剪切波弹性成像在肌筋膜疼痛综合征中的临床应用价值

Clinical application value of shear wave elastography in myofascial pain syndrome

目的应用剪切波弹性成像观察肌筋膜疼痛综合征患者肌筋膜疼痛触发点(MTrPs)处肌肉弹性改变情况,观察其在中医手法治疗中的应用。方法收集我院收治的60例肌筋膜疼痛综合征患者(观察组)和60例健康体检者(对照组)为研究对象,均行剪切波弹性成像检测,比较观察组与对照组肌肉杨氏模量值(E)、组织剪切波速度(SWV)、上斜方肌厚度、目测类比等级(VAS)评分。以后期病理生理学检测结果为标准,绘制受试者工作特征(ROC)曲线分析剪切波弹性成像诊断MTrPs的价值。根据观察组患者定位MTrPs方式差异分为2个亚组:常规组(30例)和辅助组(30例),对比常规组与辅助组治疗前和治疗后15 d的VAS评分、疼痛分级指数(PRI)评分、现有疼痛强度(PPI)评分,以及治疗1、2、3个疗程后的疼痛缓解显效率。结果观察组MTrPs处肌肉E、SWV、上斜方肌厚度、VAS评分均高于对照组,差异均有统计学意义(均P<0.05)。ROC曲线分析显示,剪切波弹性成像诊断MTrPs的曲线下面积为0.948,敏感性为95.24%,特异性为94.44%,诊断准确率为95.00%。通过对比疗效发现,辅助组1、2、3个疗程治疗后的疼痛缓解显效率均显著高于常规组,治疗后15 d的VAS评分、PRI评分、PPI评分均低于常规组,差异均有统计学意义(均P<0.05)。结论剪切波弹性成像评估肌筋膜疼痛综合征患者MTrPs处肌肉弹性改变具有较高的特异性和敏感性,有助于中医手法治疗定位,具有重要的临床价值。

Objective To evaluate the changes in muscle elasticity at the trigger points of myofascial pain trigger point(MTr Ps)by shear wave elastography in patients with myofascial pain syndrome,and to observe its application in the treatment of traditional Chinese medicine.Methods Sixty patients with myofascial pain syndrome(observation group)and 60 healthy subjects(control group)were selected,and all underwent shear wave elastography.The values of Young’s modulus(E)tissue shear wave velocity(SWV),upper trapezius muscle thickness,visual analog scale(VAS)score between the two group were compared,Based on the results of later pathophysiological testing as the evaluation standard,the receiver operating characteristic(ROC)curve was drawn to analyze the value of shear wave elastography in diagnosing muscle elasticity changes.The observation group was divided into the conventional group(30 group)and the auxiliary group(30 group)according to the difference in treatment methods.The simplified Mc Gill pain(simplified SF-MPQ)scores of 15 d before and after treatment were compared between the two groups.The pain relief efficiency was calculated after 1,2 and 3 courses of treatment.Results The E,SWV,upper trapezius muscle thickness,and VAS scores of MTr Ps in the observation group were higher than those in the control group,and the differences were statistically significant(all P<0.05).ROC curve analysis showed that the area under the curve of shear wave elastography in diagnosing MTr Ps was 0.948,the sensitivity was 95.24%,the specificity was 94.44%,and the diagnostic accuracy rate was 95.00%.By comparing the efficacy of the two groups,the results showed that the pain relief efficiency of the auxiliary group after 1 course,2 courses,and 3 courses were significantly higher than those of the conventional group.The VAS score,pain classification index score,existing pain intensity scores of 15 d after treatment were all lower those of than the conventional group,the differences were statistically significant(all P<0.05).ConclusionShear wave elastography has high specificity and sensitivity in assessing the changes in muscle elasticity at MTr Ps in patients with myofascial pain syndrome.It is assisted in the treatment of traditional Chinese medicine to better relieve pain.