磁电刺激治疗盆底肌筋膜疼痛综合征疗效及相关因素分析

目的探讨骶神经磁刺激联合盆底肌电刺激治疗盆底肌筋膜疼痛综合征(MPPS)的疗效及其影响因素。方法收集2021年3月至2023年3月在嘉兴市妇幼保健院接受骶神经磁刺激联合盆底肌电刺激治疗的167例MPPS患者临床资料,比较治疗前后盆底表面肌电Glazer评估、盆底肌触痛视觉模拟评分(VAS)及女性性功能指数(FSFI);通过单因素和多因素分析筛选影响磁电刺激治疗MPPS效果的13个相关变量。结果治疗后,显效36例,有效69例,无效52例,总有效率为62.9%。盆底表面肌电Glazer评估显示,前静息电位、后静息电位及快肌恢复时间较治疗前显著下降,总分上升;盆底肌触痛VAS评分下降;FSFI评分上升,差异均有统计学意义(P<0.05)。单因素分析显示,年龄≥40岁,BMI≥24 kg/m^(2),病程≥1年,产次≥2次,既往有人流史,分娩巨大儿或双胎,治疗前盆底肌触痛VAS评分<7分为影响MPSS疗效的高危因素;多因素分析结果显示,年龄≥40岁,BMI≥24 kg/m^(2),分娩巨大儿或双胎,既往有人流史及治疗前盆底肌触痛VAS评分<7分为影响MPSS疗效的独立危险因素。结论骶神经刺激联合盆底肌电刺激治疗MPPS效果显著,疗效受年龄、BMI、分娩巨大儿或双胎、人流史及治疗前盆底肌疼痛程度影响。

Objective To explore the efficacy and influencing factors of sacral neuromodulation combined with pelvic floor electromyography stimulation in the treatment of myofascial pelvic pain syndrome(MPPS).Methods A retrospective analysis was conducted on 167 patients with MPPS who received sacral neuromodulation combined with pelvic floor electromyography stimulation treatment at Jiaxing Maternal and Child Health Hospital from March 2021 to March 2023.Clinical data before and after treatment were compared,including Glazer assessment of pelvic floor surface electromyography,visual analog scale(VAS)for pelvic floor muscle tenderness,and Female Sexual Function Index(FSFI).Univariate and multivariate analyses were used to select 13 variables that affect the treatment outcome of MPPS.Results After treatment,there were 36 cases of significant improvement,69 cases of effectiveness,and 52 cases of no effect,with a total effective rate of 62.9%.The Glazer assessment indicated a significant decrease in pre-resting potential,post-resting potential,and fast muscle recovery time after treatment,along with an increase in the total score.The VAS score decreased,and the FSFI score increased,with statistically significant differences(P<0.05).Univariate analysis found that age≥40 years,body mass index(BMI)≥24 kg/m^(2),disease course≥1 year,parity≥2 times,history of abortion,large-for-gestational-age infants or twins,and a pre-treatment VAS score of pelvic floor muscle tenderness<7 were high-risk factors affecting the efficacy of MPPS treatment.Multivariate analysis confirmed that age≥40 years,BMI≥24 kg/m^(2),large-for-gestational-age infants or twins,history of abortion,and a pre-treatment VAS score of pelvic floor muscle tenderness<7 were independent risk factors affecting the efficacy of MPPS treatment.Conclusion The combination of sacral neuromodulation and pelvic floor electromyography stimulation is significantly effective in treating MPPS,and its efficacy is influenced by factors such as age,BMI,large-for-gestational-age infants or twins,history of abortion,and the degree of pre-treatment pelvic floor muscle tenderness.