Comparison of silver needle and nerve block in treatment of back myofascial pain based on infrared thermal imaging
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摘要:
目的探讨如何根据红外热成像结果选择背部肌筋膜炎最佳治疗方式。 方法将诊断为肌筋膜炎的100例患者行红外热成像检查后，测量患侧与相对健侧的温度（△T=患侧温度-相对健侧温度），根据患侧温度高低选出热组（W组, △T≥0.2 ℃）和冷组（C组, △T≤-0.2 ℃），50例/组，每组采用随机数字表法再各分2组，25例/组，分别行银质针导热治疗（S组）和神经阻滞治疗（N组），4组分别简称WS、WN、CS和CN组。银质针导热治疗组共治疗1次，神经阻滞治疗组每5 d 1次，根据患者疼痛缓解情况共行2~3次。在治疗前（0 d）、治疗第1、6、15、30、180天采用视觉模拟评分法（VAS）评估患者疼痛变化。 结果随访期内，热组患者在第1、30、180天的VAS评分显示WS组明显高于WN组（P < 0.05）；冷组患者在第15、30、180天的VAS评分显示CS组明显低于CN组，两组数据之间差异均有统计学意义（P < 0.05）。 结论利用红外热成像进行患区温度判断，热区（△T≥0.2 ℃）选择神经阻滞治疗，冷区（△T≤-0.2℃）选择银质针治疗疗效较好。 Abstract:ObjectiveTo measure the temperature in the affected area using infrared thermal imaging.The warm area and the cold area were divided into two groups for silver needle heat conduction and nerve block treatment, then the efficacy was compared to choose the best treatment method for back myofascial pain. MethodsAfter patients who diagnosed with myofascial pain had been examed by infrared thermal imaging, we measured the temperature of the affected side and the relative healthy side(△T=the temperature of affected area - the temperature of healthy area). Fifty cases were selected in both warm group (group W, △T≥0.2 ℃) and the cold group (group C, △T≤-0.2 ℃). Then each group was randomly divided into 2 groups (WS, WN, CS, CN) with 25 patients. Group WS and CS received silver needle thermal conduction therapy (S) once in a month, and group WN and CN received nerve block treatment (N) once every 5 days, 2-3 times in total depends on how much the pain relieved. The change of patients' pain were inquired and compared with Visual Analogue Scale (VAS) at day 0 (before treatment), 1, 6, 15, 30 and 180 after the treatment. ResultsDuring the follow-up period, VAS of patients in group W at day 1, 30 and 180 showed that group WS was significantly higher than group WN. VAS of patients in group C at day 15, 30 and 180 showed that group CS was significantly lower than group CN(P < 0.05). ConclusionInfrared thermal imaging is used to judge the temperature of affected area, nerve block therapy used in warm and silver needle therapy is used in cold. -
Key words:
- infrared thermal imaging /
- myofascial pain /
- trigger point /
- temperature of skin surface
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图 1 患者男性，右侧胸背部疼痛3月，诊断为肌筋膜炎，红外热成像显示右侧温度大于左侧（△T=0.4 ℃），纳入W组
Figure 1. A male patient with right chest back pain for 3 months was diagnosed with myofascial pain. Infrared thermal imaging showed that the temperature on the right side was higher than that on the left (△T=0.4 ℃), and he was included in the warm group.
图 2 患者男性，右侧腰背痛10余年，诊断为肌筋膜炎，红外热成像显示右侧温度小于左侧（△T=-0.3 ℃），纳入C组
Figure 2. A male patient with right low back pain for more than 10 years was diagnosed as myofascial pain. Infrared thermal imaging showed that the temperature on the right side was lower than that on the left (△T=-0.3 ℃), and the patient was included in the cold group.
表 1 进针点皮肤表面达到42±2 ℃加热温度值的设置
Table 1. Setting of heating temperature of 42 ± 2 ℃ on the skin surface at the insertion point
加热温度的设定值（℃） 银质针外露部分长度（mm） 80 25~35 90 35~45 100 40~50 110 45~55 
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表 2 四组患者一般资料比较
Table 2. Comparison of general data of four groups of patients
组别 年龄（岁，Mean±SD） 性别（n） 部位（n） 男 女 颈 胸 腰 WS 43.73±18.20 8 17 4 8 13 WN 46.50±17.53 10 15 4 10 11 t/χ2 0.417 0.347 0.472 P 0.691 0.556 0.927 CS 55.40±16.09 12 13 6 11 8 CN 52.55±10.43 10 15 5 10 10 t/χ2 0.483 0.325 0.361 P 0.628 0.569 0.835 WS: 热区银质针导热治疗; WN: 热区神经阻滞治疗; CS: 冷区银质针导热治疗; CN: 冷区神经阻滞治疗.
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表 3 随访6月内W组VAS评分比较
Table 3. Comparison of VAS between two groups of patients during six months follow-up(Mean±SD, n=25)
随访时间(d) VAS(WS) VAS(WN) t P 0 5.69±0.308 5.89±0.351 0.401 0.6912 1 4.85±0.492 3.72±0.278* 2.124 0.0423 6 4.00±0.519 3.06±0.235 1.82 0.0791 15 3.62±0.432 3.00±0.214 1.387 0.1759 30 3.23±0.709 1.39±0.282* 2.691 0.0117 180 3.23±0.662 1.11±0.371* 2.989 0.0057 *P < 0.05 vs WS组. VAS: 视觉模拟评分.
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表 4 随访6月内C组VAS评分比较
Table 4. Comparison of VAS between two groups of patients during six months follow-up(Mean±SD, n=25)
随访时间(d) VAS(CS) VAS(CN) t P 0 5.90±0.315 6.18±0.352 0.592 0.5607 1 4.80±0.250 5.18±0.296 0.976 0.3414 6 3.70±0.367 4.09±0.315 0.813 0.4263 15 2.50±0.373 3.91±0.343* 2.789 0.0117 30 1.20±0.490 3.18±0.585* 2.569 0.0188 180 1.30±0.473 3.27±0.715* 2.253 0.0362 *P < 0.05 vs CS组.
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表 5 第30天疗效对比
Table 5. Comparison of two groups of patients during 30 days follow-up
组别 显效 有效 无效 有效率（%） χ2 P WS 10 4 11 56 WN 22 2 1 96# 10.965 0.001 CS 22 3 0 100 CN 13 3 9 64△ 8.672 0.003 #P < 0.05 vs WS组；△P < 0.05 vs CS组.
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表 6 第180天疗效对比
Table 6. Comparison of efficacy during 180 days follow-up
组别 显效 有效 无效 有效率（%） χ2 P WS 10 4 11 56 WN 21 2 2 92# 8.42 0.004 CS 22 0 3 88 CN 10 1 14 44△ 10.784 0.001 #P < 0.05 vs WS组；△P < 0.05 vs CS组.
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