肌筋膜疼痛触发点针刺与局封治疗网球肘疗效的对比研究

Study comparing acupuncture at the myofascial trigger points with local blocking at pain points in the treatment of tennis elbow

目的比较肌筋膜疼痛触发点针刺与局部痛点封闭治疗网球肘的临床疗效。方法将62例网球肘病人分为触发点针刺组32例和局部封闭组30例。局部封闭组患者在疼痛部位的封闭（1％的利多卡因＋确炎舒松）治疗后，回家进行前臂伸肌群牵张训练；触发点针刺组在局部封闭组基础上增加有关触发点针刺治疗，1次／周，1-2次为1疗程。对每组患者治疗前及治疗后1个月进行视觉模拟评分，观察治疗后疼痛改善情况。2年后随访，观察其复发率。结果触发点针刺组疗效优21例，良9例，差2例；痛点封闭组优13例，良8例，差9例，触发点针刺组疗效优于痛点封闭组。两组治疗前后视觉模拟评分比较，差异有统计学意义（P〈0．05）；组问前后视觉模拟评分比较差异无统计学意义（P=0．12l8）。2年后远期疗效比较，差异有统计学意义（P〈0．05）。结论触发点针刺治疗网球肘患者疗效更持久，能有效解决其疼痛。

Objective To compare the clinical therapeutic effect of acupuncture at the myofascial trigger points and local blocking at pain points for the treatment of tennis elbow. Methods 62 cases with tennis elbow were divided into 2 groups, with 32 cases treated by acupuncture at the trigger points of myofascial pain and 30 cases treated by local blocking at pain points. Patients in local blocking group were treated by 1% lidocaine plus Triamcinolone injection at pain points. Then they were required to do stretching exercise of the forearm extensor muscles group. Patients in acupuncture group were treated by local blocking, followed by acupuncture at the trigger points of myofascial pain. Both groups were treated once a week, 1 to 2 sessions constituting a therapeutic course. The pain intensity before and one month after the treatment were evaluated using the visual analogue scale（ VAS）, After 2 years of follow-up, the recurrent rate was observed. Results In acupuncture group, the numbers showing excellent effect, good effect, and poor effect were 21, 9, and 2 respectively. In local blocking group, the numbers showing excellent effect, good effect, and poor effect were 13, 8, and 9 respectively. The short-term effect of acupuncture group was better than that of local blocking group. There was significant difference between the VAS score before and after the treatment in each group （P 〈 0.05）. The VAS score between two groups showed no difference, while the long-term effect of acupuncture group was better than that of local blocking group （P 〈 0.05）. Conclusion Acupuncture at the myofaseial trigger points combined with local blocking at pain points in treating tennis elbow shows the advantage of better and longer effect compared with local blocking at pain points alone.