针刺肌筋膜触发点与经络穴位治疗腰背肌筋膜疼痛综合征临床观察

[目的]比较针刺肌筋膜触发点与经络穴位治疗腰背肌筋膜疼痛综合征临床疗效,为治疗腰背肌筋膜疼痛综合征探寻一种新的综合治疗模式.[方法]将300例符合诊断标准的患者随机分为肌筋膜触发点组、经络穴位组及综合治疗组,每组100例,每组均临床常规用药,肌筋膜触发点组采用每周1次针刺肌筋膜触发点进行治疗,经络穴位组采用每天1次经络取穴针灸治疗,综合治疗组每天1次经络取穴针灸治疗,并配合每周1次针刺肌筋膜触发点进行治疗,6天为1个疗程,疗程间休息1天.治疗8周后,进行三组自身治疗前后对照和组间疗效的比较.[结果]三组自身治疗前后对照,各组疼痛指数、功能状态指数和硬结条索状物指数均降低(P＜0.05);有效率方面,综合治疗组总有效率96％,肌筋膜触发点组总有效率85％,经络穴位组总有效率82％,肌筋膜触发点组与经络穴位组比较,无显著性差异(P＞0.05),综合治疗组与其他两组比较有显著性差异(P＜0.05).[结论]针刺肌筋膜触发点与经络穴位治疗腰背肌筋膜疼痛综合征疗效相当,二者合用可提高治疗效果,值得临床进一步研究和推广.     

超声波治疗疼痛触发点的研究现状

大多数颈肩腰腿痛都与肌筋膜疼痛触发点的产生及活化有关，而对于其治疗手段也是多种多样。相对于传统的注射技术和针法，超声波治疗技术因其无创、经济、安全及有效被广泛用于疼痛触发点的临床治疗。本文通过阅读大量的文献，对超声波治疗疼痛触发点的研究现状进行综述。     

应用触发点疼痛原理诊治足跟痛31例

目的探讨利用触发点疼痛原理对足跟痛诊断和治疗。方法对31例患者有肌筋膜触发点疼痛的部位反复针刺,每隔7~10天治疗1次,治疗2~3次。辅助补充多种维生素和改善周围循环的药物1个月,并做腓肠肌、比目鱼肌、庶方肌的牵张锻炼。结果优24例(30足),占77.42%;良4例(5足),占12.90%;好转3例(4足),占9.68%;无效0例。优良率为90.32%,有效率为100%。结论跟痛症的跟部疼痛是腓肠肌、比目鱼肌、庶方肌肌筋膜触发点的牵涉痛,对受累肌肉进行触发点疼痛治疗可以改善患者疼痛,是一种简易有效的方法,值得临床推广应用。     

肌筋膜触发点联合牵伸运动治疗股髌疼痛综合征

目的观察基于肌筋膜疼痛触发点联合牵伸运动治疗髌股疼痛综合征的临床疗效。方法 60例髌股疼痛综合征患者随机分为观察组、对照组各30例。观察组采用针刺肌筋膜疼痛触发点联合牵伸运动治疗,对照组采用痛点电疗联合牵伸运动治疗。比较2组患者VAS评分、Lysholm评分和Q角大小及综合疗效。结果治疗后,观察组患者VAS评分下降,Lysholm评分比对照组明显增高(P<0.05),观察组与对照组Q角比较(P<0.05);观察组治愈率及总有效率均明显高于对照组(P<0.05)。结论基于肌筋膜疼痛触发点理论治疗髌股疼痛综合征,能明显缓解疼痛、改善关节功能,且疗效优于局部痛点治疗。     

肩周炎关联肌筋膜疼痛触发点的湿针治疗临床分析

目的:以湿针为主治疗肩周炎关联肌筋膜疼痛触发点,观察其治疗效果。方法:80例评分在5分以上肩周炎患者,根据肩关节疼痛和功能障碍特征认证受累肌肉,定位受累肌肉肌筋膜疼痛触发点的位置。以湿针治疗结合受累肌肉的自我牵张锻炼,并做治疗前中后的疼痛评估。结果:治疗中期,好转率100%;2个月后治愈率和良好率分别达85%和15%,比较差异具有统计学意义(P<0.05)。结论:治疗肩周炎时,考虑治疗受累肌肉筋膜疼痛触发点。     

肌筋膜疼痛触发点的临床研究概况

肌筋膜疼痛综合征(myofascial pain syndrome,MPS)是引起神经肌肉骨骼性疼痛最常见的原因之一,而肌筋膜疼痛触发点是引发肌筋膜疼痛综合征的因素,现将该研究状况综述如下.     

股方肌损伤的诊断与治疗

目的：探讨利用肌筋膜触发点疼痛理论对股方肌损伤进行诊断和中西医结合分期综合治疗的疗效。方法：将坐骨结节外缘均有触发点疼痛的62例患者以发病1个月为界限,急性期采取推拿加理疗、触发点注射;慢性期采取针刀加理疗为主,均配合股方肌牵张锻炼和服用维生素的方法治疗。结果：治疗前VAS平均评分为（4.95±1.19）分,治疗后VAS平均评分为（0.15±0.44）分,治疗前、后平均VAS有显著性差异（t=29.78,P〈0.001）。总有效率为100%。结论：利用肌筋膜触发点疼痛理论对股方肌损伤进行诊断并采取中西医结合分期综合治疗,具有十分现实的临床应用价值和良好的疗效。     

利用触发点疼痛原理进行肱骨外上髁炎诊断与治疗

目的 观察利用触发点疼痛原理对肱骨外上髁炎进行诊断与治疗的效果.方法 2002～2006年骨科门诊35例被诊断为肱骨外上髁炎的患者,主要累及肘外侧肌群.对发现有肌筋膜触发点疼痛的部位反复针刺、牵张锻炼和多种维生素、复方或冠心丹参片.结果 35例肱骨外上髁炎的患者都得到了有效的治疗,治疗前后的平均评分分别为4.4±1.03和1.2±0.4(P＜0.001).结论 肱骨外上髁肘外侧肌群肌筋膜疼痛综合征是肱骨外上髁炎的主要原因,对受累肌肉进行触发点疼痛治疗是一简易有效的方法.     

关节牵伸联合肌筋膜触发点按压治疗神经根型颈椎病的疗效观察

目的:探讨关节牵伸联合肌筋膜触发点按压治疗神经根型颈椎病的临床疗效.方法:选择2018年8月—2019年8月在浙江大学医学院附属金华医院康复科门诊就诊的神经根型颈椎病患者60例,随机分为观察组和对照组,每组30例,对照组采用肌筋膜触发点按压治疗,观察组在此基础上加用关节牵伸,2组均连续治疗4周.采用视觉疼痛模拟评分法(...     

体外冲击波疗法治疗肌筋膜疼痛综合征研究进展

肌筋膜疼痛综合征是临床常见的慢性肌肉疼痛综合征之一,其发病机制尚不明确,临床上对于该病的诊断及治疗尚无统一的标准,目前对于肌筋膜疼痛综合征的治疗手段多样,大体可分为侵入性治疗和非侵入性治疗,主要有针灸、药物治疗、激痛点注射、推拿、体外冲击波、超声波、冷冻疗法等,或单独或多种治疗方法联合应用,多取得了显著的临床效果。该病复发率高,严重影响患者的日常生活质量,临床上一般采用多种治疗方式联合应用,相对于单一治疗方式有其独特的优势,治疗效果显著,且不易复发,可明显减轻患者疼痛,因此针对不同患者及疾病发展情况应选择适宜的治疗方式。体外冲击波疗法目前已广泛应用于治疗肌筋膜疼痛综合征,并取得良好的临床疗效;其通过传导作用将能量逐层传递,降低病变肌筋膜自发电活动;不仅可以改善肌筋膜触发点区域的血液循环状态,降低肌张力,还可促进损伤肌筋膜的修复;同时体外冲击波疗法还可提高肌肉的机械痛阈。文章将对体外冲击波疗法治疗肌筋膜疼痛综合征的可能机制及治疗效果做一综述。     

针刺夹脊穴为主治疗腰背部肌筋膜疼痛综合征的临床观察

[目的]观察针刺夹脊穴为主治疗腰背部肌筋膜疼痛综合征(MPS)的临床疗效.[方法]将符合MPS诊断的患者60例随机分为针刺组与触发点局部阻滞组(对照组)各30例.针刺组采用针刺腰背部夹脊穴为主,配合肌筋膜触发点局部针刺;对照组采用利多卡因触发点局部阻滞治疗.1个疗程后应用视觉模拟量表(VAS)观察两组对MPS疼痛的影响.[结果]针刺组完全缓解3例,明显缓解12例,中度缓解13例,轻度缓解2例;对照组完全缓解4例,明显缓解9例,中度缓解15例,轻度缓解2例.两组疼痛缓解度中度以上的患者均占93.33%,两组比较差异无显著性意义(P>0.05),说明两组在缓解疼痛方面疗效相仿.治疗后两组VAS评分较治疗前均有显著下降(P<0.01),但组间比较,差异无显著性意义(P>0.05).[结论]针刺是治疗MPS的一种有效方法,其疗效与利多卡因局部阻滞法相仿,但能够避免利多卡因的副反应.     

锋钩针挑刺激痛点治疗腰部肌筋膜疼痛综合征临床研究

目的 :观察锋钩针挑刺激痛点(Tr P)治疗腰部肌筋膜疼痛综合征(MPS)的临床疗效。方法 :将56例患者采用随机数字表法分为观察组和对照组,每组28例。观察组采取锋钩针挑刺激痛点治疗,对照组采用普通针刺治疗。连续治疗10 d为1个疗程。以两组治疗前后疼痛视觉模拟量表(VAS)、功能障碍调查表(Roland-Morris)评分的变化情况来评价临床疗效。结果:两组患者1个疗程结束后,VAS、Roland-Morris评分与治疗前比较均有统计学意义,且观察组表现优于对照组(P<0.01)。观察组治疗后临床总有效率89.29%,优于对照组的64.29%(P<0.01)。结论:锋钩针挑刺激痛点治疗肌筋膜疼痛综合征疗效可靠。     

基于红外线热成像技术定位针刺肌筋膜触发点治疗腰背肌筋膜疼痛综合征的临床疗效

目的 观察基于红外线热成像技术定位针刺肌筋膜触发点治疗腰背肌筋膜疼痛综合征的临床疗效。 方法 选取2018年6月—2019年6月广西中医药大学附属瑞康医院诊治的60例MPS患者,按随机数字表法分为治疗组及对照组各30例,治疗组运用红外线热成像诊断技术定位并针刺灭活肌筋膜触发点,对照组则定位传统腧穴进行针刺,2组患者均隔天治疗1次,每周3次,共治疗2周,疗程结束后观察2组患者治疗前后红外线热成像分布图、McGill简化量表疼痛评分及临床疗效。 结果 2组患者治疗前疼痛分级指数(PRI)评分、视觉模拟评分法(VAS)评分及现有痛强度(PPI)评分比较(t=-0.399、-0.454、-0.210),差异均无统计学意义(均P>0.05);2组患者治疗后PRI、VAS及PPI评分均较同组治疗前降低,差异均具有统计学意义(均P<0.05),治疗后2组间PRI、VAS及PPI评分差异具有统计学意义(均P<0.05),且在改善程度上治疗组患者相对于对照组更为明显;同时治疗组腰背部高温区较治疗前明显降低,分布亦减少,而对照组腰背部高温区较治疗前亦有降低,分布亦减少,但与观察组相比在高温区及分布减少程度上仍有一定差距。 结论 通过红外线热成像图对肌筋膜触发点进行定位后针刺灭活治疗腰背部肌筋膜疼痛综合征是一种有效、快速、精准的治疗方法,值得临床推广应用。      

不同容量注射液触痛点注射在治疗肌筋膜痛综合征的应用研究

目的比较不同容量注射液触痛点注射在治疗肌筋膜痛综合征中的效果。方法选择48例肌筋膜痛综合征患者,随机分成A、B 2组,A组为试验组B组为对照组。A组每一触痛点注射配制液8～10 ml,B组每一触痛点注射配制液3～5 ml,观察2组患者在治愈率,并发症等的治疗效果并在疗程结束后随访1年。将2组结果进行统计学比较。结果第1疗程后A组治愈率优于B组(P<0.05)。第2疗程结束后2组患者治愈率的差异无统计学意义,2组患者均未有并发症发生。随访1年,B组有2例好转的患者复发,且A、B 2组患者治愈率的差异有统计学意义(P<0.05)。结论较大容量注射液触痛点注射较传统小容量注射治疗肌筋膜痛综合征在疗效及降低复发率方面有一定优点。     

Evidence and Expert Opinions: Drying Needling versus Acupuncture (Ⅰ)—The American Alliance for Professional Acupuncture Safety (AAPAS) White Paper 2016

In the last twenty years, in the United States and other Western countries, dry needling (DN) became a hot and debatable topic, not only in academic but also in legal fields. This White Paper is to provide the authoritative information of DN versus acupuncture to academic scholars, healthcare professional administrators, lawmakers, and the general public through providing the authoritative evidence and experts' opinions regarding critical issues of DN versus acupuncture, and then reach consensus. DN is the use of dry needles alone, either solid filiform acupuncture needles or hollow-core hypodermic needles, to insert into the body for the treatment of muscle pain and related myofascial pain syndrome. DN is sometimes also known as intramuscular stimulati on, trigger points (TrP) acupuncture, TrP DN, myofascial TrP DN, or biomedical acupuncture. In Western countries, DN is a form of simplified acupuncture using biomedical language in treating myofascial pain, a contemporary development of a portion of Ashi point acupuncture from Chinese acupuncture. It seeks to redefine acupuncture by reframing its theoretical principles in a Western manner. DN-like needling with filiform needles have been widely used in Chinese acupuncture practice over the past 2,000 years, and with hypodermic needles has been used in China in acupuncture practice for at least 72 years. In Eastern countries, such as China, since late of 1800s or earlier, DN is a common name of acupuncture among acupuncturists and the general public, which has a broader scope of indications, not limited to treating the myofascial pain.     

Evidence and Expert Opinions:Drying Needling versus Acupuncture(Ⅰ)——The American Alliance for Professional Acupuncture Safety(AAPAS) White Paper 2016

In the last twenty years,in the United States and other Western countries,dry needling(DN) became a hot and debatable topic,not only in academic but also in legal fields.This White Paper is to provide the authoritative information of DN versus acupuncture to academic scholars,healthcare professional administrators,lawmakers,and the general public through providing the authoritative evidence and experts' opinions regarding critical issues of DN versus acupuncture,and then reach consensus.DN is the use of dry needles alone,either solid filiform acupuncture needles or hollow-core hypodermic needles,to insert into the body for the treatment of muscle pain and related myofascial pain syndrome.DN is sometimes also known as intramuscular stimulation,trigger points(TrP) acupuncture,TrP DN,myofascial TrP DN,or biomedical acupuncture.In Western countries,DN is a form of simplified acupuncture using biomedical language in treating myofascial pain,a contemporary development of a portion of Ashi point acupuncture from Chinese acupuncture.It seeks to redefine acupuncture by reframing its theoretical principles in a Western manner.DN-like needling with filiform needles have been widely used in Chinese acupuncture practice over the past 2,000 years,and with hypodermic needles has been used in China in acupuncture practice for at least 72 years.In Eastern countries,such as China,since late of 1800 s or earlier,DN is a common name of acupuncture among acupuncturists and the general public,which has a broader scope of indications,not limited to treating the myofascial pain.     

Evidence and Expert Opinions: Drying Needling versus Acupuncture(Ⅱ)——The American Alliance for Professional Acupuncture Safety(AAPAS) White Paper 2016

In the United States and other Western countries, dry needling has been a topic in academic and legal fields. This White Paper is to provide the authoritative information of dry needling versus acupuncture to academic scholars, healthcare professionals, administrators, policymakers, and the general public by providing the authoritative evidence and expertise regarding critical issues of dry needling and reaching a consensus. We conclude that Dr. Travell, Dr. Gunn, Dr. Baldry and others who have promoted dry needling by simply rebranding(1) acupuncture as dry needling and(2) acupuncture points as trigger points(dry needling points). Dry needling simply using English biomedical terms(especially using "fascia" hypothesis) in replace of their equivalent Chinese medical terms. Dry needling is an over-simplified version of acupuncture derived from traditional Chinese acupuncture except for emphasis on biomedical language when treating neuromuscularskeletal pain(dry needling promoters redefined it as "myofascial pain"). Trigger points belong to the category of Ashi acupuncture points in traditional Chinese acupuncture, and they are not a new discovery. By applying acupuncture points, dry needling is actually trigger point acupuncture, an invasive therapy(a surgical procedure) instead of manual therapy. Dr. Travell admitted to the general public that dry needling is acupuncture, and acupuncture professionals practice dry needling as acupuncture therapy and there are several criteria in acupuncture profession to locate trigger points as acupuncture points. Among acupuncture schools, dry needling practitioners emphasize acupuncture's local responses while other acupuncturists pay attention to the responses of both local, distal, and whole body responses. For patients' safety, dry needling practitioners should meet standards required for licensed acupuncturists and physicians.