王明杰网球肘的新认识.ppt

原有的认识, 肌筋膜触发点的认识。 1、病理认识。 2、网球肘关联骨骼肌（触发点）。 网球肘的综合治疗。,原有的认识,网球肘，又称肱骨外上髁炎。大多数病人主诉肱骨外上髁处的疼痛、前臂运动性疼痛和无力。过去仅注意到肱骨外上髁的病理变化，如：局部淋巴细胞浸润、疤痕化等。因此，重点放在对肱骨外上髁的治疗，治疗时常对肱骨外上髁处疼痛的局部封闭、理疗、针刺治疗。这种疗法早期治疗尚可，但后期反复复发，严重影响了患者的工作和生活质量。 Tennis elbow, also called the extenal humerus epicondylitis. Most patients complained of the external condyle humerus pain, their forearm is fatigue pain and weakness. In the Past， doctors only took notice of the external condyle humerus pathological changes, such as: partial lymphocytes infiltration, scariation, etc. Therefore, focuses on the external condyle humerus, the cure on the external condyle humerus often are implementations of blockade, physiotherapy, acupuncture treatment at the local pain on condyle. This kind of therapy works as early treatment, but it would relapse in later period, and influence patients job and life quality.,The original understanding,肘关节正侧位片,L,肌筋膜触发点疼痛的认识,引入肌筋膜触发点疼痛理论，改变了我们对肱骨外上髁炎的认识。肱骨外上髁疼痛不是原发疼痛，而是一个来自接近肱骨外上髁肘外侧肌群（主要是伸肌群）的肌筋膜触发点疼痛的牵涉痛。 Introduction of myofascial trigger points theory changed our understanding of external humeral epicondylitis. The external condyle humerus pain is not a primary pain, but referred pain to the myofascial trigger points around external condyle humerus on elbow musculus lateralis externi (mainly extensor muscles).,Understanding of Myofascial trigger points of pain,肌筋膜触发点疼痛的认识,这种痛性综合征常因为肘外侧肌过渡疲劳或损伤，造成慢性持续肌节缩短，大大地增加局部能量的消耗和局部血循环的减少，从而引起异常的肌纤维运动终板处异常的放电，以致静息状态下肌肉持续痉挛，而产生疼痛 。 Because of the elbow musculus lateralis externi injury or fatigue, this kind of ache syndrome often result in continued chronic sarcomere shortening. The local energy consumption increases and local blood circulation decease greatly, thus causes the muscle fibers end plate discharge abnormally, so convulsion of muscles would last in the resting state, then causes the pain.,Understanding of Myofascial trigger points of pain,肌筋膜触发点疼痛的认识,最近的微电极诊断证据证实异常肌运动终板神经末梢处的乙酰胆碱浓度在休息状况下存在着病理性增高，结果引起肌的后连接持续的去极化，从而产生持续性肌节缩短和肌纤维收缩，因此出现了运动终板处的收缩结节。 Recent evidence to substantiate the microelectrode diagnosis, in the resting condition, there is pathological increase of acetylcholine concentration in abnormal muscle movement endplate nerve endings. The result causes depolarization of tendons, which to generate continued constant shortening of muscle fibers and sarcomere, and thus appeared the end plate contraction knots.,肌筋膜触发点疼痛的认识,这种慢性持续肌节缩短将大大地增加局部能量的消耗和局部血循环的减少；局部缺血和低氧可刺激神经血管反应物质的释放，这些物质使传入神经致敏而引起触发点疼痛。这些物质又可以刺激异常的乙酰胆碱释放，形成了一个正反馈环的恶性刺激，对短缩肌节的拉长可以打破这个环。 This chronic continued shortening of sarcomere lead to great increase of local energy consumption and reduction of local blood circulation. Ischemia and low oxygen can stimulate the release of vessels and nerves reaction substances, these substances that afferent nerve sensitization triggers caused pain. These substances also can stimulate the abnormal release of acetylcholine, formed a positive feedback loop of the malignant stimulation, spinning of the shortened sarcomere can break the loop.,肌筋膜触发点疼痛的认识,如果长期短缩肌节，还会产生骨骼肌周围筋膜的挛缩，而防碍肌肉牵张治疗。当伤害性感受器被致敏时，由传入神经将疼痛信号传入脊髓，产生了中枢疼痛信号，再扩散到邻近的脊髓节段引起牵涉痛。长期的中枢疼痛致敏可以增高神经元的兴奋性和神经元受体池的扩大，造成顽固性牵涉痛。 If there is a long-term sarcomere shortening, a contracture of aponeurosis around the skeletal muscles can be produced, which would hinder muscles stretch treatment. While there is sensitization in harmful sensor, the pain signals are afferent into the spinal cord by the afferent nerve, producing the central pain signals which spread to neighboring segmental spinal cord,