慢性肌肉筋膜激痛点大鼠模型发病机制及弱激光干预研究

发布时间：2018-04-03 04:37

本文选题：肌肉筋膜疼痛综合征　切入点：激痛点　出处：《北京协和医学院》2016年博士论文

【摘要】：肌肉筋膜疼痛综合征(myofascial pain syndromes)是肌肉骨骼疼痛(musculoskeletal disorders)疾病类中最多见的一类疾病,其主要症状表现为肌肉慢性损伤和疼痛,其不但影响患者的生活质量,而且造成极大的医疗资源消耗,在临床治疗上日益引起重视。虽然肌肉筋膜疼痛综合征得发病率极高,但发病机制仍认识不清,诊断标准客观化不足,尚未有一个统一的诊断标准来确诊肌筋膜疼痛综合征。肌肉筋膜疼痛综合征的激光干预治疗研究,在干预治疗参数选择存在一定的盲目性,统一性差。目前肌肉筋膜疼痛综合征比较通用的诊断标准,是1990年Simons提出的临床诊断标准,主要通过激痛点,局部抽搐反应和自发性电活动来有效确诊。肌肉筋膜疼痛综合征患病部位的疼痛结节或紧绷带的病理学特性是收缩节(contraction knots),这主要是由于乙酰胆碱的过度释放造成。本文的实验内容主要包括三部分,第一部分是肌肉筋膜综合征客观化的探索,通过对肌筋膜疼痛综合征模型大鼠进行剪切波弹性超声检查,通过剪切波超声弹性模量值来量化激痛点,并与肌电诊断方法相比较,两者对激痛点位置的定位有着同样的一致性,这为肌肉筋膜疼痛综合征的诊断提供新的方法；第二部分是大鼠模型的炎性机制探索,主要通过验证核转录因子KappaB/p65、COX2、钙离子通道是否在模型鼠激痛点处的高效表达,通过三者之间的相互诱导机制,初步证实了Simons提出的肌肉筋膜疼痛综合征的综合假说；第三部分是弱激光治疗肌肉筋膜疼痛综合征有效性探索,一方面通过预后的肌电评估和剪切波弹性模量检测,证实了剪切波弹性模量在预后的敏感性,另一方面通过肌电评估、剪切波弹性模量和生化指标的检测,证实了同一剂量参数下,波长是影响治疗的主要因素,这为临床疗效观察实验提供新的评估方法和治疗方案设定依据。目前对肌肉筋膜疼痛综合征发病机制研究主要基于肌筋膜触发点的综合假说。本文通过研究初步证实了综合假说的筋膜疼痛综合征的发病机制探索中的有效性,并通过实验确定了剪切波弹性超声模量在诊断中的敏感性,为肌肉筋膜疼痛综合征得诊断提供新的方法,为发病机制提供新的认识。
[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.
【学位授予单位】：北京协和医学院
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R-332;R685

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