0.7), (1.3±0.6)/(1.6±0.4), (0.4±0.3)/(0.9±0.6) points. The difference before and after treatment between the two groups was statistically significant (F=2.056, F=1.988, P<0.05), and the intergroup difference was statistically significant (t=1.680, P<0.05). The NDI were (43.2±2.9)/(42.9±2.8), (26.7±3.4)/(31.1±3.3), (11.4±3.2)/(23.3±3.4) points, and the differences before and after treatment between the two groups were statistical significance (F=3.689, F=3.002, P<0.05), the intergroup comparison was statistically significant (t=1.680, P<0.05). After 3 weeks of the treatment, the hardness and thickness of the trapezius fascia were improved from (18.4±4.3)/(17.9±4.4) kPa and (7.9±0.8)/(7.8±0.8) mm before treatment to (6.5±2.8)/(9.7±3.2) kPa and (4.6±0.5)/(5.4±0.7) mm, the difference was statistically significant (t=6.325, t=5.256, t=2.589, t=2.014, P< 0.05), and the treatment group were better than the control group, difference was statistically significant (t=2.652, t=1.801, P<0.05). The hardness and thickness of the levator fascia of the two groups were improved, from (14.7±3.4)/(14.9±3.1) kPa and (6.7±0.6)/(6.8±0.5) mm before treatment to (5.9±2.4)/(8.1±3.7) kPa and (4.8±0.6)/(5.1±0.6) mm, the difference were statistically significant (t=4.585, t=3.652, t=1.982, t=1.710, P<0.05). The treatment group were better than the control group, and the difference was statistically significant (t=2.655, t=1.699, P<0.05). The hardness and thickness of the rhomboid fascia of the two groups were improved, from (10.3±4.2)/(11.1±3.8) kPa and (6.0±0.7)/(6.4±0.6) mm to (4.2±1.3)/(6.4±2.8) kPa and (4.7±0.3)/(5.6±0.6) mm, the difference were statistically significant (t=4.602, t=4.055, t=2.621, t=1.986, P<0.05), and the treatment group were better than the control group, difference was statistically significant (t=2.540, t=1.729, P<0.05). ConclusionUltrasound-guided extracorporeal shock wave can effectively relieve the pain of neck-shoulder myofascial pain syndrome, improve the function of neck and the shoulder. Meanwhile, the application of shear-wave ultrasonic elastography can provide accurate diagnosis and treatment, which is worthy of clinical application.