本文選題：胸鎖乳突肌 + 肌筋膜�。� 參考：《第一軍醫(yī)大學(xué)》2007年碩士論文

【摘要】： 目的： 一、為胸鎖乳突肌乳突部肌筋膜痛的體表定位、手法操作和扳機(jī)點(diǎn)注射等治療提供胸鎖乳突肌乳突部的解剖形態(tài)學(xué)資料及應(yīng)用基礎(chǔ)。 二、觀察胸鎖乳突肌乳突部肌筋膜痛的臨床特征，明確局部扳機(jī)點(diǎn)注射、推拿和牽拉康復(fù)療法的治療效果。 方法： 一、臨床研究：選取胸鎖乳突肌乳突部肌筋膜痛的患者30例，明確其疼痛的部位、性質(zhì)、持續(xù)時(shí)間、牽涉痛的范圍和伴隨癥狀以及以往診治情況等。采用局部扳機(jī)點(diǎn)注射技術(shù)和推拿療法，配合胸鎖乳突肌的牽拉康復(fù)等治療。比較治療前與治療后1周、1月、3月及6月后局部壓痛的疼痛量化評(píng)分(visual analogue scale，VAS)，判斷其療效。 二、解剖學(xué)研究：選取17具尸體，觀測(cè)胸鎖乳突肌乳突部解剖形態(tài)學(xué)結(jié)構(gòu)特征、毗鄰關(guān)系以及枕動(dòng)脈、枕大神經(jīng)、枕小神經(jīng)和耳大神經(jīng)等走行及分布特征。 結(jié)果： 一、臨床研究：胸鎖乳突肌乳突部肌筋膜痛較為多見(jiàn)。癥狀包括枕下痛、乳突部和顳部痛，疼痛性質(zhì)多為鈍痛。有時(shí)疼痛可放射至同側(cè)顳部、后枕部、頭頂甚至前額及眶部。伴隨癥狀有頭昏、頭暈、耳鳴、眼花、惡心甚至嘔吐等。體征主要是以乳突部的局限性壓痛為主，其中以乳突前下部和乳突后下部壓痛最為明顯。療效：對(duì)30例胸鎖乳突肌乳突部肌筋膜痛的病人全部跟蹤隨訪。治療前、治療后1周、1月、3個(gè)月和6個(gè)月VAS的評(píng)分分別是7.12±1.13、3.83±0.94、2.88±0.68、2.37±0.59、2.00±0.59。壓痛程度在治療后1周、1月、3個(gè)月和6個(gè)月均較治療前有明顯緩解(P＜0.01)�；颊咧髟V頭痛及牽涉痛在治療后1周、1月、3月和6月明顯緩解甚至消失，優(yōu)良率分別為93.7％、94.5％、96.7％和100％。 二、解剖學(xué)研究：胸鎖乳突肌兩個(gè)頭向上行走，至肌的上1／3處互相融合，胸骨頭肌束向上止于乳突及上項(xiàng)線的前部；鎖骨頭淺部止于上項(xiàng)線的中部；鎖骨頭深部的肌束在乳突下方與胸骨頭深面的肌束共同形成肌腱止于乳突前與乳突下。胸鎖乳突肌的前緣長(zhǎng)為(15.78±1.09)cm、后緣長(zhǎng)(13.39±1.27)cm；中點(diǎn)寬(2.95±0.37)cm、乳突部寬為(3.76±0.52)cm。乳突尖水平胸鎖乳突肌前緣厚度(0.96±0.05)cm、中部厚度(1.03±0.07)cm、后緣厚度(0.37±0.01)cm。乳突尖部肌前緣至耳垂距離1.74±0.25(1.69～1.76)cm、肌后緣至耳垂距離6.27±1.25(6.03～6.52)cm。枕大神經(jīng)和枕小神經(jīng)重疊分布于枕部，耳大神經(jīng)和枕小神經(jīng)重疊分布于顳部和枕外側(cè)部，并且枕大和枕小神經(jīng)的分支之間有吻合。98％的枕動(dòng)脈在胸鎖乳突肌乳突部走行于乳突內(nèi)側(cè)的枕動(dòng)脈溝內(nèi)，有約2％走行偏低甚至在乳突尖以下出現(xiàn)。 結(jié)論： 一、胸鎖乳突肌乳突部肌筋膜痛的病變很常見(jiàn)，主要體征是胸鎖乳突肌乳突部的壓痛。以往多被誤診為偏頭痛、枕大神經(jīng)痛、神經(jīng)血管性頭痛、椎脈型頸椎病和腦血管缺血以及寰樞椎半脫位或錯(cuò)縫等病變，在臨床診治枕部疼痛時(shí)應(yīng)給予足夠的重視。 二、胸鎖乳突肌乳突部行扳機(jī)點(diǎn)注射療法及點(diǎn)按推拿對(duì)胸鎖乳突肌乳突部肌筋膜痛有確切的療效，且方便易行，能夠消除或明顯緩解頭枕部疼痛癥狀及減輕壓痛。在此基礎(chǔ)之上配合牽張療法和熱敷是治療胸鎖乳突肌肌筋膜痛的有效方法，，并可預(yù)防復(fù)發(fā)。 三、從胸鎖乳突肌乳突部的解剖特征來(lái)看，乳突部行扳機(jī)點(diǎn)注射或針刺時(shí)一般較為安全，需要注意的是針刺深度及用藥濃度，操作時(shí)應(yīng)垂直進(jìn)針、深度不宜超過(guò)20.00mm，并回抽無(wú)血時(shí)方可進(jìn)針，以免意外傷及枕動(dòng)脈等神經(jīng)血管重要結(jié)構(gòu)，引起不必要的損傷。 四、引起枕部疼痛的病因很多，頸項(xiàng)部肌肉和筋膜炎所造成的病變占有很大的比例，特別是胸鎖乳突肌的病變可累及枕小神經(jīng)和耳大神經(jīng)，造成患者頭枕部或顳部的疼痛癥狀。由于上述神經(jīng)與枕大神經(jīng)在枕部形成重疊分布，易使醫(yī)生誤將這類(lèi)病變?cè)\斷為枕大神經(jīng)痛。在診治枕部疼痛時(shí)，除了要考慮枕大神經(jīng)因素外，還要考慮枕小神經(jīng)、耳大神經(jīng)及胸鎖乳突肌等肌源性因素。
[Abstract]:Purpose :






1 . The anatomical morphology data and the application basis of the mastoid muscle of the cleidomastoid muscle were provided for the body surface localization , manipulation manipulation and trigger point injection of the mastoid muscle of the mastoid muscle of the cleidomastoid muscle .






2 . To observe the clinical characteristics of the muscle and fascia pain of the mastoid muscle of the cleidomastoid muscle , and to clarify the therapeutic effect of the local trigger point injection , massage and traction rehabilitation therapy .






Method :






I . Clinical study : 30 cases of patients with cleidomastoid muscle and fascia pain were selected , the location , nature , duration , the range of pain , the symptoms and the past diagnosis and treatment were identified . Local trigger point injection technique and massage therapy were used in combination with the traction and rehabilitation of the cleidomastoid muscle .






Second , anatomical study : 17 bodies were selected to observe the morphological and morphological characteristics of the mastoid , the adjacent relation , the occipital artery , the occipital nerve , the occipital nerve , the auricular nerve , and so on .






Results :






1 week , 1 month , 3 months and 6 months VAS scores were 7.12 鹵 1.13 , 3.83 鹵 0.94 , 2.88 鹵 0.68 , 2.37 鹵 0.59 , 2.00 鹵 0.59 , respectively .






2 . anatomical study : the two heads of the cleidomastoid muscle of the chest - locked cleidomastoid move up and merge with each other at 1 / 3 of the muscle , and the head muscle bundle of the breast head is stopped at the front part of the mastoid process and the upper line ;
the shallow part of the locking head is stopped at the middle part of the upper line ;
The anterior margin of the cleidomastoid muscle was ( 15.78 鹵 1.09 ) cm and the trailing edge was ( 13.39 鹵 1.27 ) cm .
The median width ( 2.95 鹵 0.37 ) cm , the width of the mastoid part ( 3.76 鹵 0.52 ) cm , the thickness of the anterior margin of the mastoid muscle ( 0.96 鹵 0.05 ) cm , the middle thickness ( 1.03 鹵 0.07 ) cm , the posterior border thickness ( 0.37 鹵 0.01 ) cm .






Conclusion :






1 . The pathological changes of the mastoid muscle of the mastoid muscle of the cleidomastoid muscle are common , and the main signs are the tenderness of the mastoid part of the cleidomastoid muscle .






secondly , the injection therapy and the point of the trigger point of the mastoid muscle of the cleidomastoid muscle of the breast lock have definite curative effect on the muscle and fascia pain of the cleidomastoid muscle of the breast - locking cleidomastoid muscle , and is convenient and easy to operate , can eliminate or obviously relieve the pain symptoms of the head rest part and relieve the tenderness .






3 . In view of the anatomy of the mastoid muscle of the breast - locked mastoid muscle , it is generally safer to inject or needle the trigger point of the mastoid part . It is necessary to pay attention to the depth of acupuncture and the concentration of the drug . When the operation is performed , the needle should be inserted vertically , the depth should not exceed 20.00mm , and the needle can be injected into the needle without blood , so as to avoid the unnecessary injury caused by the accidental injury and the important structure of the nerve vessel such as the occipital artery .






4 . The causes of the pain of occipital region are many , the pathological changes caused by cervical muscle and fasciitis occupy a large proportion , especially the pathological changes of cleidomastoid muscle can involve the pain symptoms of the head rest or the temporal part of the patient .
【學(xué)位授予單位】：第一軍醫(yī)大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2007
【分類(lèi)號(hào)】：R322

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相關(guān)期刊論文 前10條

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6 趙長(zhǎng)地,王

本文編號(hào)：2004990