目的 探讨深层肌肉刺激(deep muscle stimulation,DMS)联合运动疗法对颈肩肌筋膜疼痛综合征(myofascial pain syndrome,MPS)患者肌骨超声形态学及功能的影响.方法 随机选取2021年8月-2022年12月在成都市双流区第一人民医院诊治的120例颈肩MPS患者,随机分为A、B、C、D 4组,每组30例.A组采用调制中频治疗,B组采用调制中频+DMS治疗,C组采用调制中频+运动疗法,D组采用调制中频+DMS+运动疗法.4组患者均于治疗前、治疗4周后应用实时剪切波弹性成像技术定量测量其斜方肌剪切波速度(shear wave velocity,SWV),利用高频超声测量斜方肌厚度,并评估视觉模拟评分(Visual Analogue Scale,VAS)、颈椎功能障碍指数(Neck Disability Index,NDI)、改良 Barthel 指数(modified Barthel Index,MBI)、工具性日常生活活动量表(Instrumental Activities of Daily Living Scale,IADL)、世界卫生组织生存质量测定简表(World Health Organization Quality of Life-BREF,WHOQOL-BREF)、焦虑自评量表(Self-rating Anxiety Scale,SAS)和抑郁自评量表(Self-rating Depression Scale,SDS)等指标,比较4组患者在不同干预方式下的治疗效果.结果 4组患者治疗前的斜方肌SWV、斜方肌厚度、VAS评分、NDI评分、MBI评分、IADL评分、WHOQOL-BREF评分、SAS评分和SDS评分比较,差异均无统计学意义(P＞0.05).治疗4周后,4组患者的斜方肌SWV、VAS评分、NDI评分、WHOQOL-BREF评分中的生理及心理领域得分、SAS评分和SDS评分比较,差异均有统计学意义(P＜0.05),且D组的斜方肌SWV、WHOQOL-BREF评分中的生理及心理领域得分、SDS评分较A、B、C组改善更明显(P＜0.05);4组患者的斜方肌厚度、MBI评分、IADL评分、WHOQOL-BREF评分中的社会关系和环境领域得分比较,差异无统计学意义(P＞0.05).结论 DMS联合运动疗法可改善颈肩MPS患者斜方肌弹性,改善心理状态,提高生活质量.
Effect of deep muscle stimulation combined with exercise therapy on neck and shoulder myofascial pain syndrome
Objective To explore the effect of deep muscle stimulation(DMS)combined with exercise therapy on morphological changes of the trapezius muscle assessed by musculoskeletal ultrasound and the function for patients with neck and shoulder myofascial pain syndrome(MPS).Methods One hundred and twenty patients with neck and shoulder MPS admitted to the First People's Hospital of Shuangliu District,Chengdu between August 2021 and December 2022 were randomly selected and divided into 4 groups.There were 30 cases in each group.Group A received modulated middle frequency electrotherapy,group B received modulated middle frequency electrotherapy combined with DMS,group C received modulated middle frequency electrotherapy combined with exercise therapy,and group D received modulated middle frequency electrotherapy,DMS combined with exercise therapy.Before treatment and after 4 weeks of treatment,shear wave elastography was used to detect the shear wave velocity(SWV)of the four groups,high frequency ultrasound was used to detect the muscle thickness of the trapezius muscle.The Visual Analogue Scale(VAS)scores,Neck Disability Index(NDI),modified Barthel Index(MBI),Instrumental Activities of Daily Living Scale(IADL),World Health Organization Quality of Life-BREF(WHOQOL-BREF),Self-rating Anxiety Scale(SAS),and Self-rating Anxiety Scale(SDS)were also assessed to compare the therapeutic effects among the four groups of patients under different intervention methods.Results Before treatment,there was no significant difference in trapezius muscle SWV,trapezius muscle thickness,VAS,NDI,MBI,IADL,WHOQOL-BREF,SAS or SDS among the four groups(P＞0.05).After 4 weeks of treatment,there were significant differences in trapezius muscle SWV,VAS,NDI,WHOQOL-BREF in the physiological domain and psychological domain,SAS and SDS among the four groups(P＜0.05),and the improvements of trapezius muscle SWV,WHOQOL-BREF in the physiological domain and psychological domain,and SDS in group D were more obvious than those in other groups(P＜0.05).After 4 weeks of treatment,there was no significant difference in MBI,IADL,or WHOQOL-BREF in the society domain and environmental domain among the four groups(P＞0.05).Conclusion DMS combined with exercise therapy can significantly improve trapezius muscle elasticity,psychological state and quality of life of patients with neck and shoulder MPS.
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