【作者】 刘改红；

【导师】 类维富； 齐峰；

【作者基本信息】 山东大学 ， 麻醉学（专业学位）， 2013， 硕士

【摘要】 目的：1.临床研究：探讨药物注射疗法对颈肩肌筋膜疼痛综合征病人的短期、中长期疗效及治疗有效率。2.基础研究：肌筋膜疼痛综合征病人扳机点的病理形态学改变及EphrinB2配体的表达与否,进而推测(?)Eph/Ephrin信号系统是否与肌筋膜疼痛综合征相关。方法：1.临床研究：选择24例颈肩肌筋膜疼痛综合征(myofascial pain syndrome, MPS)病人,男12例,女12例,年龄21～53岁,病程2-10年。嘱患者取端坐伏案位,指压检查扳机点(Trigger Points, TrPs),消毒铺巾,将利美达松1ml、维生素B12lmg、2%利多卡因5ml、用0.9%生理盐水稀释至20ml,注射于病人症状明显的TrPs,每点约3-4ml。随访观察治疗前、治疗后1周、1个月和3个月后局部疼痛的视觉模拟量表(visual analogue scale, VAS)评分情况,对治疗效果进行动态观察比较,并参照疼痛改变的幅度,即：VAS加权值,分析其临床疗效,计算其治疗有效率。2.基础研究：经山东大学齐鲁医院伦理委员会审查批准,并经过患者正式同意后,将同意穿刺活检的7例病人取TrPs组织活检,以4%多聚甲醛固定,并将TrPs组织活检标本制成石蜡包埋蜡块,行常规HE染色及免疫组化染色技术,观察TrPs组织的病理形态学改变及EphrinB2配体的表达情况。结果：1.临床研究：对24例颈肩MPS患者全部跟踪随访,治疗前、治疗后1周、1个月和3个月的VAS评分分别是：7.38±1.11,4.12±1.40,3.47±1.04,3.12±0.95,其压痛程度在治疗后1周、1个月和3个月时均较治疗前有明显的减轻缓解(P<0.01),治疗有效率分别为83.3%,91.7%,95.8%。患者主诉其头颈肩部钝痛、牵涉痛以及伴随症状在治疗后的1周、1个月和3个月时均较治疗前有明显缓解甚至消失。2.基础研究：扳机点部位HE染色病理形态学显示：血管周围以及肌组织与肌组织之间的结缔组织均可见到以单核巨噬细胞为主的轻微的反应性炎性改变,偶见少量红细胞存在；肌组织内出现部分变性萎缩的肌纤维。扳机点部位免疫组化染色可见到EphrinB2配体呈阳性表达,主要位于肌纤维胞浆或胞膜,阳性表达强度和分布部位存在差异,变性萎缩程度高的肌纤维染色强度明显且分布密度高。另外,组织中血管的内皮细胞也可见到EphrinB2配体的阳性表达,但染色强度和分布部位相对一致。结论：1.临床研究：药物注射疗法能够消除或明显缓解颈肩肌筋膜疼痛综合征患者的疼痛、牵涉痛和伴随症状,具有确切的短期、中长期疗效和治疗有效率,并且此治疗方法简便易行,安全性高,值得进一步推广实施。2.基础研究：MPS患者的扳机点部位发生了炎性改变,且有Eph/Ephrin言号系统的阳性表达,推测MPS发病与Eph/Ephrir(?)信号系统有关。另外,组织中血管内皮细胞EphrinB2配体的阳性表达,支持以往大多数学者关于Eph/Ephrin言号系统参与生理性或病理性血管形成发育过程的结论。更多还原

【Abstract】 Objective:1.Clinical Research:Exploring the short-term, medium and long term efficacy and treatment efficiency for the patients with myofascial syndrome of the neck by drug injection therapy.2.Basic Research:Exploring the trigger points’pathomorphology of the patients with myofascial pain syndrome and the expression or not of EphrinB2ligand, and then speculated the relationship between Eph/Ephrin signaling system and myofascial pain syndrome.Methods:1.Clinical Research:Selecting24cases of the patients with myofascial pain syndrome(MPS)of the neck, of which12males and12females, aged21-53years old, duration of2-10years. Demanding the patients to sit at his desk bit and checking the trigger points (TrPs) by acupressure. Disinfecting and drape. Diluting lml of limethason,1mg of vitamin B12and5ml of2%lidocaine to20ml with0.9%physiological saline and injecting the mixture into their symptomatic TrPs, about3-4ml.Observing and following up the visual analog scale of the local pain in the time before treatment and the time after treatment1st week,1st month and3rd month and comparing their treatment effects dynamically. Analyzing the clinical efficacy and calculating its treatment efficiency according to the suggest from Han Jisheng academicians of Chinese Pain Society with the amplitude of the change in pain VAS weighted value.2.Basic Research:After the examination and approbation by the Ethics Committee of Qilu Hospital of Shandong University and the consent of the patients, acquiring the biopsy specimens of the TrPs from the7patients.Fixing the biopsy specimens with4%paraformaldehyde, and embedding the biopsy specimens into paraffin. After the techniques of routine HE and immunohistochemical staining, observing its pathomorphology and the expression of EphrinB2ligand.Results:1.Clinical Research:Follow up all of the24cases of the patients with MPS of the neck, the scores of VAS in the time before treatment and the time after treatment1st week,1st month and3rd month respectively were7.38±1.11,4.12±1.40,3.47±1.04,3.12±0.95,the degree of tenderness in the time after treatment1st week,1st month and3rd month has eased significantly than before treatment (P<0.01),and the treatment efficiency respectively was83.3%,91.7%and95.8%,and the pain of neck, referred pain and associated symptoms patients complained of having eased significantly or even disappear in the time after treatment1st week,1st month and3rd month.2.Basic Research:The pathomorphology of the TrPs by HE staining technique displays mild inflammatory changes which can be seen around the blood vessels and between the muscle tissues,in which the monocyte-macrophage cells mainly and a small amount of red blood cells occasionally; part atrophic muscle fibers appear within the musule organization.The trigger point tissue after immunohistochemical technique can be seen EphrinB2ligand positive expression, mainly located in cytoplasm or membrane,the expression of muscle fibers are generally differences in intensity and distribution, which is in a high level in atrophic muscle fibers. In addition, the expression of EphrinB2ligand can be seen in vascular endothelial cells, but the staining intensity and distribution of parts is relatively consistent.Conclusion:1.Clinical Research:Drug injection therapy can eliminate or significantly alleviate the pain, referred pain and associated symptoms of MPS of the neck with the exact short-term, medium-and long-term efficacy and treatment efficiency, and this treatment method is simple and security,deserving further promote the implementation.2.Basic Research:The trigger point of MPS patients is changed inflammatory,with the positive expression of Eph/Ephrin signaling system,suggesting that the incidence of MPS is in relation to Eph/Ephrin signaling system.In addition,the expression of EphrinB2ligand in vascular endothelial cells supports most scholars’conclusions in the past about Eph/Ephrin signaling system which is involved in the development process of the physiologic or pathologic angiogenesis.更多还原