肌筋膜触发点针刺联合低频电刺激和骶髂关节拉伸复位治疗围产期耻骨联合分离症的疗效观察
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摘要
目的探讨肌筋膜触发点针刺联合低频电刺激和骶髂关节手法拉伸复位对围产期耻骨联合分离症的治疗效果。方法选取2013年1月至2016年7月在淮安市妇幼保健院分娩及外院转诊的围产期耻骨联合分离的产妇100例,随机分为综合治疗组、低频电刺激组、手法复位组,骨盆带组和对照组,每组20例。综合治疗组采用肌筋膜触发点(myofascial trigger points,MTr Ps)针刺联合电刺激和手法拉伸复位治疗,另外3个治疗组分别给予低频电刺激治疗、手法复位治疗和骨盆带,对照组给予制动观察。比较各组间的数字评价量表(numerical rating scale,NRS)疼痛评分情况和临床疗效。结果治疗后6d,综合治疗组、低频电刺激组、手法复位组、骨盆带组和对照组5组的治愈人数分别为18例、7例、4例、0例和0例;治疗后6周,5组的治愈人数分别为20例、13例、11例、4例和0例;治疗后6个月,5组的治愈人数分别为20例、18例、15例、13例和9例。综合组治疗效果最好,其次为电刺激组和手法复位组。结论肌筋膜疼痛触发点针刺联合仿生物理电刺激和手法拉伸复位,能够在短期内迅速缓解围产期耻骨联合分离症患者的疼痛,并能够使耻骨联合形态迅速恢复正常。治疗效果较好,痛苦小,具有较高的临床推广价值。
Objective To observe the impact of acupuncture on myofascial trigger points(MTrPs),low-frequency electrical stimulation and manipulative stretch reduction on sacroiliac joint on perinatal period separation of symphysis pubis.Methods Totally 100 cases of perinatal separation of pubic symphysis in Huai'an Women and Children Health Hospital from January 2013 to July 2016 were selected.They were randomly divided into comprehensive treatment group,electrical stimulation group,manipulative reduction group,pelvic belt group and control group,20 cases in each group.The comprehensive treatment group was given acupuncture on myofascial trigger points,low-frequency electrical stimulation and manipulative stretch reduction on sacroiliac joint,the other three treatment groups were treated with their respective monotherapy,and the control group only received the brake observation.The NRS pain score and clinical efficacy were compared among the groups.Results Six days after treatment,18 cases,7 cases,4 cases,0 case and 0 case were cured in the five groups,respectively.Six weeks after treatment,20 cases,13 cases,11 cases,4 cases and 0 case were cured in the five groups,respectively.Six months after treatment,20 cases,18 cases,15 cases,13 cases and 9 cases were cured in the five groups,respectively.The treatment effect of the comprehensive group was the best,followed by the electric stimulation group,and then manipulation reduction group.Conclusion acupuncture on myofascial trigger points and electrical stimulation combined with manipulative stretch reduction can not only quickly relieve the pain of patients in a short time,but also quickly make the pubic symphysis form return to normal.It has a high treatment efficiency and is less painful.So it has a high clinical value.
Objective To observe the impact of acupuncture on myofascial trigger points(MTrPs),low-frequency electrical stimulation and manipulative stretch reduction on sacroiliac joint on perinatal period separation of symphysis pubis.Methods Totally 100 cases of perinatal separation of pubic symphysis in Huai'an Women and Children Health Hospital from January 2013 to July 2016 were selected.They were randomly divided into comprehensive treatment group,electrical stimulation group,manipulative reduction group,pelvic belt group and control group,20 cases in each group.The comprehensive treatment group was given acupuncture on myofascial trigger points,low-frequency electrical stimulation and manipulative stretch reduction on sacroiliac joint,the other three treatment groups were treated with their respective monotherapy,and the control group only received the brake observation.The NRS pain score and clinical efficacy were compared among the groups.Results Six days after treatment,18 cases,7 cases,4 cases,0 case and 0 case were cured in the five groups,respectively.Six weeks after treatment,20 cases,13 cases,11 cases,4 cases and 0 case were cured in the five groups,respectively.Six months after treatment,20 cases,18 cases,15 cases,13 cases and 9 cases were cured in the five groups,respectively.The treatment effect of the comprehensive group was the best,followed by the electric stimulation group,and then manipulation reduction group.Conclusion acupuncture on myofascial trigger points and electrical stimulation combined with manipulative stretch reduction can not only quickly relieve the pain of patients in a short time,but also quickly make the pubic symphysis form return to normal.It has a high treatment efficiency and is less painful.So it has a high clinical value.
引文
[1]Gillaux C,Eboue C,Herlicoviez M,et al.History of pubic symphysis separation and mode of delivery[J].J Gynecol Obstet Biol Reprod(Paris),2011,40(1):73-76.
[2]Smith MW,Marcus PS,Wurtz LD.Orthopedic issues in pregnancy[J].Obstet Gynecol Surv,2008,63(2):103-111.
[3]刘萍,王月祉,余艳红,等.磁共振分析初产妇骶髂关节与耻骨联合骨髓水肿的变化及其临床意义[J].中国实用妇科与产科杂志,2018,34(8):918-922.
[4]马乐,刘娟,李环,等.产后盆底康复流程第一部分--产后盆底康复意义及基本原则[J].中国实用妇科与产科杂志,2015,31(4):314-321.
[5]Chang JL,Wu V.External fixation of pubic symphysis diastasis from postpartum trauma[J].Orthopedics,2008,31(5):493.
[6]李学玉.手法治疗产后耻骨联合分离症病例分析[J].中国医药指南,2011,9(33):425-427.
[7]刘娟,曾洁,王海兰,等.电刺激治疗围产期耻骨联合分离疗效研究[J].中国实用妇科与产科杂志,2016,32(2):181-184.
[8]乔祖康,张仕年.四指推法结合手法复位治疗分娩后耻骨联合分离的临床分析[J].山西医药杂志,2015,44(11):1307-1309.
[9]张盛.三步手法治疗产后骶髂关节半脱位合并耻骨联合分离22例[J].中医正骨,2013,25(5):57-58.
[10]唐广满,水小龙,戴志兵,等.空心拉力螺钉与重建钢板治疗耻骨联合分离的疗效比较[J].创伤外科杂志,2011,13(6):515-519.
[11]张金慧,杜洪灵,丁小兰,等.围产期耻骨联合分离的诊断与治疗[J].中国妇幼健康研究,2014,15(2):322-324.
[12]Melzack R.The McGill pain questionnaire:major properties and scoring methods[J].Pain,1975,1(3):277-299.
[13]Andrew JR,Snyder-Mackel L.Clinical electrophysiology:electrotherapy and electrophysiologic testing[M].America:Lippincott Williams&Wilkins,2011:213-234.
[14]Borg-Stein J,Simons DG.Focused review:myofascial pain[J].Arch Phys Med Rehabil,2002,83(3 Suppl 1):S40-47,S48-49.
[15]Chu J,Schwartz I.The muscle twitch in myofascial pain relief:effects of acupuncture and other needling methods[J].Electromyogr Clin Neurophysiol,2002,42(5):307-311.
[16]严小勤,郭耀光,杨玲.近几年来针灸治疗肌筋膜疼痛综合征的临床研究现状[J].医药前沿,2017,7(3):190-191.
[17]杨冬艳.电刺激治疗围产期耻骨联合分离疗效研究(附88例报道)[J].中国医学创新,2017,14(4):72-75.
[18]黄强民,庄小强,谭树生.肌筋膜疼痛触发点的诊断与治疗[M].广西:广西科学技术出版社,2010:10-100.
[19]关岭(译).解剖列车:徒手与动作治疗的肌筋膜经线[M].3版.北京:军事医学科学出版社:109-126.(2018-09-24收稿2018-11-08修回)
[2]Smith MW,Marcus PS,Wurtz LD.Orthopedic issues in pregnancy[J].Obstet Gynecol Surv,2008,63(2):103-111.
[3]刘萍,王月祉,余艳红,等.磁共振分析初产妇骶髂关节与耻骨联合骨髓水肿的变化及其临床意义[J].中国实用妇科与产科杂志,2018,34(8):918-922.
[4]马乐,刘娟,李环,等.产后盆底康复流程第一部分--产后盆底康复意义及基本原则[J].中国实用妇科与产科杂志,2015,31(4):314-321.
[5]Chang JL,Wu V.External fixation of pubic symphysis diastasis from postpartum trauma[J].Orthopedics,2008,31(5):493.
[6]李学玉.手法治疗产后耻骨联合分离症病例分析[J].中国医药指南,2011,9(33):425-427.
[7]刘娟,曾洁,王海兰,等.电刺激治疗围产期耻骨联合分离疗效研究[J].中国实用妇科与产科杂志,2016,32(2):181-184.
[8]乔祖康,张仕年.四指推法结合手法复位治疗分娩后耻骨联合分离的临床分析[J].山西医药杂志,2015,44(11):1307-1309.
[9]张盛.三步手法治疗产后骶髂关节半脱位合并耻骨联合分离22例[J].中医正骨,2013,25(5):57-58.
[10]唐广满,水小龙,戴志兵,等.空心拉力螺钉与重建钢板治疗耻骨联合分离的疗效比较[J].创伤外科杂志,2011,13(6):515-519.
[11]张金慧,杜洪灵,丁小兰,等.围产期耻骨联合分离的诊断与治疗[J].中国妇幼健康研究,2014,15(2):322-324.
[12]Melzack R.The McGill pain questionnaire:major properties and scoring methods[J].Pain,1975,1(3):277-299.
[13]Andrew JR,Snyder-Mackel L.Clinical electrophysiology:electrotherapy and electrophysiologic testing[M].America:Lippincott Williams&Wilkins,2011:213-234.
[14]Borg-Stein J,Simons DG.Focused review:myofascial pain[J].Arch Phys Med Rehabil,2002,83(3 Suppl 1):S40-47,S48-49.
[15]Chu J,Schwartz I.The muscle twitch in myofascial pain relief:effects of acupuncture and other needling methods[J].Electromyogr Clin Neurophysiol,2002,42(5):307-311.
[16]严小勤,郭耀光,杨玲.近几年来针灸治疗肌筋膜疼痛综合征的临床研究现状[J].医药前沿,2017,7(3):190-191.
[17]杨冬艳.电刺激治疗围产期耻骨联合分离疗效研究(附88例报道)[J].中国医学创新,2017,14(4):72-75.
[18]黄强民,庄小强,谭树生.肌筋膜疼痛触发点的诊断与治疗[M].广西:广西科学技术出版社,2010:10-100.
[19]关岭(译).解剖列车:徒手与动作治疗的肌筋膜经线[M].3版.北京:军事医学科学出版社:109-126.(2018-09-24收稿2018-11-08修回)