基于表面肌电的芒针治疗坐骨神经痛的临床疗效和作用机制研究

Clinical Efficacy and Mechanism of Action of Surface Electromyography Based Acupuncture in the Treatment of Sciatica

摘要: 目的：通过表面肌电(surface electromyography, sEMG)图谱分析腰部竖脊肌肌电数据信号，探索芒针治疗坐骨神经痛(腰椎间盘突出根性痛)的作用机制。方法：将符合要求的30名坐骨神经痛患者，选用华佗牌6寸(直径为0.40 mm，长度150 mm)的芒针，取腰部夹脊穴，第3至第5腰椎棘突下左右各旁开0.5寸，共6个穴进行芒针针刺，隔两日治疗一次，共治疗2周。分别在2周前后采集分析腰部竖脊肌表面肌电数据信号(averaged electromyography, AEMG, media frequency, MF值)，并采用下腰痛系统评分法(Japanese Orthopaedic Association Score, JOA)、视觉模拟量表(Visual Analogue Scale, VAS)评分对患者不适及疼痛程度进行评估；焦虑自我评定量表(Self-assessment Scale for Anxiety, SAS)评价焦虑程度。同时选取10名健康人进行表面肌电数据采集。结果：受试者均接受了表面肌电图检查。治疗后JOA = 23.90，评分较治疗前升高，VAS = 2.33，评分较治疗前降低(治疗前JOA = 9.77, VAS = 6.57)，差异有统计学意义(P < 0.05)；治疗后腰部竖脊肌的AEMG = 71.60 ± 8.73、MF = 60.30 (治疗前AEMG = 36.87 ± 5.17、MF = 51.7 ± 5.26)，治疗后时域指标(AEMG)较治疗前明显增高(P < 0.05)，频域指标(MF)较治疗前下降；本次研究选取的健康志愿者腰部竖脊肌的AEMG = 85.5 ± 3.73、MF = 51.7 ± 5.26；治疗后患者SAS = 34.10 ± 2.72分(治疗前SAS = 49.20 ± 3.62)，差异有统计学意义(P < 0.05)。结论：经过芒针治疗，提示与治疗前比较，腰部竖脊肌收缩力有所提高，疲劳程度改善。坐骨神经痛患者的腰部竖脊肌功能被激活，肌肉活动能力和疲劳程度得到不同程度改善，临床不适症状得到明显缓解；患者在芒针治疗后疼痛得以改善的同时心理状况也得到明显的改善。

Abstract: Objective: To investigate the mechanism of the treatment of sciatica (lumbar disc herniation root pain) by means of surface electromyography (sEMG). Methods: 30 patients with sciatica who met the requirements were treated with a 6 inch (0.40 mm in diameter and 150 mm in length) mount needle of Huatoutuo brand. The lumbar Jiaji point was selected and the left and right sides of the third to fifth lumbar spinous process were open 0.5 inch. A total of 6 points were treated with mount needle, once every two days for 2 weeks. The average electromyography (AEMG), media frequency (MF) values of the surface electromyography (EMG) of the lumbar erector spine muscle before and 2 weeks after treatment, were collected and analyzed respectively. Japanese Orthopaedic Association Score (JOA) and Visual Analogue Scale (VAS) were used to evaluate the degree of discomfort and pain. Self-assessment Scale for Anxiety (SAS) was used to evaluate the anxiety level. Meanwhile, 10 healthy subjects were selected for surface EMG data collection. Results: All subjects were examined by surface electromyography. After treatment, the score of JOA = 23.90 was higher than that before treatment, and the score of VAS = 2.33 was lower than that before treatment (JOA = 9.77, VAS = 6.57), and the difference was statistically significant (P < 0.05); After treatment, AEMG = 71.60 ± 8.73, MF = 60.30 (before treatment, AEMG = 36.87 ± 5.17, MF = 51.7 ± 5.26), and time domain index (AEMG) after treatment was significantly higher than that before treatment (P < 0.05), and the frequency domain index (MF) decreased compared with that before treatment; In this study, AEMG = 85.5 ± 3.73 and MF = 51.7 ± 5.26 of erector spine muscles in healthy volunteers. After treatment, SAS = 34.10 ± 2.72 points (before treatment, SAS = 49.20 ± 3.62 points), and the difference was statistically significant (P < 0.05). Conclusion: After treatment with awn needle, the contractility of lumbar erector spine muscle and fatigue degree was improved. In patients with sciatica, the function of lumbar erector spine muscle was activated, muscle activity and fatigue degree were improved to varying degrees, and clinical discomfort symptoms were significantly relieved. After the treatment of awn needle, the patients’ pain was improved and their psychological condition was also significantly improved.