触发点针刺联合手法松解及低频脉冲电刺激治疗产后盆底肌筋膜疼痛综合征临床研究

Clinical Study on Trigger Point Acupuncture Combined with Manipulative Release and Low-Frequency Pulse Electrical Stimulation in Treatment of Postpartum Myofascial Pelvic Pain Syndrome

目的:观察触发点针刺联合手法松解及低频脉冲电刺激治疗产后盆底肌筋膜疼痛综合征(MPPS)的疗效。方法:选择产后MPPS患者195例,按随机数字表法分为对照组、手法电刺激组、综合治疗组,每组各65例。对照组给予生活方式干预及指导,手法电刺激组给予触发点手法松解与低频脉冲电刺激治疗,综合治疗组在手法电刺激组的基础上配合触发点针刺。手法电刺激组和综合治疗组均隔日治疗1次,以7次治疗为1个疗程,第1疗程结束后休息7 d开始第2疗程,共治疗2个疗程。治疗前后对三组患者进行简化McGill疼痛量表评分和Oswestry功能障碍指数(ODI)评分,并通过盆底肌电图评估比较三组患者盆底肌筋膜高张与肌肉收缩状态;治疗后评价三组临床疗效及不良反应情况。结果:与治疗前比较,手法电刺激组与综合治疗组治疗后简化McGill疼痛量表评分与ODI均降低(P<0.01),盆底前、后静息电位值明显降低(P<0.01),盆底肌收缩值明显升高(P<0.01),且综合治疗组治疗后上述指标均优于对照组和手法电刺激组(P<0.05或P<0.01)。对照组、手法电刺激组、综合治疗组的总有效率分别为11.29%、88.52%、93.55%,三组临床疗效比较,差异有统计学意义(P<0.001)。治疗过程中,手法电刺激组和综合治疗组有极少数患者出现轻微不良反应,均未经特殊处理而消失。结论:触发点针刺联合手法松解及低频脉冲电刺激可缓解产后MPPS患者疼痛症状,改善患者日常功能及盆底肌筋膜高张与肌肉收缩状态,疗效确切,安全性较高。

Objective:To observe the curative efficacy of trigger point acupuncture combined with manipu-lative release and low-frequency pulse electrical stimulation on postpartum myofascial pelvic pain syndrome(MPPS).Methods:A total of 195 patients with postpartum MPPS were divided into control group,manipulation and electrical stimulation group,and comprehensive treatment group according to the random number table method.The control group was given lifestyle intervention and guidance,the manipulation and electrical stimulation group was given trigger point manipulative release and low-frequency pulse electrical stimulation,and the comprehensive treatment group was added trigger point acupuncture on the basis of the manipulation and electrical stimulation group.Both the manipulation and electrical stimulation group and comprehensive treatment group were treated once every other day,with 7 treatments as a course of treatment.After the end of the first course of treatment,the patients took a rest for 7 days and then started the second course of treatment.Before and after treatment,the simplified McGill pain scale score and Oswestry dysfunction index(ODI)were compared among the three groups,and the pelvic floor myofascial hypertensition and muscle contraction of the patients in the three groups were compared by pelvic floor electromyogram.The clinical curative efficacy and adverse reactions of the three groups were evaluated after treatment.Results:After treatment,in both the manipulation and electrical stimulation group and comprehensive treatment group,the simplified McGill pain scale score and ODI were decreased compared with those before treatment(P<0.01),the value of anteroposterior resting potential of the pelvic floor was significantly decreased compared with those before treatment(P<0.01),and the muscle contraction value of the pelvic floor was significantly increased compared with those before treatment(P<0.01).The above indicators in the comprehensive treatment group were better than those in the control group and those in the manipulation and electrical stimulation group(P<0.05 or P<0.01).The total effective rate of the control group,the manipulation and electrical stimulation group and the comprehensive treatment group was 11.29%,88.52%and 93.55%respectively,and the differences of clinical curative efficacy among the three groups were statistically significant(P<0.001).During the treatment,a small number of patients in the manipulation and electrical stimulation group and the comprehensive treatment group had mild adverse reactions which disappeared without special treatment.Conclusions:For patients with postpartum MPPS,trigger point acupuncture combined with manipulative release and low-frequency pulse electrical stimulation can relieve the pain symptoms,improve the daily function and the myofascial hypertension and muscle contraction state of pelvic floor,with definite efficacy and high safety.