颈型颈椎病阿是穴的超声影像研究

Ultrasonic imaging research at Ashi points in neck-type cervical spondylosis

目的:使用高频超声成像对颈型颈椎病的阿是穴(包括压痛点和动痛点)进行初步定位和定性研究,探索其规律,为针灸治疗方案的选择提供依据。方法:选取符合颈型颈椎病诊断标准的患者30例,每位患者均同时具有可定位在3条定位线任意一条线上的动痛点、压痛点及对照点,使用点对点高频超声实时动态成像技术,扫查定位每个点并记录其超声层次解剖及肌束膜二维超声改变、二维及彩色多普勒声像图、血流丰富程度,分析其超声特征。结果:(1)超声层次解剖及肌束膜二维超声改变:患者的动痛点和压痛点处解剖层次依次为皮肤层、皮下脂肪层、浅层肌肉组织层、深层肌肉组织层、椎骨,皮肤为线状高回声,皮下脂肪层为低回声,肌筋膜为线状高回声,肌层以低回声为主,其内肌束膜呈清晰的线状等回声,椎骨为强回声后方回声衰减。与对照点相比,动痛点93.3%(28/30)表现为肌束膜回声增强或者增厚(P<0.05),压痛点96.7%(29/30)表现为肌束膜回声增强或者增厚(P<0.05),动痛点和压痛点之间比较差异无统计学意义(P>0.05);(2)二维及彩色多普勒声像图:二维声像图中肌束膜呈清晰的线状等回声,动痛点和压痛点中肌束膜表现为回声增强或增厚。彩色多普勒声像图中动痛点及压痛点可见闪烁不稳定点状血流信号或稳定短棒状血流信号;(3)血流丰富程度:动痛点中有56.7%(17/30)的点数彩色血流信号达到Ⅱ级,压痛点中有83.3%(25/30)的点数彩色血流信号达到Ⅱ级,对照点中无(0/30)点数彩色血流信号达到Ⅱ级,动痛点和压痛点血流信号达到Ⅱ级的比率较对照点差异均有统计学意义(均P<0.05),而动痛点和压痛点比较差异无统计学意义(P>0.05)。结论:颈型颈椎病的动痛点和压痛点在高频超声成像中,具有一定的声像图特征,动痛点和压痛点的声像图特征相似,高频超声成像对颈型颈椎病阿是穴具有定位及定性价值,对治疗也有一定的指导意义。

Objective To conduct the preliminary positioning and qualitative research of high-frequency ultra- sonic imaging at Ashi points （including tender points and trigger points） in neck-type cervical spondylosis and explore the relevant law so as to provide the evidence for the selection of acupuncture scheme. Methods Thirty pa- tients in compliance with the diagnostic criteria of neck-type cervical spondylosis were selected. The trigger points, tender points and placebo points were positioned on any of the three available oriented lines. The point-to-point high-frequency real-tlme dynamic ultrasonic imaging technology was used to scan and position each point and record the changes in ultrasound gradation anatomy and two-dimensional ultrasound in perimys;um, two-dimensional and color Doppler ultrasonography and blood flow. The ultrasound characteristics were analyzed. Results ①Regard- ing the changes in ultrasound gradation anatomy and two-dimensional ultrasound in perimysium, the anatomic gradation at trigger points and tender points was in the sequence as cutaneous layer, subcutaneous fat layer, shallow muscular tissue layer, deep muscular tissue layer and vertebrae. The linear high echo presented in cutaneous layer; the low echo in subcutaneous fat layer; the linear high echo in muscular fasciae; the low echo in muscular layer and the clear linear echo in Its perimysium; the high echo and declined posterior echo in vertebrae. Compared with the placebo points, 93. 3% of trigger points （28/30） presented enhanced or thickened perimysmm echo （P〈0. 05）, and 96.7% of tender points （29/30） presented enhanced or thickened perimysium echo （P〈0. 05）. The differences were not significant between the trigger points and the tender points （P〉0.05）. ②In the two-dimensional ultrasonography, the clear linear echo presented in perimysium, the enhanced or thickened echo in perimysium of trigger points and tender points. In the color Doppler ultrasonography, the blinking unstable dotted blood flow sigal or stable short rod-like blood flow signal presented in the trigger points and tender points. ③Regarding the condition of blood flow, 56.7% of trigger points （17/30） presented Ⅱ degree of color blood flow signal and 83. 3% of tender points （25/30） presented Ⅱ degree of color blood flow signal;0% of placebo points presented Ⅱ degree of color blood flow signal. Compared with the placebo points, the differences in the rate of Ⅱ degree of color blood flow signal were significant statistically at both the trigger points and the tender points （both P〈0.05）. The difference was not significant between the trigger points and tender points （P〉 0. 05 ）. Conclusion In the high-frequency ultrasound imaging at trigger points and tender points in neck-type cervical spondylosis, the ultrasound imaging characteristics present, which are similar between the trigger points and the tender points. The high-frequency ultrasound imaging is valuable in positioning and quantitative research of Ashi points in cervical spondylosis and has a certain significance to guide treatment.