超声波联合悬吊运动在腰肌筋膜疼痛综合征中的应用效果及机制

Application and Mechanism of Ultrasound Combined with Suspension Exercise in Lumbar Myofascial Pain Syndrome

本研究建立了肌筋膜疼痛综合征动物模型,并采用超声波治疗模型大鼠,结果表明超声波治疗可明显减轻骨骼肌组织病变程度,并下调了大鼠脊髓SP和nNOS的表达,上调了5-HT的表达。为探讨超声波(ultrasound,US)联合悬吊运动疗法(sling exercise therapy,SET)治疗腰肌筋膜疼痛综合征(myofaseial pain syndrome,MPS)的临床疗效。本研究以自2016.04~2018.04期间在本院就诊的80例MPS患者为研究对象,随机分为两组(两组比例为1∶1):超声波治疗结合悬吊远动疗法为SET组,超声治疗结合传统推拿疗法为对照组。每次治疗时间为25 min,一天一次,每周治疗5次,连续治疗4周为一个疗程。结果表明:两组患者在治疗后,视觉模拟评分法VAS和腰痛Oswestry功能指数ODI评分、腰椎活动度均较治疗前有显著改善(p<0.05);治疗1周对于两组的改善效果差异不显著;而经过4周治疗后,SET组的改善程度明显优于对照组(p<0.05)。经过一个疗程(即4周)后,SET组的总有效率(92.5%)显著高于对照组(82.5%)(p<0.05)。以上结果表明:超声波对本病的治疗机制可能与下调脊髓SP和n NOS,并上调了5-HT有关。两种治疗方式在治疗前期都有良好的疗效,但随着治疗时间的增加,超声波联合悬吊运动疗法的疗效要显著优于传统疗法。

In this study,an animal model of myofascial pain syndrome was established the model rats were treated with ultrasound.Ultrasound treatment was found to significantly reduce the degree of skeletal muscle tissue lesions.Ultrasound treatment down-regulated the expression of SP and n NOS and up-regulated the expression of5-HT in rat spinal cord.To investigate the clinical effect of sling exercise therapy(SET)combined with ultrasound(US)in the treatment of myofascial pain syndrome(MPS).80 MPS patients admitted to our hospital from April2016 to April 2018 were selected as the study objects.According to the ratio of 1∶1,the patients were randomly divided into two groups:40 cases in the SET group received US combined with sling exercise therapy,40 cases in the control group received US combined with traditional massage therapy.Each treatment lasted about 25 minutes,once a day,5 times a week,for 4 consecutive weeks.As a results,the VAS and ODI score,lumbar activity(flexion and extension)of two groups were significantly improved than before treatment(p<0.05).After treatment for l week,the improvement of two groups has no significant difference(p>0.05).However,the SET group improved significantly better than the control group after treatment for 4 weeks(p<0.05).Besides,the total effective rate of the SET group(92.5%)was significantly higher than that of the control group(82.5%)after 4 weeks of treatment,the difference was statistically significant between the two groups(p<0.05).In conclusion,the therapeutic mechanism of ultrasound may be related to down-regulation of SP and nNOS and up-regulation of 5-HT.The two methods can achieve good early effect,but with the increase of treatment time,The curative effect of ultrasound combined with suspension exercise therapy was significantly better than that of traditional therapy.