超声波联合推拿治疗肌筋膜疼痛综合征的临床观察
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摘要
目的:检验手持式压力测痛仪在压痛阈测量中的信度和效度,分析健康人压痛阈特点,比较个体间及个体内压痛阈差异。
方法:研究分为两个阶段。第一阶段:3名施测者分别使用手持式压力测痛仪对37名健康正常受测者全身共12个部位进行压痛阈测量。第二阶段:1名施测者使用手持式压力测痛仪对10名肌筋膜疼痛综合征患者进行压痛阈测量,并采用目测类比评分法(VAS)进行评估。分别计算组内相关系数和Spearman相关系数以评估信度和效度。用一个施测者三次测量的平均值分析不同个体间及个体内各受测点之间的压痛阈差异。
结果:重测信度及施测者间信度均较高(ICC>0.95),重测信度优于施测者间信度;根据同一施测者3次重复测量结果的均值所计算的施测者间信度高于用单次测量的施测者间信度;肌筋膜疼痛患者肌筋膜触发点与正常对照点的压痛阈差异具有统计学意义,肌筋膜触发点压痛阈值与VAS评分呈显著的负相关;不同个体间压痛阈差异具有统计学意义(P<0.05);女性压痛阈值低于男性(P<0.05);同一个体不同部位压痛阈差异具有统计学意义(P<0.05),但双侧对称部位压痛阈的差异则无统计学意义(P>0.05)。脊旁肌的压痛阈较高而骨突处的压痛阈较低。
结论:手持式压力测痛仪测量正常健康人压痛阈时具有较高信度,其可作为量化评价肌筋膜触发点疼痛敏感性的有效工具。使用压痛阈进行临床疼痛评估时在参照点的选择以及结果分析当中应重视压痛阈在个体间以及个体内的差异。分析压痛阈的影响因素以及建立适用于中国人群的压痛阈正常参考值是今后研究的任务。
第二部分超声波联合推拿治疗肌筋膜疼痛综合征的临床观察
目的:观察超声波联合推拿治疗肌筋膜触发点的临床疗效。
方法:选择42例有单侧上斜方肌活性肌筋膜触发点的肌筋膜疼痛综合征患者,随机分为治疗组和对照组,每组各21人。治疗组采用超声波治疗(1W/cm2,10分钟,100%工作周期)联合推拿手法进行治疗,每日一次,连续5次。对照组仅采用推拿手法治疗。在治疗前、第1次治疗结束后、第5次治疗结束后即刻及治疗结束1月后分别采用目测类比评分法(VAS)、压痛阈值(PPT)、关节主动活动范围(AROM)、匹兹堡睡眠质量指数(PSQI)、12个条目的简短生命质量量表(SF-12)评定疗效。
结果:治疗组第1次超声波治疗结束后患者的AROM显著增加(P<0.05),但PPT无明显改变(P>0.05);第5次治疗结束后,治疗组和对照组的VAS评分下降(P<0.05),PPT及AROM较治疗前明显增加(P>0.05),且治疗组疗效优于对照组;治疗结束1月后两组的VAS及PSQI评分较治疗前显著降低(P<0.05),AROM及SF-12评分较治疗前增加,且差异具有统计学意义(P<0.05),但两组间对比则无显著差异。
结论:超声波结合推拿治疗能够降低活性肌筋膜触发点的疼痛敏感性,提高患者的生存质量,其疗效优于单一推拿治疗。
PartⅠReliability and validity of the hand-held pressure algometer as a measuring instrument of pressure pain threshold and the characteristics of pressure pain threshold in healthy Chinese
Objectives: To evaluate the test-retest and inter-rater reliability of the hand-held pressure algometer as a measuring instrument of pressure pain threshold (PPT), and to characterize the pressure pain threshold in healthy Chinese .
Methods: A total of 37 healthy subjects were recruited for reliability test. Three raters measured PPT at 12 body sites of the subjects. Each rater conducted three trials on each site. In the validity test, 10 patients with active trigger points in the upper trapezius were recruited and measured by one rater using the pressure algometer for PPT, the visual analogue scale (VAS) was also used to evaluate the pain intensity induced by the trigger point. The intraclass correlation coefficient and Spearman correlation coefficient were calculated to reflect the reliability and validity. And mean value of the three trails by one rater was used to compare the pressure pain threshold over different sites and between individuals.
Results: The test-retest and inter-rater reliabilities were both high (ICC>0.95), with the measurements by one rater were more reliable than measurements by multiple raters. The inter-rater reliability of PPT measurement obtained by using the mean value of 3 trials was higher than any of the 3 trials alone. The PPT values of the trigger points were significantly lower than those of the normal points, and there was a significantly negative correlation between the PPT values of the trigger points and the VAS scores. The inter-individual differences were significant (P<0.05) and females exhibited lower PPT in every sites than males (P<0.05). PPT varied among different sites on one side (P<0.05), but showed no significant difference between the antimere sites (P>0.05). PPT value obtained from the paraspinal muscle was higher and that from the mastoid was lower than those from the other sites.
Conclusions: The intra- and inter-rater PPT measurements in healthy subjects obtained with the hand-held pressure algometer were highly reliable. The algometer was valid for quantifying myofascial trigger point sensitivity. On the individual level, due to the considerable variation found in the PPT results, cautions were advised both in selecting the reference point and interpreting the results when using it as a method for clinical pain assessment. Analyzing the factors influencing the measurements and establishing the normal range of pressure pain threshold in Chinese should be approached in the near future.
PartⅡClinical study of the effects of therapeutic ultrasound combined with traditional Chinese massage on myofascial pain syndrome
Objectives: To observe the clinical effects of therapeutic ultrasound combined with traditional Chinese massage in treatment of myofascial pain syndrome. .
Methods: A total of 42 patients with myofascial pain syndrome and have active myofascial trigger points on one side of the upper trapezius were randomly divided into a therapy group and a control group, with 21 patients in each. For those in the therapy group, 10 minutes of ultrasound at the therapeutic intensity (1W/cm2, 100% duty cycle) was applied to the active myofascial trigger points before traditional Chinese massage once daily for 5 days. For the control group, only traditional Chinese massage was used. Visual analogue scale (VAS), pressure pain threshold (PPT), active range of motion (AROM), Pittsburgh sleep quality index (PSQI), 12-item short form of health survey questionnaire (SF-12) were recorded before the first treatment and immediate after the first and fifth treatment and one month later after the last treatment.
Results: AROM measurements showed statistically significant increases after the first ultrasound therapy (P<0.05) in the therapy group, while the PPT values did not when compared with pretreatment (P>0.05). For both groups, VAS scores were decreased significantly (P<0.05), PPT values and AROM were significant improved (P<0.05) after the fifth treatment, and the results of the therapy group were better than those of the control group. A follow-up observation after 1 month found that VAS and PSQI scores of both groups remained significantly lower when compared with pretreatment scores (P<0.05), meanwhile, the AROM and SF-12 scores also showed significant improvement (P<0.05).
Conclusions: Therapeutic ultrasound administered in combination with traditional Chinese massage seems to be better than traditional Chinese massage in reducing the active myofascial trigger point sensitivity and improving the quality of life in patients with MPS.
方法:研究分为两个阶段。第一阶段:3名施测者分别使用手持式压力测痛仪对37名健康正常受测者全身共12个部位进行压痛阈测量。第二阶段:1名施测者使用手持式压力测痛仪对10名肌筋膜疼痛综合征患者进行压痛阈测量,并采用目测类比评分法(VAS)进行评估。分别计算组内相关系数和Spearman相关系数以评估信度和效度。用一个施测者三次测量的平均值分析不同个体间及个体内各受测点之间的压痛阈差异。
结果:重测信度及施测者间信度均较高(ICC>0.95),重测信度优于施测者间信度;根据同一施测者3次重复测量结果的均值所计算的施测者间信度高于用单次测量的施测者间信度;肌筋膜疼痛患者肌筋膜触发点与正常对照点的压痛阈差异具有统计学意义,肌筋膜触发点压痛阈值与VAS评分呈显著的负相关;不同个体间压痛阈差异具有统计学意义(P<0.05);女性压痛阈值低于男性(P<0.05);同一个体不同部位压痛阈差异具有统计学意义(P<0.05),但双侧对称部位压痛阈的差异则无统计学意义(P>0.05)。脊旁肌的压痛阈较高而骨突处的压痛阈较低。
结论:手持式压力测痛仪测量正常健康人压痛阈时具有较高信度,其可作为量化评价肌筋膜触发点疼痛敏感性的有效工具。使用压痛阈进行临床疼痛评估时在参照点的选择以及结果分析当中应重视压痛阈在个体间以及个体内的差异。分析压痛阈的影响因素以及建立适用于中国人群的压痛阈正常参考值是今后研究的任务。
第二部分超声波联合推拿治疗肌筋膜疼痛综合征的临床观察
目的:观察超声波联合推拿治疗肌筋膜触发点的临床疗效。
方法:选择42例有单侧上斜方肌活性肌筋膜触发点的肌筋膜疼痛综合征患者,随机分为治疗组和对照组,每组各21人。治疗组采用超声波治疗(1W/cm2,10分钟,100%工作周期)联合推拿手法进行治疗,每日一次,连续5次。对照组仅采用推拿手法治疗。在治疗前、第1次治疗结束后、第5次治疗结束后即刻及治疗结束1月后分别采用目测类比评分法(VAS)、压痛阈值(PPT)、关节主动活动范围(AROM)、匹兹堡睡眠质量指数(PSQI)、12个条目的简短生命质量量表(SF-12)评定疗效。
结果:治疗组第1次超声波治疗结束后患者的AROM显著增加(P<0.05),但PPT无明显改变(P>0.05);第5次治疗结束后,治疗组和对照组的VAS评分下降(P<0.05),PPT及AROM较治疗前明显增加(P>0.05),且治疗组疗效优于对照组;治疗结束1月后两组的VAS及PSQI评分较治疗前显著降低(P<0.05),AROM及SF-12评分较治疗前增加,且差异具有统计学意义(P<0.05),但两组间对比则无显著差异。
结论:超声波结合推拿治疗能够降低活性肌筋膜触发点的疼痛敏感性,提高患者的生存质量,其疗效优于单一推拿治疗。
PartⅠReliability and validity of the hand-held pressure algometer as a measuring instrument of pressure pain threshold and the characteristics of pressure pain threshold in healthy Chinese
Objectives: To evaluate the test-retest and inter-rater reliability of the hand-held pressure algometer as a measuring instrument of pressure pain threshold (PPT), and to characterize the pressure pain threshold in healthy Chinese .
Methods: A total of 37 healthy subjects were recruited for reliability test. Three raters measured PPT at 12 body sites of the subjects. Each rater conducted three trials on each site. In the validity test, 10 patients with active trigger points in the upper trapezius were recruited and measured by one rater using the pressure algometer for PPT, the visual analogue scale (VAS) was also used to evaluate the pain intensity induced by the trigger point. The intraclass correlation coefficient and Spearman correlation coefficient were calculated to reflect the reliability and validity. And mean value of the three trails by one rater was used to compare the pressure pain threshold over different sites and between individuals.
Results: The test-retest and inter-rater reliabilities were both high (ICC>0.95), with the measurements by one rater were more reliable than measurements by multiple raters. The inter-rater reliability of PPT measurement obtained by using the mean value of 3 trials was higher than any of the 3 trials alone. The PPT values of the trigger points were significantly lower than those of the normal points, and there was a significantly negative correlation between the PPT values of the trigger points and the VAS scores. The inter-individual differences were significant (P<0.05) and females exhibited lower PPT in every sites than males (P<0.05). PPT varied among different sites on one side (P<0.05), but showed no significant difference between the antimere sites (P>0.05). PPT value obtained from the paraspinal muscle was higher and that from the mastoid was lower than those from the other sites.
Conclusions: The intra- and inter-rater PPT measurements in healthy subjects obtained with the hand-held pressure algometer were highly reliable. The algometer was valid for quantifying myofascial trigger point sensitivity. On the individual level, due to the considerable variation found in the PPT results, cautions were advised both in selecting the reference point and interpreting the results when using it as a method for clinical pain assessment. Analyzing the factors influencing the measurements and establishing the normal range of pressure pain threshold in Chinese should be approached in the near future.
PartⅡClinical study of the effects of therapeutic ultrasound combined with traditional Chinese massage on myofascial pain syndrome
Objectives: To observe the clinical effects of therapeutic ultrasound combined with traditional Chinese massage in treatment of myofascial pain syndrome. .
Methods: A total of 42 patients with myofascial pain syndrome and have active myofascial trigger points on one side of the upper trapezius were randomly divided into a therapy group and a control group, with 21 patients in each. For those in the therapy group, 10 minutes of ultrasound at the therapeutic intensity (1W/cm2, 100% duty cycle) was applied to the active myofascial trigger points before traditional Chinese massage once daily for 5 days. For the control group, only traditional Chinese massage was used. Visual analogue scale (VAS), pressure pain threshold (PPT), active range of motion (AROM), Pittsburgh sleep quality index (PSQI), 12-item short form of health survey questionnaire (SF-12) were recorded before the first treatment and immediate after the first and fifth treatment and one month later after the last treatment.
Results: AROM measurements showed statistically significant increases after the first ultrasound therapy (P<0.05) in the therapy group, while the PPT values did not when compared with pretreatment (P>0.05). For both groups, VAS scores were decreased significantly (P<0.05), PPT values and AROM were significant improved (P<0.05) after the fifth treatment, and the results of the therapy group were better than those of the control group. A follow-up observation after 1 month found that VAS and PSQI scores of both groups remained significantly lower when compared with pretreatment scores (P<0.05), meanwhile, the AROM and SF-12 scores also showed significant improvement (P<0.05).
Conclusions: Therapeutic ultrasound administered in combination with traditional Chinese massage seems to be better than traditional Chinese massage in reducing the active myofascial trigger point sensitivity and improving the quality of life in patients with MPS.
引文
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