Similarities and differences between the trigger point of myofascial pain and the traditional meridian points

In recent years,the treatment of myofascial pain trigger point is a relatively popular technology,many people regard it as"Ashi point"in meridian theory,but compared with the traditional meridian theory,the description of myofascial pain trigger point is more intuitive and easier to master.This paper expounds the similarities and differences between myofascial pain trigger point and traditional meridian theory from the aspects of theory,basic research and clinical application,in order to provide a specific idea for the scientific interpretation of meridian phenomenon in traditional Chinese medicine.

Trigger points and sensitized acupoints:same book,different covers?

Acupoints and trigger points in traditional Chinese medicine represent two different minimally invasive therapy systems-based,respectively,on traditional acupuncture and dry needles.Many studies argue that trigger points and traditional acupoints are conceptually similar because they generally have identical locations on the human body.However,whether trigger points contribute to the formation of the traditional acupuncture technique is controversial.Although many relevant studies have been conducted,this controversy continues to hinder the development of both disciplines.Recently,researchers of Chinese acupuncture have proposed the“acupoint sensitization”theory,which postulates that traditional acupoints may be sensitized by diseases,environments,and therapies.This turns them into a“sensitized state.”Recent studies suggest that trigger points and sensitized acupoints share similar biological properties.To clarify the above-mentioned confusion,we reviewed relevant studies on these two concepts and attempted to analyze their relationship.In this paper,we provide a general summary of acupoint sensitization theory and sensitized acupoints.We then compare trigger points with sensitized acupoints by categorizing their similarities and differences,including location and range,pathological morphology,pain perception,surface temperature effects,and bioelectrical properties.We believe that,because trigger points and sensitized acupoints have many shared properties,they might constitute“the same book with different covers.”

Modulation effects of pressing manipulation on local inflammatory responses and ERK/NF-κB pathway in trigger point model rats

Objective:To investigate the mechanism of trigger point deactivation induced by pressing manipulation in a rat model and to explore its potential regulation of the inflammatory response through the extracellular signal-regulated kinase(ERK)/nuclear factor-κB(NF-κB)pathway.Methods:Fifty male Sprague-Dawley rats were randomly divided into a blank group,a model group,a pressing manipulation group,an ERK agonist group,and a pressing manipulation+ERK agonist group,with 10 rats in each group.Except for the blank group,rats in other groups were used to establish the trigger point rat model using the blunt blow combined with the eccentric exercise method.The pressing manipulation group underwent pressing manipulation intervention at the trigger points.The ERK agonist group received an injection of recombinant human epidermal growth factor via the tail vein.The pressing manipulation+ERK agonist group received interventions from both the pressing manipulation and ERK agonist groups.The pressure pain threshold(PPT)was measured by a mechanical pain threshold detector before and after the intervention.The histological changes were evaluated by hematoxylin-eosin staining after the intervention;the expression levels of ERK,phosphorylated ERK(p-ERK),NF-κB p65(p65),phosphorylated NF-κB p65(p-p65),and phosphorylated NF-κB inhibitor(p-IκB)were detected by Western blotting;the levels of interleukin(IL)-1β,IL-6,and tumor necrosis factor(TNF)-αwere detected by enzyme-linked immunosorbent assay.Results:The PPT increased(P<0.05);the inflammatory cells disappeared;the ratios of p-ERK/ERK,p-p65/p65,and p-IκB/β-actin,also the levels of IL-1β,IL-6,and TNF-αall decreased in the pressing manipulation group after the intervention compared with the model group(P<0.05).The PPT decreased significantly(P<0.05),the inflammatory cell presence increased,and the ratios of p-ERK/ERK and p-p65/p65 were elevated(P<0.05);additionally,the levels of IL-6 and TNF-αwere significantly higher in the pressing manipulation+ERK agonist group compared with the pressing manipulation group(P<0.05).The PPT was significantly lower(P<0.05),the inflammatory cell count was higher,the ratios of p-ERK/ERK and p-IκB/β-actin and the levels of IL-1βand TNF-αwere significantly higher in the ERK agonist group compared with the pressing manipulation+ERK agonist group(P<0.05).Conclusion:Pressing manipulation can effectively alleviate inflammation and pain in trigger point model rats,potentially by inhibiting the ERK/NF-κB signaling pathway.

Application of TREM-1 in peripheral blood as a switching point for sequential ventilation of patients with chronic obstructive pulmonary disease complicated with respiratory failure

Objective:To investigate the application of peripheral blood triggering receptor expressed on myeloid cells-1(TREM-1)for sequential treatment switching points in patients with chronic obstructive pulmonary disease(COPD)complicated with respiratory failure.Methods:A total of 120 cases of COPD patients with respiratory failure from June 2017 to December 2018 were randomly divided into two groups:60 cases in the control group and 60 cases in the observation group.The control group received spontaneous breathing trials for 2 h to select the time for non-invasive positive pressure ventilation,while the observation group received peripheral blood TREM-1(≤90.0 pg/mL)to select the time for non-invasive positive pressure ventilation.The stress hormones,clinical pulmonary infection score and vital signs of two groups after 24 h of mechanical ventilation were detected.The treatment time and the adverse reactions of the two groups were recorded.Results:There was no significant difference in rennin,adrenaline,noradrenaline and angiotensin II between two groups(P>0.05).Compared with the control group,the clinical pulmonary infection score was decreased in the observation group(P<0.05).There was no significant difference in heart rate,respiratory rate,pH,partial pressure of carbon dioxide and partial pressure of oxygen between two groups(P>0.05).There was no significant difference in intensive care monitoring time between two groups(P>0.05).Compared with the control group,the observation group had no significant difference in invasive ventilation time and total mechanical ventilation.The time of hospitalization and hospitalization had significantly decreased(P<0.05).There was no significant difference in mortality,ventilator-associated pneumonia and re-intubation between two groups(P>0.05).Conclusion:TREM-1 can be used as a switching point during invasive-noninvasive sequential ventilation for COPD patients with respiratory failure,which can shorten the time of invasive ventilation,total mechanical ventilation and hospitalization.

慢性肌筋膜触发点模型大鼠的尿液代谢组学分析

背景:慢性肌筋膜触发点通过非靶向代谢组学技术可识别差异性代谢物变化,有助于从内源性小分子代谢物层面理解并进一步探究慢性肌筋膜触发点的病理生理过程和发病机制。目的:以慢性肌筋膜触发点模型大鼠为研究对象,基于尿液代谢组学寻找潜在生物标志物及相关代谢通路。方法:将16只SD大鼠随机分为造模组和正常组,造模组大鼠采用钝性打击结合离心运动(跑台坡度为-16°,跑速为16 m/min,训练时间为90 min/次)方式建立慢性肌筋膜触发点动物模型,每周1次,连续干预8周,休息4周;正常组大鼠不做干预。12周造模结束后,采用代谢笼法收集大鼠造模后24 h尿液,利用液相色谱-质谱联用非靶向代谢组学技术对尿样进行代谢图谱检测,筛选出共同差异代谢物,并进行生物信息学分析。结果与结论:①与正常组相比,造模组有32个差异代谢标志物,其中上调21个、下调11个;依据变量权重值>3,共14个差异代谢物被认定为潜在生物标志物;②京都基因与基因组百科全书富集分析表明,慢性肌筋膜触发点的形成与初级胆汁酸生物合成、花生四烯酸代谢通路密切相关。

The Comparison of trigger point acupuncture and traditional acupuncture

Trigger point（TrP） acupuncture（dry needling）,the use of solid filiform needles at TrPs,has been developed from a comprehensive integration and adaptation of traditional acupuncture using current understandings of TrPs.During the past twenty years,the concept and technique continues to evolve,with a potential to expand to other conditions beyond myofascial pain syndromes that can be managed via stimulating TrPs.In this article,we compared TrP acupuncture and traditional acupuncture from the following aspects：points of needle insertion,needles and needling techniques,and therapeutic indications.Traditional acupuncture encompasses an abundance of methods and techniques in acupuncture practices and has been widely used and studied for a variety of disorders.With unique specific characteristics,TrP acupuncture further develops traditional acupuncture theories,especially the concepts of Ashi point.The location of TrPs,their distribution pattern and pain indication are similar to those of traditional acupoints;the selection of needles,depth of needle insertion,and manipulation techniques are part of traditional acupuncture.TrP acupuncture is thus an integral part of traditional acupuncture.

Observation on therapeutic effect of electroacupuncture plus Tanbo-plucking the trigger points for scapulohumeral periarthritis

Objective: To observe the clinical efficacy of electroacupuncture (EA) plus Tanbo-plucking the trigger points for scapulohumeral periarthritis (SP). Methods:A total of 80 patients with SP were randomized into an observation group and an EA group by the random number table, with 40 cases in each group. The EA group was treated with EA therapy, and the observation group was treated with EA therapy plus Tanbo-plucking the trigger points. After treatment, the visual analog scale (VAS) and Melle scores of the two groups were compared to evaluate the improvement of shoulder pain and functional activity, and meanwhile the clinical efficacy was observed. Results: After treatment, the total effective rate of the observation group was 95.0% and the cure and markedly effective rate was 72.5%. The total effective rate of the EA group was 87.5% and the cure and markedly effective rate was 42.5%. There was no significant difference in the total effective rate between the two groups (P>0.05). The cure and markedly effective rate of the observation group was higher than that of the EA group, and the difference between the two groups was statistically significant (P<0.05). After treatment, the intra-group differences in VAS and Melle scores of both groups were statistically significant (bothP<0.001). The inter-group differences in the changes of the VAS and Melle scores after treatment were statistically significant (bothP<0.001). Conclusion: EA plus Tanbo-plucking the trigger points has a better curative effect than EA therapy alone in the treatment of SP.

滞动针干预“激痛点”对肌筋膜疼痛综合征模型大鼠中枢镇痛的作用机制

背景:滞动针治疗肌筋膜疼痛综合征的镇痛效果显著,但镇痛机制尚不明确。目的:探索滞动针干预激痛点缓解肌筋膜疼痛综合征疼痛的作用机制。方法:按照随机数字表法将54只SD大鼠随机分为空白组(n=16)和造模组(n=38),造模组采用“打击结合离心运动”方式制备左侧股内侧肌筋膜疼痛综合征模型,造模12周后随机挑选6只验证造模成功,将剩余32只造模大鼠随机分为模型组(n=16)与滞动针组(n=16),使用滞动针对滞动针组大鼠左侧股内侧肌局部激痛点进行干预治疗,2次/周,治疗4周。造模前后及治疗后进行左足机械缩足阈值测定;治疗后第4周,苏木精-伊红染色观察大鼠左侧股内侧肌肌肉组织形态学变化,ELISA法检测血清和中脑导水管周围灰质中P物质、β-内啡肽水平,免疫组化检测中脑导水管周围灰质中小胶质细胞标志物(Iba-1)和c-fos阳性表达,Western Blot检测中脑导水管周围灰质脑源性神经营养因子蛋白表达。结果与结论:①与空白组比较,造模后模型组、滞动针组大鼠机械缩足阈值降低(P<0.05);治疗4周后,滞动针组大鼠机械缩足阈值高于模型组(P<0.05);②苏木精-伊红染色结果显示,模型组肌纤维排列紊乱、粗细不等,肌细胞增大并出现核内移现象,细胞内出现圆形挛缩结节以及紧张带;滞动针组肌纤维排列整齐,肌细胞多呈角状,细胞内偶见挛缩结节;③与空白组比较,模型组血清中P物质水平升高(P<0.05),血清中β-内啡肽及脑中P物质、β-内啡肽水平均降低(P<0.05);与模型组比较,滞动针组血清中P物质水平降低(P<0.05),血清中β-内啡肽及脑中P物质、β-内啡肽水平均升高(P<0.05);④与空白组比较,模型组c-fos、Iba-1阳性表达及脑源性神经营养因子蛋白均升高(P<0.05);与模型组比较,滞动针组c-fos阳性表达升高(P<0.05),Iba-1阳性表达及脑源性神经营养因子蛋白均降低(P<0.05);(5)结果表明,滞动针可能通过抑制中脑导水管周围灰质小胶质细胞的活性、下调脑源性神经营养因子蛋白表达间接促进小胶质细胞向M2表型极化释放β-内啡肽、增加c-fos神经元兴奋性,从而降低中枢致敏程度,有效缓解肌筋膜疼痛综合征疼痛的症状。

Study on the relationship between relieving energy crisis in myofascial trigger points with An-Pressing manipulation and AMPK/PGC-1α pathway activation

Objective To explore the mechanism of An-Pressing manipulation in relieving energy crisis in chronic myofascial trigger points(MTrPs)by observing the effects of An-Pressing manipulation on adenosine triphosphate(ATP),adenosine 5′-monophosphate(AMP)-activated protein kinase(AMPK)/peroxisome proliferator-activated receptorγcoactivator 1α(PGC-1α)pathway and mitochondrial ultrastructure of skeletal muscle cells in MTrPs rats.Methods Forty-eight male Sprague-Dawley rats were randomly divided into a blank group,a model group,a lidocaine group,and an An-Pressing manipulation group,with 12 rats in each group.The model group,lidocaine group and An-Pressing manipulation group were used to replicate the MTrPs rat model by blunt shock and centrifugal motion method.After modeling,the An-Pressing manipulation group was subjected to 7 times An-Pressing manipulation,once every other day;the lidocaine group was treated with 3 times of injection of lidocaine at the MTrPs,once every 6 d.The blank group and the model group were fed normally without intervention.After the intervention,local muscle tissue was taken to detect the content of ATP and the expression of AMPK,phosphorylated AMPK(phospho-AMPK),PGC-1α,and glucose transporter 4(GluT4),and the ultrastructure of mitochondria was observed under an electron microscope.Results Compared with the blank group,the ATP content in the model group was decreased(P<0.05),the protein expression levels of phospho-AMPK,PGC-1α,and GluT4 and the ratio of phospho-AMPK to AMPK were decreased(P<0.05);under the electron microscope,the number of mitochondria decreased,and they were deformed,small in volume,and had deformed cristae.Compared with the model group,the ATP contents in the An-Pressing manipulation group and the lidocaine group were increased(P<0.05),and the protein expression levels of phospho-AMPK,PGC-1α,and GluT4 and the ratio of phospho-AMPK to AMPK were increased(P<0.05);under the electron microscope,the number of mitochondria increased,the shape and size of the mitochondria were basically normal,and the cristae could be seen.Compared with the lidocaine group,phospho-AMPK and the ratio of phospho-AMPK to AMPK in the An-Pressing manipulation group were increased(P<0.05);under the electron microscope,the numbers of mitochondria were similar,and the shape and size of the mitochondria were basically normal without swelling,and the cristae could be observed.Conclusion An-Pressing manipulation can increase the ATP content in MTrPs tissue,improve the expression levels of PGC-1α and GluT4 proteins and the ratio of phospho-AMPK to AMPK;its mechanism may relate to the activation of AMPK/PGC-1α signaling pathway to promote the repair of mitochondrial damages.

腰臀肌筋膜触发点疼痛和其下肢牵涉痛的诊断与治疗

目的:探讨腰臀肌触发点疼痛和其腿部牵涉痛的特征,观察以反复针刺为主,受累腰臀肌牵张为辅的治疗效果。方法:研究对象为114例不同腰臀肌筋膜触发点疼痛的病例,根据诊断对这些患者以湿针刺触发点和对不同受累肌牵张疗法进行治疗。针刺触发点后,教患者在家做自我受累肌牵张和随访,并根据疼痛的程度、并发症状和体征设计和定义评分标准,对治疗前后自拟疼痛评分。本文重点描述大部分腰臀肌触发点位置和它们特定牵涉痛的范围;同时也重点描述各腰臀肌的自我牵张法和湿针刺触发点方法。结果:治疗前为4.6±1.1分,治疗后(3—6个月)为1.5±1.2分,治疗后的疼痛评分显著低于治疗前评分(P<0.001)。结论:本法对伴有腿部牵涉痛的腰臀肌触发点疼痛治疗有效,并且方便易行。

Clinical observation of needling gluteus medius muscle trigger point plus chiropractic for sacroiliac joint subluxation

Objective:To observe the clinical effect of needling gluteus medius muscle trigger point (TrP) plus chiropractic for sacroiliac joint subluxation.Methods:A total of 124 cases conforming to the inclusion criteria of sacroiliac joint subluxation were classified by anterior subluxation and posterior subluxation,and randomized into a TrP group and a conventional group respectively.There were 63 patients with anterior subluxation who were randomized into a TrP group of 32 cases (including 4 dropped out cases) and a conventional group of 31 cases (including 3 dropped out cases);and 61 patients with posterior subluxation who were randomized into a TrP group of 31 cases (including 3 dropped out cases) and a conventional group of 30 cases (including 3 dropped out cases).Patients in the TrP group received the treatment of needling gluteus medius muscle TrP plus chiropractic,while patients in the conventional group received conventional acupuncture treatment plus chiropractic.The treatment was done twice a week for a succession of 8 weeks.Then,the pain visual analog scale (VAS),Oswestry disability index (ODI) and therapeutic efficacy were evaluated.Results:After treatment,the total effective rate of TrP group with anterior subluxation was 96.9%,higher than 77.4% in the conventional group,the difference showed a statistical significance (P<0.05);the total effective rate was 93.5% in the TrP group with posterior subluxation,higher than 73.3% in the conventional group.After treatment,the VAS and ODI scores in both groups dropped obviously,the differences showed statistical significance (all P<0.05);the scores of VAS and ODI in the TrP group were obviously lower than those in the conventional group (all P<0.05).Conclusion:Needling gluteus medius muscle TrP plus chiropractic had a better therapeutic effect than conventional acupuncture plus chiropractic for sacroiliac joint subluxation.

超声形态学评估银质针对腰椎间盘突出症患者多裂肌形态学的影响

背景:银质针等针刺治疗腰椎间盘突出症的研究较多,但基于肌筋膜触发点理论的研究尚少。目的:从肌筋膜触发点理论出发探讨银质针综合疗法对腰椎间盘突出症患者多裂肌超声形态学及临床疗效的影响。方法:前瞻性选取2022年1月至2023年4月就诊的159例腰椎间盘突出症患者作为研究对象,按照随机数字表法随机分为常规组(n=53)、传统针灸组(n=53)和银质针组(n=53)。常规西药组给予常规西药治疗,传统针灸组根据经络走向和症状定位采用传统针刺疗法治疗,银质针组采用银质针灸肌筋膜疼痛触发点进行治疗,3组均连续治疗4周。记录所有患者治疗前后筋膜触发点数量、疼痛程度、腰椎功能、多裂肌超声形态学变化、临床疗效、中医症候评分。结果与结论:(1)治疗后3组的腰背部各肌肉筋膜触发点数量减少,且银质针组较传统针灸组和常规西药组明显减少(P<0.05);(2)银质针组的疼痛分级指数评分、目测类比评分、现有疼痛强度评分、Oswestry功能障碍指数和下背痛功能障碍调查问卷评分均低于传统针灸组和常规西药组(P<0.05);(3)银质针组的多裂肌超声形态学各指标均优于传统针灸组和常规西药组(P<0.05);(4)银质针组的中医症候评分低于传统针灸组和常规西药组(P<0.05);(5)3组的临床疗效比较有显著差异(P<0.05)。结果表明:基于肌筋膜触发点理论应用银质针综合疗法能有效减轻腰椎间盘突出症患者疼痛,提高临床疗效,改善腰椎功能障碍和多裂肌形态。

Understanding of myofascial trigger points

Objective To investigate the current practice of myofascial pain syndrome （MPS） including current epidemiology, pathology, diagnosis and treatment. Data sources The data analyzed in this review were mainly from relevant articles without restriction on the publication date reported in PubMed, MedSci, Google scholar. The terms ＂myofasial trigger points＂ and ＂myofacial pain syndrome＂ were used for the literature search. Study selection Original articles with no limitation of research design and critical reviews containing data relevant to myofascial trigger points （MTrPs） and MPS were retrieved, reviewed, analyzed and summarized. Results Myofascial pain syndrome （MPS） is characterized by painful taut band, referred pain, and local response twitch with a prevalence of 85% to 95% of incidence. Several factors link to the etiology of MTrPs, such as the chronic injury and overload of muscles. Other factors, such as certain nutrient and hormone insufficiency, comorbidities, and muscle imbalance may also maintain the MTrP in an active status and induce recurrent pain. The current pathology is that an extra leakage acetylcholine at the neuromuscular junction induces persistent contracture knots, relative to some hypotheses of integration, muscle spindle discharges, spinal segment sensitization, ect. MTrPs can be diagnosed and localized based on a few subjective criteria. Several approaches, including both direct and supplementary treatments, can inactivate MTrPs. Direct treatments are categorized into invasive and conservative. Conclusion This review provides a clear understanding of MTrP pain and introduces the most useful treatment approaches in China.

王麟鹏教授“逐邪通络”法治疗原发性三叉神经痛

总结王麟鹏教授运用“逐邪通络”法治疗原发性三叉神经痛的学术思想。王麟鹏教授通过总结前人经验,提出“逐邪通络”针刺法,分期治疗原发性三叉神经痛;强调应根据邪气的致病特点、发作分期、正邪盛衰确定不同的针刺方案,提出局部取穴应用经络辨证为主;主张疼痛发作期以祛邪为要,缓解期主张扶正与祛邪兼而有之,重视调理脏腑、疏通经络,慎用扳机点的治疗理念,获得很好的临床效果。

不同力量推拿按法对大鼠肌筋膜疼痛触发点的影响

背景:推拿按法干预肌筋膜触发点疼痛疗效明确,但是不同力量按法的作用需要深入研究。目的:观察不同力量推拿按法对肌筋膜疼痛大鼠触发点的影响。方法:将60只SPF级雄性SD大鼠随机分为不参与造模的空白组10只和参与触发点造模的大鼠50只。以定期钝性击打结合离心运动法在大鼠左侧大腿内侧肌建立慢性触发点模型,将造模成功的40只大鼠随机分为模型组、轻按组、中按组和重按组,每组10只。空白组、模型组大鼠不予干预,轻按组、中按组和重按组以自制按法刺激器,分别以轻力量(0.3 kg)、中力量(0.5 kg)和重力量(0.7 kg)对触发点局部进行干预,7.5 min/次,隔天1次,共计7次。在干预前后分别以电生理仪、软组织张力测定仪和机械痛阈测定仪检测触发点局部肌电图、软组织张力和机械痛阈值。干预结束后,空白组大鼠取左侧大腿内侧肌组织,其余组大鼠取触发点组织,以苏木精-伊红染色观察病理形态,ELISA法检测环氧化酶2、前列腺素E2和缓激肽水平。结果与结论:①与空白组比较,模型组机械痛阈值降低,软组织张力升高,自发电活动振幅频率升高,病理形态学明显改变,环氧化酶2、前列腺素E2和缓激肽水平增加(P<0.05);②与模型组比较,中按组和重按组机械痛阈值升高,软组织张力降低,肌电图频率和振幅降低,环氧化酶2、前列腺素E2和缓激肽水平降低(P<0.05),病理形态学恢复明显;轻按组以上指标无明显变化(P>0.05);③与中按组比较,重按组上述指标改善作用更明显(P<0.05)。结果表明:对触发点疼痛,按压力度可能为中至重度才能有治疗效果。

Myofascial Foot Pain Following Uneventful Epidural Analgesia for Labor and Delivery

Following an uneventful delivery under epidural analgesia, a 17 year old female patient was referred to the Pain Clinic because of numbness and pain of the left big toe for 2 and a half Months. An Orthopedic consultation had ruled out foot injury and concluded that the pain was radicular and secondary to nerve damage from the epidural analgesia. A Pain Clinic evaluation made the diagnosis of myofascial pain which was successfully treated with trigger pint block using normal saline.

针灸肌筋膜触发点作用机制研究进展

肌筋膜触发点(myofascial trigger points,MTrPs)为骨骼肌绷紧带中的过敏结节,可引发压痛、特征性转移痛、运动功能障碍和自主神经现象。近年来,基于MTrPs特殊的病理生理机制,采用针灸治疗非器质性神经肌纤维的疼痛综合征取得了满意的效果。针刺干预MTrPs对于组织修复、恢复功能活动具有重要的指导价值,为临床治疗肌筋膜疼痛综合征(myofascial pain syndrome,MPS)提供了有效手段。但针刺MTrPs作用机制尚未完全阐明,今后还需从多层次、多角度、多领域深入探究,以期为临床针灸施治提供有力的理论依据。

冲击波联合肌筋膜触发点治疗神经根型颈椎病疗效观察

目的:探讨发散式体外冲击波联合针刺肌筋膜触发点治疗神经根型颈椎病(CSR)的疗效。方法:将80例神经根型颈椎病患者随机分为两组,各40例。两组患者均给予颈椎牵引、口服甲钴胺片,对照组在此基础上给予发散式体外冲击波联合普通针刺治疗,观察组给予发散式体外冲击波联合针刺颈肩部肌筋膜触发点治疗。比较两组治疗前后简化McGill疼痛问卷(SF-MPQ)、颈椎功能障碍指数量表(NDI)及中文版简明健康调查问卷(SF-36)评分变化情况,比较两组治疗后的临床疗效及6个月内的复发情况。结果:两组均治疗4周,治疗前,两组患者一般资料、SF-MPQ、NDI、SF-36评分组间比较,无统计学差异(P>0.05)。治疗后,两组患者的SF-MPQ评分、NDI评分较治疗前均降低(P<0.05),SF-36评分较治疗前均升高(P<0.05);组间比较,观察组患者的SF-MPQ、NDI及SF-36改善程度均优于对照组(P<0.05);治疗后,观察组总有效率(97.5%)高于对照组(80.0%),治疗后6个月内观察组复发率(5%)低于对照组(25%),差异均有统计学意义(χ^(2)=4.507、6.275,均P<0.05)。结论:发散式体外冲击波联合肌筋膜触发点治疗能够有效减轻神经根型颈椎病患者的疼痛症状,改善颈椎功能,提高生活质量,临床疗效显著,复发率低。

Successful Treatment of a Case of First Bite Syndrome without Any Cause

Background: For the first bite syndrome (FBS), various causes were suggested such as parapharyngeal space surgery, resection of styloid process, carotid endarterectomy, parotid gland tumor, submandibular gland tumor, and upper cervical surgery. Actually, the real cause of FBS is still not clear. Also, suggested methods of treatment for the FBS are botulinum toxin injection, laser tympanic plexus ablation, pharmacologic approach, and no treatment. The results of those treatments were not satisfactory. Aim: The authors tried to find out the adequate method of treatment for the FBS and also tried to figure out pathologic cause of the FBS through observation of the patient response to the treatment. Case Presentation: A 38-year-old male was presented at head and neck surgery clinic with a sharp pain on the left parotid area especially at the first bite of eating food for two days. There was no cause. The patient was given trigger point injections on his left sternocleidomastoid, masseter, and temporal muscles with left mandibular nerve block five times 3 - 4 days apart. Also small amount of oral anticonvulsants were added for four weeks. Before finishing taking oral medication, the pain was gone completely. Conclusion: The authors experienced a case of FBS with no detectable cause, and treated successfully with the methods of trigger point injection, mandibular nerve block, and oral antiepileptic medication.

按压肌筋膜触发点对功能性踝关节不稳患者的疗效研究

目的:探讨按压肌筋膜触发点在功能性踝关节不稳(functional ankle instability,FAI)患者中的临床疗效。方法:选取西南大学医院康复医学中心门诊2021年5月—8月就诊的功能性踝关节不稳患者29例,随机分为试验组15例和对照组14例。试验组在踝关节平衡训练基础上增加按压肌筋膜触发点技术,对照组采用BOSU球进行踝关节平衡训练。分别在基线、干预第4周后和干预第8周后对两组患者进行疼痛视觉模拟评分(visual analogue scale,VAS)评估、踝关节功能量表评分(American Orthopedic Foot and Ankle Score,AOFAS)和Y平衡测试(Ybalance test,YBT)评估。结果:治疗前,两组患者在评估的各项指标上无明显差异(P>0.05)。治疗8周后,两组患者在VAS疼痛评分上均有显著降低(P<0.05),Y平衡测试综合数值得到显著改善(P<0.01),AOFAS踝关节功能评分得到显著提高(P<0.05)。治疗后,试验组在上述各项评估指标中均显著优胜于对照组(P<0.05)。结论:为期8周的平衡训练和平衡训练联合按压MTrPs治疗均对FAI患者有显著的临床康复疗效,而平衡训练联合按压MTrPs治疗在缓解FAI患者的疼痛、促进踝关节功能和动态平衡的改善等方面具有更好的康复效益。