浅析疼痛与筋膜硬度的关联:基于斜角肌远端取穴与菱形肌局部取穴的针刺临床试验

Investigation of correlation between pain and fascia hardness:Clinical trail of acupuncture trigger point at scalenus muscle and ash point at rhomboid muscle

目的:针刺斜角肌激痛点和菱形肌阿是穴,测量针刺前后菱形肌筋膜硬度的变化,结合治疗前后患者疼痛视觉模拟评分(VAS)的改变,探讨远端取穴和局部取穴对筋膜硬度的影响及其与疼痛的关联。方法:选取2019年1月至2022年6月在首都医科大学附属北京世纪坛医院针灸科就诊的菱形肌筋膜疼痛综合征患者64例,随机分为试验组和对照组,每组32例。试验组取斜角肌激痛点,对照组取菱形肌痛处阿是穴。观察治疗前后患者VAS、菱形肌筋膜杨氏模量的变化。结果:治疗结束时,试验组VAS较对照组显著下降(P<0.01)。试验组针刺后菱形肌筋膜杨氏模量未见明显改变,对照组针刺后菱形肌筋膜杨氏模量显著下降(P<0.05)。结论:针刺斜角肌激痛点止痛效果优于针刺菱形肌阿是穴,单纯降低痛处筋膜硬度可能不是止痛最优解,结合远端取穴可能疗效更佳。

Objective:To investigate and understand the corresponding pains of the fascia hardness of acupuncture at the trigger point of the scalenus muscle,and the ash point of the rhomboid muscle based on the analysis of the visual analogue scale(VAS)of the patients before and after the treatment.Methods:Sixty-four patients with myofascial pain syndrome of rhomboid muscle were collected from Acupuncture Department of Beijing Shijitan Hosipital,Capital Medical University from Jan 2019 to Jun 2022.The patients were separated evenly into the test and control groups,with 32 in each group.VAS and Young's modulus were utilized to analyze the differences in the pain response on the triggered scalenus muscle in the test groups compared to the ash rhomboid muscle in the controlled group.Results:At the end of treatment,the VAS of the test group decreased significantly compared to the control group(P<0.01).The Young's modulus of the fascia in the control group decreased after acupuncture(P<0.05),but there was no statistically significant change in the Young's modulus of the fascia in the test group after acupuncture.Conclusion:The analgesic effect of acupuncture at the trigger point of the scalenus muscle is better than acupuncture at the ash point of the rhomboid muscle.Solely focusing on reducing the fascia hardness to alleviate the pain is not the best choice,and combined with distal acupoint selection may have better curative effect.