胸锁乳突肌乳突部肌筋膜痛的解剖与临床

发布时间：2018-06-11 11:10

本文选题：胸锁乳突肌 + 肌筋膜　；参考：《第一军医大学》2007年硕士论文

【摘要】： 目的：一、为胸锁乳突肌乳突部肌筋膜痛的体表定位、手法操作和扳机点注射等治疗提供胸锁乳突肌乳突部的解剖形态学资料及应用基础。二、观察胸锁乳突肌乳突部肌筋膜痛的临床特征，明确局部扳机点注射、推拿和牵拉康复疗法的治疗效果。方法：一、临床研究：选取胸锁乳突肌乳突部肌筋膜痛的患者30例，明确其疼痛的部位、性质、持续时间、牵涉痛的范围和伴随症状以及以往诊治情况等。采用局部扳机点注射技术和推拿疗法，配合胸锁乳突肌的牵拉康复等治疗。比较治疗前与治疗后1周、1月、3月及6月后局部压痛的疼痛量化评分(visual analogue scale，VAS)，判断其疗效。二、解剖学研究：选取17具尸体，观测胸锁乳突肌乳突部解剖形态学结构特征、毗邻关系以及枕动脉、枕大神经、枕小神经和耳大神经等走行及分布特征。结果：一、临床研究：胸锁乳突肌乳突部肌筋膜痛较为多见。症状包括枕下痛、乳突部和颞部痛，疼痛性质多为钝痛。有时疼痛可放射至同侧颞部、后枕部、头顶甚至前额及眶部。伴随症状有头昏、头晕、耳鸣、眼花、恶心甚至呕吐等。体征主要是以乳突部的局限性压痛为主，其中以乳突前下部和乳突后下部压痛最为明显。疗效：对30例胸锁乳突肌乳突部肌筋膜痛的病人全部跟踪随访。治疗前、治疗后1周、1月、3个月和6个月VAS的评分分别是7.12±1.13、3.83±0.94、2.88±0.68、2.37±0.59、2.00±0.59。压痛程度在治疗后1周、1月、3个月和6个月均较治疗前有明显缓解(P＜0.01)。患者主诉头痛及牵涉痛在治疗后1周、1月、3月和6月明显缓解甚至消失，优良率分别为93.7％、94.5％、96.7％和100％。二、解剖学研究：胸锁乳突肌两个头向上行走，至肌的上1／3处互相融合，胸骨头肌束向上止于乳突及上项线的前部；锁骨头浅部止于上项线的中部；锁骨头深部的肌束在乳突下方与胸骨头深面的肌束共同形成肌腱止于乳突前与乳突下。胸锁乳突肌的前缘长为(15.78±1.09)cm、后缘长(13.39±1.27)cm；中点宽(2.95±0.37)cm、乳突部宽为(3.76±0.52)cm。乳突尖水平胸锁乳突肌前缘厚度(0.96±0.05)cm、中部厚度(1.03±0.07)cm、后缘厚度(0.37±0.01)cm。乳突尖部肌前缘至耳垂距离1.74±0.25(1.69～1.76)cm、肌后缘至耳垂距离6.27±1.25(6.03～6.52)cm。枕大神经和枕小神经重叠分布于枕部，耳大神经和枕小神经重叠分布于颞部和枕外侧部，并且枕大和枕小神经的分支之间有吻合。98％的枕动脉在胸锁乳突肌乳突部走行于乳突内侧的枕动脉沟内，有约2％走行偏低甚至在乳突尖以下出现。结论：一、胸锁乳突肌乳突部肌筋膜痛的病变很常见，主要体征是胸锁乳突肌乳突部的压痛。以往多被误诊为偏头痛、枕大神经痛、神经血管性头痛、椎脉型颈椎病和脑血管缺血以及寰枢椎半脱位或错缝等病变，在临床诊治枕部疼痛时应给予足够的重视。二、胸锁乳突肌乳突部行扳机点注射疗法及点按推拿对胸锁乳突肌乳突部肌筋膜痛有确切的疗效，且方便易行，能够消除或明显缓解头枕部疼痛症状及减轻压痛。在此基础之上配合牵张疗法和热敷是治疗胸锁乳突肌肌筋膜痛的有效方法，，并可预防复发。三、从胸锁乳突肌乳突部的解剖特征来看，乳突部行扳机点注射或针刺时一般较为安全，需要注意的是针刺深度及用药浓度，操作时应垂直进针、深度不宜超过20.00mm，并回抽无血时方可进针，以免意外伤及枕动脉等神经血管重要结构，引起不必要的损伤。四、引起枕部疼痛的病因很多，颈项部肌肉和筋膜炎所造成的病变占有很大的比例，特别是胸锁乳突肌的病变可累及枕小神经和耳大神经，造成患者头枕部或颞部的疼痛症状。由于上述神经与枕大神经在枕部形成重叠分布，易使医生误将这类病变诊断为枕大神经痛。在诊治枕部疼痛时，除了要考虑枕大神经因素外，还要考虑枕小神经、耳大神经及胸锁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 卤 1.13 , 3.83 卤 0.94 , 2.88 卤 0.68 , 2.37 卤 0.59 , 2.00 卤 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 卤 1.09 ) cm and the trailing edge was ( 13.39 卤 1.27 ) cm .
The median width ( 2.95 卤 0.37 ) cm , the width of the mastoid part ( 3.76 卤 0.52 ) cm , the thickness of the anterior margin of the mastoid muscle ( 0.96 卤 0.05 ) cm , the middle thickness ( 1.03 卤 0.07 ) cm , the posterior border thickness ( 0.37 卤 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 .
【学位授予单位】：第一军医大学
【学位级别】：硕士
【学位授予年份】：2007
【分类号】：R322

【参考文献】