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中华老年骨科与康复电子杂志

中华老年骨科与康复电子杂志 ›› 2024, Vol. 10 ›› Issue (02) : 117 -122. doi: 10.3877/cma.j.issn.2096-0263.2024.02.008

麻醉医学

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
陈雷1,†(), 李丹丹2   
  1. 1. 071000　保定，中国中医科学院广安门医院保定医院骨科
    2. 071000　保定，中国中医科学院广安门医院保定医院麻醉科
  • 收稿日期:2023-12-09 出版日期:2024-04-05
  • 通信作者: 陈雷
  • 基金资助:
    保定市科技局计划项目(2341ZF287)

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

Lei Chen1,†(), Dandan Li2   

  1. 1. Chinese Academy of Traditional Chinese Medicine Guang'anmen Hospital Baoding Hospital Orthopedics Department, Baoding 071000, China
    2. Anesthesiology Department of Baoding Hospital, Guang'anmen Hospital, Chinese Academy of Traditional Chinese Medicine, Baoding 071000, China
  • Received:2023-12-09 Published:2024-04-05
  • Corresponding author: Lei Chen
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陈雷, 李丹丹. 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[J]. 中华老年骨科与康复电子杂志, 2024, 10(02): 117-122.

Lei Chen, Dandan Li. Effect Observation of Ultrasound-Guided Injection of Botulinum Toxin Type A in Treatment of Back Myofascial Pain Syndrome[J]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2024, 10(02): 117-122.

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。

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
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.

Key words: Ultrasound Guidance, Botulinum Toxin Type A, Injection Therapy, Low Back Myofascial Pain Syndrome
图1 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疗效观察流程图
表1 两组腰背肌筋膜疼痛综合征患者一般资料比较
组别 例数 性别（例） 年龄（岁，±s） 病程（月，±s） 激痛点数量（个，±s）
男 女
观察组 39 22 17 48.18±5.02 4.32±0.68 4.02±0.56
对照组 39 24 15 47.91±4.95 4.28±0.64 3.96±0.53
t值   0.212 0.239 0.268 0.486
P值   0.645 0.812 0.790 0.628
表2 两组腰背肌筋膜疼痛综合征患者MPQ问卷评分比较（±s，各组n=39）
组别 例数 PRI VAS PPI
治疗前 治疗后 治疗前 治疗后 治疗前 治疗后
观察组 39 6.02±0.76 2.03±0.24 5.89±0.70 1.98±0.28 3.46±0.35 1.24±0.12
对照组 39 6.10±0.72 2.84±0.30 6.03±0.73 2.59±0.35 3.50±0.33 1.66±0.17
统计值 T值 0.477 13.167 0.864 8.499 0.519 12.605
  P值 0.634 P<0.05 0.390 P<0.05 0.605 P<0.05
表3 两组腰背肌筋膜疼痛综合征患者血清炎性因子、致痛因子水平比较（±s，各组n=39）
组别 例数 IL-6（pg/ml） TNF（ng/ml） PEG2（g/L） COX-2（pg/ml）
治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后
观察组 39 84.65±8.72 39.34±5.34 5.12±1.21 2.02±0.48 18.03±3.12 9.42±1.07 73.45±7.15 29.43±4.03
对照组 39 84.78±9.73 48.83±7.20 5.13±1.18 2.69±0.54 17.19±3.96 12.66±2.14 73.60±6.30 37.68±5.15
统计值 T值 0.062 6.611 0.037 5.791 -1.041 8.457 0.098 7.879
  P值 0.950 <0.05 0.970 <0.05 0.301 <0.05 0.922 <0.05
表4 两组腰背肌筋膜疼痛综合征患者的综合疗效比较[例（%），各组n=39]
组别 痊愈 显效 有效 无效 有效率
观察组 20 9 7 3 36（92.31）
对照组 14 8 7 10 29（74.36）
χ2值         4.523
P值         0.033
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