体外冲击波联合针灸治疗腰背肌筋膜疼痛综合征的临床观察

Clinical Observation on the Treatment of Myofascial Pain Syndrome of the Lumbar and Dorsal Muscles with Extracorporeal Shock Wave Therapy Combined with Acupuncture

摘要: 目的：针灸联合体外冲击波治疗(EWST)腰背肌筋膜疼痛综合征的临床观察。方法：2019年5月至2023年10月在兰州五零四医院疼痛科诊治腰背肌筋膜疼痛症状患者90例，男50例，女40例，年龄21~75岁，随机分为3组，每组30例。A组：每天给予每个激痛点针刺，10次一疗程；B组：每天给予以激痛点定位冲击点，每次治疗一个或多个冲击点(疼痛区域)，以不同的治疗参数采用瑞士EMS体外冲击波治疗，3天一次，3次为一疗程；C组：冲击波激痛点治疗联合针灸治疗，做冲击波当天不做针灸治疗，治疗13天；ABC组每天治疗后做20 min基础治疗，给予中医定向透药电疗，并随访记录首次治疗前(T0)、首次治疗后1周(T1)、2周(T2)、3周(T3)的VAS评分、压痛阈值及疗效评定、症状改善优良率、总有效率。结果：3组病例经过相应方法治疗1周、2周、3周后，较治疗前比较，VAS评分显著降低，压痛阈值测定明显升高；A组治愈为33.33%，总有效率为90.00%；B组EWST治愈率为46.67%，总有效率93.33%；C组治愈率为70.00%，总有效率为96.67%；联合组治愈率及总有效率均明显优于针刺组(A组)和EWST组(B组)，三组比较差异有统计学意义(P < 0.05)。结论：EWST技术联合针灸治疗腰背肌筋膜疼痛综合征疗效显著。

Abstract: Objective: To observe the clinical effect of acupuncture combined with extracorporeal shock wave therapy (EWST) in the treatment of myofascial pain syndrome of the lumbar and dorsal muscles. Methods: From May 2019 to October 2023, 90 patients with lumbar and dorsal myofascial pain syndrome were treated in the Pain Department of Lanzhou 504 Hospital. There were 50 males and 40 females, aged 21 to 75 years. They were randomly divided into 3 groups, with 30 cases in each group. Group A: Acupuncture was given at each trigger point every day, with 10 sessions as one course of treatment; Group B: Shock wave therapy was given at the trigger point location every day, with one or more shock points (pain areas) treated each time, using different treatment parameters with the Swiss EMS extracorporeal shock wave therapy, once every 3 days, with 3 sessions as one course of treatment; Group C: Shock wave therapy at the trigger point combined with acupuncture, no acupuncture on the day of shock wave therapy, for 13 days. All groups received 20 minutes of basic treatment with Chinese directional transdermal drug therapy after each treatment, and the VAS score, pain threshold, therapeutic effect evaluation, symptom improvement excellent and good rate, and total effective rate were recorded before the first treatment (T0), 1 week (T1), 2 weeks (T2), and 3 weeks (T3) after the first treatment. Results: After 1 week, 2 weeks, and 3 weeks of treatment, the VAS score of all three groups was significantly reduced, and the pain threshold was significantly increased compared with before treatment. The cure rate of Group A was 33.33%, and the total effective rate was 90.00%; the cure rate of Group B with EWST was 46.67%, and the total effective rate was 93.33%; the cure rate of Group C was 70.00%, and the total effective rate was 96.67%. The cure rate and total effective rate of the combined group were significantly better than those of the acupuncture group (Group A) and the EWST group (Group B), and the differences among the three groups were statistically significant (P < 0.05). Conclusion: The combination of EWST and acupuncture is effective in the treatment of myofascial pain syndrome of the lumbar and dorsal muscles.