颈椎病常见压痛点的临床观察

【作者】 杨晓倩；

【导师】 汤立新；

【作者基本信息】 北京中医药大学 ， 针灸推拿学， 2010， 硕士

【摘要】 近年来,颈椎病的发病率呈现上升的趋势。其病因有：颈椎退行性改变、创伤、劳损、发育性椎管狭窄等。近年来,对颈肌的重视及对颈椎生物力学的研究进展,为颈椎病的病因学研究开辟了新思路。颈椎生物力学致病因素可分为内源性和外源性两方面,内源性因素为：椎体、椎弓及其突起、椎间盘和相连的韧带等结构受到的不平衡机械应力促进颈椎退行性病变；外源性因素主要是颈肌运动的不平衡导致了肌肉力量的不均衡,加剧了颈椎病的发生和发展。颈椎病致痛机制有：椎间盘源性、神经根性、硬脊膜、韧带与关节囊源性以及肌源性。颈椎病患者病变相关软组织都存在压痛点,有学者认为压痛点与生物力学密切相关,多位于肌肉的起点和作用力方向纵轴所经过的直线上机械应力比较集中的部位。它对颈椎病的诊断与治疗有重要意义。中医认为,颈椎病乃本虚标实之证,其本为肝肾亏虚,标为瘀血阻滞。风、寒、湿邪侵袭、劳损和外伤是发病的重要因素,总的病机为肝肾亏虚,筋骨失养,经脉闭阻,气血运行不畅,出现不通则痛或不荣则痛。颈椎病的临床表现与经筋病的表现极为相似。经筋理论对颈椎病的诊断及治疗具有重要的指导意义。经筋的结聚、“会于节”的地方是痛点容易出现的地方,“以痛为腧”是经筋病的重要治疗法则。现代医学对颈椎病的治疗方法杂多,然而实践证实,以压痛点加针灸辨证取穴治疗本病疗效佳,副作用少,故寻找并确定压痛点是诊疗的一个重要环节。但是文献中,鲜有对压痛点具体位置的探讨,更少有对压痛点分布规律的观察研究。目的：观察117例颈椎病患者常见压痛点的分布规律,为临床诊治提供依据。研究方法：按照从骨骼到肌肉,从上至下,从健侧到患侧的顺序,有序的查找患者颈肩及上臂部的压痛点。研究中,要求检查者用力均衡,并标记VAS评分4分以上的压痛点。最后对压痛点进行归纳分析,总结分布规律。结果显示：(1)在不同的位置,压痛点有点、束、片状分布的不同；(2)压痛点多位于关节周围；(3)压痛点多位于肌肉的起止点、骨边、肌肉与肌肉或肌腱之间；(4)在肢体部的经筋多为束状,其压痛点多处于筋束之间；在胸背部经筋多为片状,而压痛点多在经筋之上；(5)压痛点多分布于手足三阳经筋上,并与经筋的“交合结聚”密切相关；(6)52.7%的压痛点与经穴或经外奇穴位置相近或相重,69.4%的压痛点位于经脉循行线上；(7)颈部的压痛点不仅分布于颈椎后面,在侧面及前面均有分布；(8)与椎体相关的压痛点主要位于横突以及病变所累及的棘突附近,疼痛程度以横突为甚；(9)肩胛骨周围是压痛点出现的高频区域,特别是冈下窝,而且此处痛点疼痛较甚；(10)压痛点不仅限于患侧,健侧亦有出现,且疼痛程度不一定低于患侧。更多还原

【Abstract】 In recent years, the incidence of cervical spondylosis is upward trend. The causes are: Cervical vertebra degenerative changes, trauma, strain, developmental spinal stenosis. In recent years, the importance of the neck muscle and the cervical spine biomechanics research, as the etiology of cervical disease has opened up new ideas. Pathogenic factors of cervical spine biomechanics can be divided into endogenous and exogenous both endogenous factors:body of vertebra, vertebral arch and its processes, intervertebral disc and associated ligaments and other structures subject to mechanical stress imbalance in the promotion of cervical degenerative lesions; exogenous factors are mainly cervical muscle movement imbalance of muscle strength imbalance, increasing the occurrence and development of cervical spondylosis. Spondylosis pain mechanisms:discogenic nerve root, dura, ligament and joint capsule and muscle-derived origin.Related cervical lesions in patients with soft tissue tenderness are present, there are some scholars believe that the tender point is closely related with the biological mechanics, and more in the direction of muscle force starting point and vertical line through which mechanical stress concentrated on the site. Its diagnosis and treatment of cervical spondylosis have this significance.Chinese medicine (TCM), cervical spondylosis is evidence of the vacuity of its being the liver and kidney deficiency, marked blood stasis. Wind, cold, wet attacks, fatigue and injuries is an important factor in the disease, the overall pathogenesis for the liver and kidney deficiency, bones dystrophy, Meridian closed resistance, blood runs sluggish, there is not pain or General Wing is pain. The clinical performance of cervical disease and the performance by the tendons are very similar. A meridian on the diagnosis and treatment of cervical disease has important significance. The tendon of the knot together, "festival will be" the place is prone to pain point where the "pain as the Meridian" is an important treatment by the law of tendon disease.The modern treatment of cervical spondylosis heteropoly, however, practice showed that differentiation to tender point acupuncture acupoints good therapeutic effect, less side effects, so look for and identify tenderness is an important part of treatment. Review of the literature, few of the specific location of tender point, even fewer tender points on the observation of distribution.Objective:117 cases of cervical tenderness in patients with common point of distribution, provide the basis for clinical diagnosis and treatment. Methods:In accordance to the muscle from the bone, from top to bottom, from the contra lateral to the affected side of the order, ordered to find patients with neck and shoulder and upper arm of the tender point. Tender points and regular analysis, summarized the law. Study, asked the examiner force balance, and mark VAS score of 4 or tender spot. Finally consolidation of tender points, tender points summed up on the patients in the cervical distribution.The results showed:(1) in different locations, tender point a bit, beam, the distribution of the different sheet; (2) tender points were located around the joints; (3) tender point over the start and end points in the muscle, bone side, between the muscle and the muscle or tendon;(4) in the body mostly by the Ministry of tendon bundles, the tenderness between many points in the reinforcement beams; in the chest and back by the bar over the sheet, and point tenderness over the tendons on by; (5) tender points are distributed in the hand, foot Sanyang meridians on, and by the reinforcement of the "intercourse gather for" closely related; (6) 52.7% of the tender points and acupoints or meridian Extra points are located close to or overlapping,69.4% of the tender point in the meridian line;(7) neck tenderness point behind not only found in cervical, were distributed in the side and front; (8) tender points associated with the vertebral transverse process and the lesions are mainly located at the spinal process involved close to transverse staggering pain; (9) is tender points around the scapula emerging high-frequency region, in particular, infraspinatus fossa, and the point of pain, pain here than even; (10) tender points are not limited to the affected side, there appeared unaffected, and the pain is not necessarily lower than the affected side.更多还原