作　　者： ; ; ; ; ; ; ; ;

机构地区： 河南省洛阳正骨医院

出　　处： 《针刺研究》 2020年第1期57-61,共5页

摘　　要： 目的:观察膝关节病变患者膝周疼痛点和牵涉痛的分布特征,探讨肌筋膜激痛点与穴位敏化的关系。方法:在4家医院对膝关节疼痛的患者行膝部探查,采用拇指按压的方法,记录原发性疼痛部位与牵涉痛点出现的区域,并在相关图谱上进行描记。结果:膝关节痛的患者483例,336例患者病变部位和压痛点分布于膝关节周围;另有147例肌筋膜疼痛综合征患者在膝关节出现较为明显的牵涉性压痛点(区)。患髌腱炎、胫骨结节骨骺炎和股四头肌腱止点炎的105例,局部疼痛主要分布在膝前区。患内侧副韧带损伤、内侧半月板损伤、鹅足滑囊炎和半膜肌止点炎的76例,其局部疼痛主要发生在膝内侧区。外侧副韧带损伤、外侧半月板损伤、髂胫束肌腱炎、腘肌止点炎和股三头肌腱炎的127例患者的局部疼痛多出现在膝外侧区。后交叉韧带损伤、腘绳肌止点炎的28例患者的局部疼痛分布在膝后部。牵涉痛发生在股外侧肌群有43人(牵涉痛区多出现在股外侧和膝关节外侧区)、股前肌群有39人(牵涉痛出现在大腿前侧和膝前部)、股内收肌群有26人(牵涉痛出现在股部正中和膝内侧部)、腘窝后肌群有15人(小腿后侧腘窝部出现牵涉痛)、股后肌群有13人(后侧膝部出现牵涉痛),小腿内侧发生牵涉痛的有11人(牵涉痛出现在小腿内侧)。结论:膝关节病变的原发性痛区以局部分布为主;各肌群病变原发性疼痛位于各自的骨骼肌内,其牵涉痛区大都分布在骨骼肌远端和膝关节周围。原发部位的激痛点与穴位敏化有很多共同之处。 Objective The present study is to investigate the characteristic distribution of primary pain points and referred pain areas in patients with knee-joint pain diseases,therefore revealing the correlation between the myofascial trigger point and acupoint sensitization.Methods A total of 483 patients(320 men and 163 women,36 to 72 years in age)with knee-joint pain recruited from 4 clinical centers were observed from July,2017 to April,2019 in the present study.The areas of primary and referred pain in these patients were detected by thumb-pressing and marked on human anatomic atlas.Results Of the 483 enrolled participants,336 had lesion sites or tender points around the injured knee joint,and 147 with myofascial pain syndrome showed referred pain spots(zones)in the knee joint area.In 105 patients with patellar tendonitis,epiphysitis of the tibial tuberosity,or quadriceps tendonitis,the pain area was mainly distributed in the anterior region of the knee.In 76 patients with medial collateral ligament injury,medial meniscal lesion,goose foot bursitis or semimembranosus ending-point inflammation,the pain points mainly occurred in the medial area of the knee.In 127 patients with lateral collateral ligament,lateral meniscus lesion,iliotibial band tendonitis,popliteus or triceps tendinitis,the pain spots were found in the lateral region of the knee.In 28 patients with posterior cruciate ligament injury or popliteal fossa tendonitis,the local pain was found to be at the back of the knee.Referred pain areas were normally detected in the lateral femoral muscles(43 cases),anterior femoral muscles(39 cases),adductor group of femur(26 cases),posterior popliteal fossa muscles group(15 cases),hamstrings(13 cases)and medial leg(11 cases).Conclusion The primary pain areas or spots of the knee injury mainly distribute around the joint,whereas those of each muscle group lesion are often located in their respective skeletal muscle.Most of the referred pain areas often occur in the distal end of skeletal muscle and around the knee joint

关 键 词： 穴位敏化 膝关节 肌筋膜激痛点 牵涉痛

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