经皮电刺激疗法结合生物反馈治疗对盆底肌筋膜疼痛综合征的疗效评价

Evaluation of the efficacy of transcutaneous electrical nerve stimulation combined with biofeedback therapy for myofascial pelvic pain syndrome

目的评估经皮电刺激疗法结合生物反馈治疗对盆底肌筋膜疼痛综合征的临床疗效。方法选取2018年9月至2019年9月于遵义医科大学附属医院妇科门诊就诊,按照纳入标准及排除标准确诊为盆底肌筋膜疼痛综合征的患者107例,给予经皮电刺激治疗结合生物反馈治疗,共10次。对比患者治疗前后主观疼痛感觉视觉模拟评分(VAS)、盆底肌筋膜压痛感觉视觉模拟评分(VAS)及疼痛缓解程度,同时对比治疗前后盆底表面肌电变化情况以评估盆底肌功能。结果107例患者平均年龄(38.24±5.99)岁,治疗前后患者疼痛感觉VAS评分分别为7(6,8)分和2(1,3)分,治疗前后盆底肌压痛VAS评分分别为8(8,9)分和3(2,5)分,均有明显下降(P<0.05)。盆底表面肌电值:治疗前后的前静息电位平均波幅分别为(8.15±1.52)μv和(4.59±1.80)μv,后静息电位平均波幅分别为(8.01±1.25)μv和(3.56±1.43)μv,均有明显下降(P<0.05)。疼痛完全缓解者38例(35.5%),明显缓解者52例(48.6%),中度缓解者8例(7.5%),轻微缓解者5例(4.7%),无效者4例(3.7%),总有效率96.3%(103/107)。结论TENS结合BFB能够有效的减轻MPPS患者的疼痛症状及降低盆底肌压痛评分,降低盆底肌肉静息阶段的肌电波幅,减轻盆底肌肉的痉挛,改善盆底肌的舒缩状况。

Objective To evaluate the clinical efficacy of transcutaneous electrical nerve stimulation combined with biofeedback therapy for myofascial pelvic pain syndrome.Methods A total of 107 patients diagnosed with myofascial pelvic pain syndrome according to inclusion criteria and exclusion criteria were selected from the gynecological outpatient department of our hospital from September 2018 to 2019.Visual analogue scale(VAS)of subjective pain sensation,visual analogue scale(VAS)of pelvic floor myofascial tenderness and pain relief degree of patients before and after treatment were compared,and surface electromyography of pelvic floor changes before and after treatment were compared to evaluate pelvic floor muscle function.Results The average age of 107 patients was(38.24±5.99)years old,the pain VAS scores of patients before and after treatment were 7(6,8)and 2(1,3),and the pelvic floor muscle tenderness VAS scores before and after treatment were 8(8,9)and 3(2,5),respectively,with a significant decrease(P<0.05).Surface electromyography of pelvic floor value:Before and after treatment,the average amplitude of the former resting potential was(8.15±1.52)V and(4.59±1.80)V,respectively,and that of the latter was(8.01±1.25)V and(3.56±1.43)V,respectively,with significant decreases(P<0.05).There were 38 cases of complete remission(35.5%),52 cases of significant remission(48.6%),8 cases of moderate remission(7.5%),5 cases of mild remission(4.7%),and 4 cases of inefficacy(3.7%),with a total response rate of 96.3%(103/107).Conclusion TENS combined with biofeedback therapy can effectively relieve the pain symptoms and pelvic floor muscle tenderness score of MPPS patients,relieve the electromyography amplitude of the resting stage of pelvic floor muscles,relieve the spasm of pelvic floor muscles,and improve the contraction of pelvic floor muscles.