| ObjectiveA large number of studies have shown that myofascial pain syndrome is one of the reasons for people with chronic pain,myofascial pain syndrome is due to the myofascial trigger point pain on muscle activation,the quadriceps myofascial trigger point pain activation can cause knee joint of a series of symptoms,such as knee pain,knee joint ring,weakness,etc.Although the theory of myofascial pain trigger point was put forward by Janet Travel,an American clinical professor,in 1942,many clinical treatments have been carried out based on this theory and its efficacy has been recognized by many people,for the better development of the theory,the application of ultrasonic technology is gradually expanding.Therefore,in this study,ultrasound imaging was used to explore the imaging changes of trigger point nodule after acupuncture,and to explore whether the morphological changes in this ultrasonic imaging were related to the curative effect,so as to further confirm the scientific nature of the trigger point nodule theory with this objective means.At the same time,ultrasound technology can be used not only for the diagnosis of myofascial trigger nodule,but also for the evaluation of trigger nodule inactivation.MethodsFrom October 2020 to June 2021,a part of the patients were recruited by pasting the subject recruitment posters in the outpatient hall of Shanghai Hudong Hospital,in addition,some of the outpatient patients who met the admission criteria in the department of pain and orthopedics and some of the patients who volunteered to participate in the study were recruited through wechat and other methods.Finally,according to the inclusion and exclusion criteria,52 patients with quadriceps FEMoris MPS meeting the needs of this clinical study were screened out.Before the formal experiment,the purpose,precautions,adverse reactions and other information of the experiment should be made clear to the patients participating in the clinical study,so as to ensure that all the patients participating in the study clearly understand the content of the informed consent and sign the informed consent.This clinical study has been reviewed and approved by the Ethics Committee of Shanghai Hudong Hospital with the ethics Approval Document No.2020(No.28),and the clinical trial registration Number is CHICTR-RCC-20200282001.Using random number table method,52 qualified patients were randomly divided into two groups according to random numbers generated by Excel: experimental group and control group,with 26 patients in each group.In the experimental group,ultrasound-guided acupuncture was performed on the trigger point of the quadriceps muscle nodule once a week for 6 times(one course),including 26 subjects.Control group also in ultrasound guided sham acupuncture intervention,namely USES the internationally recognized the placebo acupuncture,the needle truncation,needle point grinding blunt,sterile surgical marker in calibration of sham acupuncture intervention,the trigger area after truncation grinding blunt needle only tap the skin surface,plucked needle tail give subjects have been into the skin within the organization.Similar to the experimental group,all subjects underwent insertion,but did not Pierce the skin into the subcutaneous tissue,once a week,intervention 6 times(one course),a total of 26 subjects.In both groups,knee pain,ROM and function were assessed before and after treatment,as well as the thickness,echo and hardness of trigger nodules were measured.Results1.After needling the trigger point nodule of quadriceps femoris,the score of patients’ NPRs was significantly improved.There was no significant difference in NPRS score between the experimental group and the control group before treatment,and NPRS score in the control group was significantly higher than that in the experimental group 3 weeks after treatment,6weeks after treatment and 3 months after treatment.The experimental group and control group before treatment,after treatment for 3 weeks,6 weeks after treatment and after treatment for 3 months visit NPRS score difference,the results show that different time in experimental NPRS score had significant difference before and after the treatment,two comparison results show that the experimental group after treatment for 3 weeks,6 weeks and 3 months after treatment NPRS scores were significantly lower than before the treatment,The NPRS score at 6 weeks after treatment and 3 months after treatment was lower than that at 3 weeks after treatment(P>0.05).2.The Lysholm score of knee joint was significantly improved after needling the trigger point nodule of quadriceps femoris.Before treatment,there was no significant difference in Lysholm score between the experimental group and the control group(P>0.05).After 3 weeks of treatment,6weeks and 3 months after treatment,Lysholm score of the control group was significantly lower than that of the experimental group.After 3 weeks of treatment,Lysholm score at 6 weeks and 3 months after treatment in the experimental group was significantly higher than before,and showed a trend of gradual increase.Lysholm score at 6 weeks after treatment and 3 months after treatment were both higher than 3weeks after treatment,all P>0.05).3.After needling the trigger node of quadriceps femoris,the ROM of knee joint was significantly improved.There was no significant difference in ROM of active knee flexion and extension between the experimental group and the control group before treatment(P>0.05).After 3 weeks of treatment,6 weeks and 3 months follow-up,ROM Angle of active knee flexion and extension in the experimental group was larger than that in the control group.In the experimental group,after 3 weeks of treatment,the ROM of active knee flexion and extension at 6 weeks and 3 months follow-up was significantly higher than before,and showed a trend of gradual increase.The ROM of active knee flexion and extension at 6 weeks of treatment and 3 months follow-up was higher than that at 3 weeks of treatment,all P>0.05.4.After needling the trigger point nodule of quadriceps femoris,the thickness of the trigger point nodule becomes smaller.Before treatment,there was no significant difference in the thickness of trigger nodule between the two groups(P>0.05);after 3 weeks and 6 weeks of treatment,the thickness of trigger nodule in the experimental group was smaller than that in the control group,there were significant differences in the thickness of trigger nodule between the two groups.Groups:the thickness of trigger nodule at 3 weeks and 6weeks after treatment in the experimental group was lower than that before treatment,all P>0.05.5.After needling the trigger point nodule of quadriceps femoris,the echo of the trigger point nodule of the patient gradually approaches the echo of normal muscle tissue.There was no significant difference in the echo of trigger point nodule between the experimental group and the control group before treatment,P>0.05;After 3 weeks and 6 weeks of treatment,there were significant differences in the echo of trigger point nodules between the two groups.In the experimental group,the echo of trigger point nodules gradually tended to normal muscle tissue echo,while in the control group,it tended to low echo.The echo of trigger point nodules in the experimental group after 3 weeks and 6 weeks of treatment was significantly higher than t before treatment(P>0.05).6.After needling the trigger point nodule of quadriceps femoris,the hardness of the trigger point nodule becomes smaller.There was no significant difference in the hardness of trigger point nodules between the experimental group and the control group before treatment,P>0.05;There were significant differences in the hardness of trigger point nodules between the two groups after 3 weeks and 6 weeks of treatment.The hardness of trigger point nodules in the experimental group was lower than that in the control group after 3weeks and 6 weeks of treatment.The hardness of nodules at trigger points in the experimental group after 3 weeks and 6 weeks of treatment was significantly lower than that before treatment(P>0.05).Conclusion(1)In ultrasonic imaging,the thickness of the trigger point nodule of quadriceps femoris fascia decreased,the hardness became smaller,the nodule flattened and softened,and the nodule echo gradually tended to the change of normal muscle echo.(2)Acupuncture at the trigger point of quadriceps femoris fascia can reduce knee pain,improve knee function score and improve the range of motion of knee active flexion and extension joint.(3)When the trigger point nodule gradually flattens and softens,and the echo gradually approaches the normal muscle tissue,the pain symptoms of the subjects also gradually reduce,the active flexion and extension range of motion of the knee joint becomes larger,and the functional score improves. |
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