肌筋膜指法放松配合神经肌肉电刺激治疗盆底痛疗效及对盆底肌肌力和并发症的影响

Efficacy of myofascial fingering relaxation combined with neuromuscular electrical stimulation for treating patients with pelvic floor pain and its influence on the pelvic floor muscle strength and complications

目的:探究肌筋膜指法放松配合神经肌肉电刺激治疗盆底痛疗效及对患者临床症状、盆底肌肌力和并发症的影响。方法:选取2021年8月-2023年7月来院就诊的198例盆底痛患者,随机数表法分为电刺激组和指法组各99例,电刺激组采用神经肌肉电刺激治疗,指法组在此基础上联合肌筋膜指法放松。比较两组临床疗效,治疗前、治疗7天、治疗28天、停止治疗14天临床症状[疼痛视觉模拟量表评分(VAS)、Oswestry功能障碍指数(ODI)],治疗前后盆底肌肌力分级、盆底肌电指标(前静息电位、后静息电位、快速收缩、持续收缩)、盆底肌障碍评估(PFIQ-7)、并发症和疾病复发情况。结果:治疗4周后指法组总有效率(89.9%)高于电刺激组(79.8%)(P<0.05);治疗7天、治疗28天、停止治疗14天,两组VAS、ODI评分逐渐下降且指法组均低于电刺激组,治疗后两组盆底肌肌力分级均优于治疗前且指法组优于电刺激组,两组前静息电位、后静息电位波幅均下降,快速收缩、持续收缩均上升,且指法组前静息电位、后静息电位波幅低于电刺激组,两组PFIQ-7评分均下降且指法组均低于电刺激组(均P<0.05)。治疗期间两组均未出现明显并发症;治疗后随访3个月,疼痛复发电刺激组(8.1%)与指法组(3.0%)无差异(P>0.05)。结论:肌筋膜指法放松配合神经肌肉电刺激可提高治疗盆底痛疗效,有效临床症状,提升盆底肌肌力和活动功能作用,治疗安全。

Objective:To explore the efficacy of myofascial fingering relaxation combined with neuromuscular electrical stimulation for treating patients with pelvic floor pain,and to study its influence on the clinical symptoms,pelvic floor muscle strength and complications of the patients.Methods:198patients with pelvic floor pain who visited the hospital were enrolled and were divided into two groups(99cases in each group)according to the random number table method from August 2021to July 2023.The patients in group A were treated with neuromuscular electrical stimulation,while the patients in group B were given myofascial fingering relaxation combined with neuromuscular electrical stimulation.The clinical efficacy,the clinical symptoms scores evaluated by visual analogue scale(VAS)and Oswestry dysfunction index(ODI)before treatment,in 7and 28days of treatment and after 14days of treatment,the pelvic floor muscle strength grading,the pelvic floor electromyography indicators before and after treatment,such as anterior resting potential,posterior resting potential,rapid contraction and continuous contraction,the score of pelvic floor impact questionnaire(PFIQ-7),the complications rate and the recurrence of the pelvic floor pain of the patients were compared between the two groups.Results:After 4weeks of treatment,the total effective rate(89.9%)of the patients in group B was significantly higher than that(79.8%)of the patients in group A(P<0.05).In 7days of treatment,in 28days of treatment,and after 14days of treatment,the VAS and ODI scores of the patients in the two groups had decrease gradually,and which of the patients in group B were significantly lower than those of the patients in group A.The pelvic floor muscle strength grade of the patients in the two groups after treatment was significantly better than that before treatment,and which of the patients in group B was significantly better than that of the patients in group A.The amplitude of anterior and posterior resting potential of the patients in the two groups had decreased significantly,and the rapid contraction and sustained contraction of the patients in the two groups had increased significantly.The amplitude of anterior and posterior resting potential of the patients in group B was significantly lower than that of the patients in group A.The score of PFIQ-7of the patients in both groups had decreased significantly,and which of the patients in group B was significantly lower than that of the patients in group A(all P<0.05).There was no patient with obvious complication in the two groups during the treatment.In 3months of follow-up after treatment,there was no significant difference in the pain recurrence rate(8.1%vs.3.0%)of the patients between the two groups(P>0.05).Conclusion:Myofascial fingering relaxation combined with neuromuscular electrical stimulation for treating the patients with pelvic floor pain can improve their curative effect,effectively relieve their clinical symptoms,improve the pelvic floor muscle strength and functional function,and with the safety of treatment.