下背肌筋膜疼痛電針治療前後之動作分析; Motion Analysis in Lumbar Myofascial Pain Before and After Electro-Acupuncture Treatment

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题名:	下背肌筋膜疼痛電針治療前後之動作分析;Motion Analysis in Lumbar Myofascial Pain Before and After Electro-Acupuncture Treatment
作者:	李佳鴻;Jia-Hong Li
贡献者:	中國醫藥大學中國醫學研究所
关键词:	慢性下背痛;肌筋膜疼痛症候群;電針;動作分析;chronic low back pain;myofascial pain syndrome;electro-acupuncture;motion analysis
日期:	2004
上传时间:	2010-01-20
摘要:	下背肌筋膜疼痛電針治療前後之動作分析研究生李佳鴻指導教授林昭庚中國醫藥大學中國醫學研究所慢性下背痛(chronic low back pain)是國內最常見的醫療及社會問題。有六成至九成的成年人在生命各階段中，經常暴露在下背痛的危險因子中，所以如何治療此症候成為醫生及病患最重要的課題。下背痛病人當中約有百分之八十五的盛行率是導因於肌筋膜疼痛。肌筋膜疼痛症候群 (Myofascial Pain Syndrome, MPS) 定義為已活化的激痛點 (trigger points) 導致傳導痛並與失能有關。肌筋膜疼痛症候群對於病患的經濟及心理狀況有巨大影響，所以在早期階段對疾病有效的治療，能省去不少病患的負擔及社會資源的浪費。目前藥物治療對下背痛病患，雖然有其效果，然而因為藥物易干擾生理活動及產生不可避免的副作用，其療效並不令人滿意，所以對於下背痛非藥物治療成為大家注目的焦點。電針是傳統針刺加上電刺激的療法，研究發現對多種疼痛有一定療效。近三十年來，各項研究皆證實電針能止痛、麻醉。而三維動作分析係透過紅外線攝影機記錄黏貼在人體肢段上被動反光標記 (passive retroreflective markers) 的運動軌跡，同時利用測力板量測地面反作用力，再使用人體數學模型計算出人體生物力學行為，在臨床應用上，可作為執行功能性或治療性活動的分析工具。本研究嘗試以較客觀的動作分析系統結合視覺類比刻度 (Visual Analogue Scale, VAS)，來探討電針治療下背肌筋膜疼痛之實際療效。有關肌筋膜症候群，Travell及Simons的攣縮缺氧惡性循環主張已行之多年，而電針具有疏通經絡之功效，故本研究採取隨機對照試驗以評估電針對下背肌筋膜症候群療效。21位被合格專科醫師診斷為慢性下背痛中肌筋膜症候群的病人，且符合研究特定條件，被選入本研究中。這些病人被隨機分配到兩組，其一為電針組（11位；針刺於腎俞、大腸俞及委中；電刺激頻率100 Hz），另一組是偽電針組（10位；針刺於同樣穴位但不得氣；針雖接上電針機，但未給予電刺激）治療前後以VAS和三維動作分析系統 (VICON 512 system) 評估軀幹前彎後仰、左右側彎、左右旋轉、坐到站、步態的關節活動度及其他參數之變化。本研究結果顯示，電針治療可減少疼痛所引起的各項動作限制，包括腰部前彎、後仰、左右側彎、左右旋轉之動作角度、速度皆有顯著增加，腰部前彎力矩增加，坐到站時間縮短，且達統計顯著意義。偽電針組在治療前後各項表現上並無明顯的療效。VAS顯示電針確實能有效緩解疼痛，但偽電針並無疼痛緩解作用，然而，在使用VAS評估時，應該考慮到病患心理因素對結果的影響。電針組與偽電針組藉由VAS和動作分析之主觀、客觀評估，可知電針組在疼痛緩解、減少動作角度的限制、促進動作協調表現上，對慢性下背痛治療有明顯助益。未來研究努力方向應朝向更長時間的追蹤電針治療結果發展。關鍵字：慢性下背痛、肌筋膜疼痛症候群、電針、動作分析; Motion Analysis in Lumbar Myofascial Pain Before and After Electro-Acupuncture Treatment Jia-Hong Li Major professor: Jaung-Geng Lin Institute of Chinese Medical Science, China Medical University, Taiwan, ROC ABSTRACT Chronic low back pain (LBP) is one of the most common medical and social problems in Taiwan. About 60%-90% of the adult population is at risk of developing low back pain at some point in their lives. Therefore, how to cure of the syndrome would be the most important for doctors and patients. The prevalence of myofascial pain ranges from around 85% in patients with chronic low back pain (LBP). Myofascial pain syndrome (MPS) is defined as pain referred from active myofascial trigger points with an associated dysfunction. MPS has huge impact on patients’ financial and psychological situation. Therefore, effective treatments at early stage can save a lot of unnecessary suffering to patients and resources later used on treatments. The current pharmacologic analgesic therapies may be effective for patients with LBP. However, they are unsatisfactory for many patients. The use of pharmacologic therapy can interfere in physical activity and produce inevitable side effects. These concerns have increased interest in nonpharmacologic therapies for LBP, such as electro-acupuncture. Recently, an analgesic effect of acupuncture to alleviate pain is paid much attention by international research workers. Electro-acupuncture is traditional acupuncture needle connected with electrical stimulation. In past thirty years, many researches have proved that electro-acupuncture treatments are effective in pain relief and anesthesia. 3D motion analysis utilized planar trajectories of passive retroreflective markers attached to the skin, which were measured by infrared sterophotogrammetry. The motion analysis system also used the force plates to sense reacting force of the ground and used the novel approach guided by the mathematical model to propose deriving human biomechanical patterns of movements. In clinical application, it can be a useful tool for analysis of functional or therapeutic activities. Besides this, numerous therapies have been compared the relative efficacy of myofascial therapy for LBP by subjective tools, such as VAS et al. But only a few studies have compared the relative efficacy of electro-acupuncture treatment by objective tools. At this writing, a randomized clinical trial has been conducted to evaluate the effectiveness of electro-acupuncture treatment for myofascial pain, which has been discussed about contraction-ischemia vicious cycle promoted by Travell and Simons for more than four decades. Twenty patients diagnosed chr
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