电刺激结合按摩对产后盆腔肌筋膜疼痛的疗效研究

Curative effect of electrical stimulation combined with massage on postpartum myofascial pelvic pain

目的 探讨神经肌肉电刺激结合手法按摩对产后盆腔肌筋膜疼痛的治疗效果。方法 研究对象为产后6～8周检查时发现的盆腔梨状肌和闭孔肌肌筋膜疼痛的女性489例，随机分为电刺激组（ A组）、手法按摩组（ B组）、电刺激＋手法按摩组（C组），A组采用神经肌肉电刺激方法治疗（法国PHENIX盆底康复系列治疗仪），B组应用手法按摩肌筋膜疼痛处深部及相关穴位，C组结合电刺激＋手法按摩，共治疗6次。记录所有研究对象此次分娩的基本情况，应用疼痛数值评分量表（ NRS）评估疼痛的严重程度，并进行轻、中、重度的分类。同时应用PHENIX盆底仪检测患者的阴道平均动态压力，治疗结束后评估相关指标的变化情况。结果 产后女性盆腔肌筋膜疼痛的发生率为21．38％。治疗后3组轻、中、重度疼痛人数的比较有显著性差异（χ^2=473．815，P＜0．05），其中C组数值显著低于A、B两组（z值分别为－18．344、－18．261，均P＝0．000）。经治疗6次后盆腔肌筋膜疼痛症状缓解明显，混合性疼痛疗效组间差异显著（χ^2=6．110，P＝0．047），C组的疗效明显优于A组（χ^2=5．091，P＝0．038），而A组与B组及B组与C组组间比较无统计学差异（χ^2分别为1．829、1．265，P值分别为0．364、0．444）。治疗前后3组的阴道平均动态压力无明显改变（t值分别为1．142、0．785、1．569，均P＞0．05）。结论 神经肌肉电刺激结合手法按摩可有效治疗产后盆腔肌筋膜疼痛，但可能不是通过阴道平均动态压的改变发挥作用，具体机制有待于进一步研究。

Objective To investigate the effect of neuromuscular electrical stimulation combining massage therapy on postpartum myofascial pelvic pain （ MFPP） .Methods A total of 489 women suffering from pelvic piriformis and/or obturator myofascial pain detected in check at 6-8 week after childbirth were recruited and were randomly divided into three groups ： group A （ electrical stimulation group ） , group B （ massage group ） and group C （ electrical stimulation combining massage group ） .Group A was treated by neuromuscular electrical stimulation （ PHENIX Neuromuscular Electrical Stimulation Therapy System , France ） , group B with massage to press the deep part of pelvic piriformis and obturator myofascial pain point , and group C with electrical stimulation treatment combined with massage for six times in all.The clinical data of the women were recorded .The degree of MFPP was evaluated by using Numerical Rating Scale （ NRS） and classified into mild, moderate or severe pain .In addition, the vaginal dynamic pressure was assessed using PHENIX instrument .Results The prevalence of MFPP in postpartum women was 21.38%.The number of women with mild , moderate and severe pain in three groups reduced significantly after treatment （χ^2=473.815,P〈0.05）.In addition, the NRS score of group C was significantly lower than that of group A and group B after treatment （z value was -18.344 and -18.261, respectively, both P =0.000）.The rate of MFPP was significantly different among three groups （χ^2=6.110,P=0.047）.The curative effect of group C was significantly superior to group A （χ^2=5.091,P=0.038）, but there was no significant difference between group A and group B , group B and group C （χ^2value was 1.829 and 1.265, respectively, P was 0.364 and 0.444, respectively ）.The vaginal dynamic pressure in three groups did not changed significantly after treatment （t value was 1.142, 0.785 and 1.569, respectively, all P〉0.05）.Conclusion Neuromuscular electrical stimulation combined with massage is effective for relieving postpartum MFPP , which might not affect and regulate vaginal dynamic pressure.Further studies are needed to determine its effectiveness in the future .