“通关利窍”针刺法治疗卒中后吞咽障碍的主穴定位解剖学研究

Anatomical study of the main points of"Tongguan Liqiao"acupuncture method in the treatment of post-stroke dysphagia

目的利用现代影像学技术探讨“通关利窍”针刺法主穴(风池、完骨、翳风)的针刺作用靶点及操作安全性。方法利用CT三维重建技术,围绕风池、完骨、翳风3个有别于传统针刺手法的穴位开展影像学研究,描记针刺操作下的穴位局部解剖结构。结果3个穴位在头颈部逐层解剖断面结构,风池:皮肤-胸锁乳突肌与斜方肌间-头夹肌-头半棘肌,其深层有颈丛神经的分支和副神经通过;完骨:皮肤-胸锁乳突肌-头夹肌-头半棘肌-头最长肌,其浅层有耳大神经分布到腮腺以及咬肌下部;翳风:皮肤-胸锁乳突肌前部-茎乳孔下方-咽缩肌,其深层有面神经通过,伴有舌咽、迷走、副神经走行。CT图像显示风池、完骨、翳风针刺过程中未触及椎动脉、颈动脉鞘、脊髓等重要组织结构,且所有患者针刺后均未出现头晕、头痛、局部感染等不良反应。结论“通关利窍”针刺法中风池、完骨、翳风操作安全,针刺作用可能与面神经、迷走神经、舌咽神经、副神经相关,为临床规范化操作及疗效机制研究提供参考。

Objective Modern imaging technology was utilized to explore the acupuncture targets and operation safety of the main points of the"Tongguan Liqiao"acupuncture method,including Fengchi(GB 20),Wangu(GB 12),Yifeng(TE 17),so as to ensure the standardization and clinical effectiveness,and to promote further application.Methods This study mapped the local anatomical structure of three main acupoints during needle insertion,whose operation are different from traditional acupuncture methods,using CT three-dimensional reconstruction technology.Results Three acupoints in the head and neck are dissected layer by layer.GB 20:skin,between sternocleidomastoid and the trapezius,splenius capitis,semispinalis capitis,with branches of cervical plexus and accessory nerve passing through its deep layer of the acupoint;GB 12:skin,sternocleidomastoid,splenius capitis,semispinalis capitis,longissimus capitis,with the superficial distribution of the greater auricular nerve to the parotid gland and the lower part of the masseter muscle.TE 17:skin,anterior part of sternocleidomastoid,below stylomastoid foramen,pharyngeal muscles,with the facial nerve passing through its deep layers,accompanied by glossopharyngeal nerve,vagus and accessory nerve.The CT images showed that during the process of needling GB 20,GB 12,and TE 17,the vertebral artery,carotid artery sheath,spinal cord,and other important tissue structures were not touched.Additionally,all patients did not experience adverse reactions such as dizziness,headache,or local infection after needling.Conclusions The operation of main points(GB 20,GB 12,TE 17)of"Tongguan Liqiao"acupuncture method is safe.The effect of acupuncture may be related to the facial nerve,vagus nerve,glossopharyngeal nerve and accessory nerve,providing reference for research on therapeutic mechanism.