本文選題：肌肉筋膜疼痛綜合征　切入點(diǎn)：激痛點(diǎn)　出處：《北京協(xié)和醫(yī)學(xué)院》2016年博士論文

【摘要】：肌肉筋膜疼痛綜合征(myofascial pain syndromes)是肌肉骨骼疼痛(musculoskeletal disorders)疾病類中最多見的一類疾病,其主要癥狀表現(xiàn)為肌肉慢性損傷和疼痛,其不但影響患者的生活質(zhì)量,而且造成極大的醫(yī)療資源消耗,在臨床治療上日益引起重視。雖然肌肉筋膜疼痛綜合征得發(fā)病率極高,但發(fā)病機(jī)制仍認(rèn)識(shí)不清,診斷標(biāo)準(zhǔn)客觀化不足,尚未有一個(gè)統(tǒng)一的診斷標(biāo)準(zhǔn)來確診肌筋膜疼痛綜合征。肌肉筋膜疼痛綜合征的激光干預(yù)治療研究,在干預(yù)治療參數(shù)選擇存在一定的盲目性,統(tǒng)一性差。目前肌肉筋膜疼痛綜合征比較通用的診斷標(biāo)準(zhǔn),是1990年Simons提出的臨床診斷標(biāo)準(zhǔn),主要通過激痛點(diǎn),局部抽搐反應(yīng)和自發(fā)性電活動(dòng)來有效確診。肌肉筋膜疼痛綜合征患病部位的疼痛結(jié)節(jié)或緊繃帶的病理學(xué)特性是收縮節(jié)(contraction knots),這主要是由于乙酰膽堿的過度釋放造成。本文的實(shí)驗(yàn)內(nèi)容主要包括三部分,第一部分是肌肉筋膜綜合征客觀化的探索,通過對肌筋膜疼痛綜合征模型大鼠進(jìn)行剪切波彈性超聲檢查,通過剪切波超聲彈性模量值來量化激痛點(diǎn),并與肌電診斷方法相比較,兩者對激痛點(diǎn)位置的定位有著同樣的一致性,這為肌肉筋膜疼痛綜合征的診斷提供新的方法；第二部分是大鼠模型的炎性機(jī)制探索,主要通過驗(yàn)證核轉(zhuǎn)錄因子KappaB/p65、COX2、鈣離子通道是否在模型鼠激痛點(diǎn)處的高效表達(dá),通過三者之間的相互誘導(dǎo)機(jī)制,初步證實(shí)了Simons提出的肌肉筋膜疼痛綜合征的綜合假說；第三部分是弱激光治療肌肉筋膜疼痛綜合征有效性探索,一方面通過預(yù)后的肌電評估和剪切波彈性模量檢測,證實(shí)了剪切波彈性模量在預(yù)后的敏感性,另一方面通過肌電評估、剪切波彈性模量和生化指標(biāo)的檢測,證實(shí)了同一劑量參數(shù)下,波長是影響治療的主要因素,這為臨床療效觀察實(shí)驗(yàn)提供新的評估方法和治療方案設(shè)定依據(jù)。目前對肌肉筋膜疼痛綜合征發(fā)病機(jī)制研究主要基于肌筋膜觸發(fā)點(diǎn)的綜合假說。本文通過研究初步證實(shí)了綜合假說的筋膜疼痛綜合征的發(fā)病機(jī)制探索中的有效性,并通過實(shí)驗(yàn)確定了剪切波彈性超聲模量在診斷中的敏感性,為肌肉筋膜疼痛綜合征得診斷提供新的方法,為發(fā)病機(jī)制提供新的認(rèn)識(shí)。
[Abstract]:Myofascial pain syndrome is the most common disease in musculoskeletal pain (musculoSkeletal disorders.). Its main symptoms are chronic muscle injury and pain, which not only affect the quality of life of patients, but also affect the quality of life of patients.Moreover, it causes great consumption of medical resources and attracts more and more attention in clinical treatment.Although the incidence of myofascial pain syndrome is very high, the pathogenesis is still unclear, the diagnostic criteria are not objective enough, and there is not yet a unified diagnostic standard to diagnose myofascial pain syndrome.Laser intervention in the treatment of myofascial pain syndrome has some blindness and unity in the choice of intervention parameters.At present, the common diagnostic criteria for myofascial pain syndrome are the clinical diagnostic criteria proposed by Simons in 1990. They are mainly diagnosed by excitatory pain points, local convulsive reactions and spontaneous electrical activity.The histopathological feature of the pain nodules or tension bands in the muscle fascia pain syndrome is contraction knots.This is mainly due to the excessive release of acetylcholine.The experimental contents of this paper mainly include three parts. The first part is to explore the objectification of myofascial syndrome (MfS). The Shear wave elastic ultrasonic examination was carried out on the rat model of myofascial pain syndrome.The ultrasonic modulus of shear wave was used to quantify the excitatory pain point, and compared with the electromyographic diagnosis method, the location of the excitatory pain point was the same between the two methods, which provided a new method for the diagnosis of myofascial pain syndrome.The second part is to explore the inflammatory mechanism of rat model, mainly by verifying the high expression of KappaB / p65 COX2 and calcium channel at the excitatory pain point of the model rat, and through the mutual induction mechanism among the three factors.In the third part, the effectiveness of weak laser in treating myofascial pain syndrome was explored. On the one hand, the prognosis was evaluated by electromyography and the elastic modulus of shear wave was measured.The sensitivity of shear wave elastic modulus in prognosis was confirmed. On the other hand, through the myoelectric evaluation, the detection of shear wave elastic modulus and biochemical indexes, it was proved that wavelength was the main factor affecting the treatment under the same dose parameters.This provides a new evaluation method and treatment plan for clinical efficacy observation experiment.At present, the pathogenesis of myofascial pain syndrome is mainly based on the comprehensive hypothesis of myofascial trigger point.This paper preliminarily confirmed the validity of the synthetic hypothesis in the exploration of the pathogenesis of fascia pain syndrome, and determined the sensitivity of the elastic modulus of shear wave in the diagnosis of fascia pain syndrome by experiments.To provide a new method for the diagnosis of myofascial pain syndrome and a new understanding of the pathogenesis.
【學(xué)位授予單位】：北京協(xié)和醫(yī)學(xué)院
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2016
【分類號(hào)】：R-332;R685

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