超声引导下A型肉毒毒素注射治疗腰背肌筋膜疼痛综合征的疗效观察-中华老年骨科与康复电子杂志

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Title:: Effect Observation of Ultrasound-Guided Injection of Botulinum Toxin Type A in Treatment of Back Myofascial Pain Syndrome

作者:: 陈雷1; 李丹丹2; 071000保定，中国中医科学院广安门医院保定医院骨科1，麻醉科2

Author(s):: Chen Lei1; Li Dandan2; 1 Chinese Academy of Traditional Chinese Medicine Guang’anmen Hospital Baoding Hospital Orthopedics Department,?Baoding 071000, China；2Anesthesiology Department of Baoding Hospital, Guang’anmen Hospital, Chinese Academy of Traditional Chinese Medicine，Baoding 071000, China

关键词:: 超声引导; A型肉毒毒素; 注射治疗; 腰背肌筋膜疼痛综合征

Keywords:: Ultrasound Guidance; Botulinum Toxin Type A; Injection Therapy; Low Back Myofascial Pain Syndrome

DOI:: 10.3877/cma.j.issn.2096-0263.2024.02.008

文献标志码:: A

摘要:: 目的探讨超声引导下A型肉毒毒素注射治疗腰背肌筋膜疼痛综合征的临床疗效。方法前瞻性收集2020年1月~2024年6月我院78例腰背肌筋膜疼痛综合征患者，男46例，女32例，年龄（48.04±4.95）岁。数字表法随机分为两组，对照组给予激痛点阻滞治疗，观察组超声引导下激痛点A型肉毒毒素注射治疗。比较两组患者治疗前后McGill疼痛问卷（McGill pain questionnaire, MPQ），检测治疗前后血清炎性因子水平以及致痛因子水平，评估综合临床疗效。结果 78例患者获得完整随访，随访时间（30.5±2.0）d。治疗后两组患者MPQ问卷疼痛分级指数（pain rating index PRI）、类比评分（visual analogue scale, VAS）、强度（present pain index, PPI）评分均显著下降，且治疗后观察组3项评分（2.03±0.24，1.98±0.28，1.24±0.12）均显著低于对照组（2.84±0.30，2.59±0.35，1.66±0.17，P<0.05）；治疗后两组患者血清白细胞介素6（IL-6）、肿瘤坏死因子（TNF-α）、前列腺素E2（PGE2）、环氧化酶2 （COX-2）等因子水平均显著降低，且治疗后观察组4项指标（39.34±5.34，2.02±0.48，9.42±1.07，29.43±4.03）显著低于对照组（48.83±7.20，2.69±0.54，12.66±2.14，37.68±5.15，P<0.05）；观察组总有效率（92.31%）显著高于对照组（74.36%，P<0.05）。结论超声引导下激痛点A型肉毒毒素注射治疗腰背肌筋膜疼痛综合征镇痛效果显著，能降低炎性因子以及内源性致痛因子水平。

Abstract:: Objective To explore the clinical efficacy of ultrasound-guided injection of botulinum toxin type A in the treatment of low back myofascial pain syndrome. Methods Prospective collection of 78 patients with lower back myofascial pain syndrome in our hospital from January 2020 to June 2024, including 46 males and 32 females,aged(48.04±4.95) years. they were randomly divided into two groups by the digital table method. The control group was given trigger point block therapy, and the observation group was treated with trigger point botulinum toxin type A injection under ultrasound guidance. The McGill Pain Questionnaire (MPQ) before and after treatment was compared between the two groups. Serum levels of inflammatory factors and pain-causing factors were detected before and after treatment. The comprehensive clinical efficacy was assessed. Results 78 patients were followed up for (30.5±2.0) days. After treatment, the MPQ questionnaire pain classification (pain rating indexPRI), analogy score (visual analogue scaleVAS), and intensity (present pain index PPI) scores of the two groups of patients decreased significantly, the three scores of the observation group were 2.03±0.24 1.98±0.28 1.24±0.12 and the control group were 2.84±0.30 2.59±0.35 1.66±0.17, which were significantly lower than those of the control group (P<0.05). After treatment, the levels of serum interleukin 6 (IL-6), tumor necrosis factor (TNF-α) and other inflammatory factors, as well as prostaglandin E2 (PGE2), cyclooxygenase 2 (COX-2), etc. caused pain in the two groups. The factor level was significantly reduced, the four indexes in the observation group were 39.34±5.34 2.02±0.48 9.42±1.07 29.43±4.03. The control group was 48.83±7.20 2.69±0.54 12.66±2.14 37.68±5.15, which were significantly lower than the control group (P<0.05). The total effectiverate was 92.31% in the observation group and 74.36% in the control group, which was significantly higher than that in the control group (P<0.05). Conclusions Trigger point type A botulinum toxin injection under ultrasound guidance has a significant analgesic effect on Lumbodorsal myofascial pain syndrome which can reduce the levels of inflammatory factors and endogenous pain-causing factors.

中华老年骨科与康复电子杂志[ISSN:1674-3911/CN:11-9292/R]

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