骶神经磁刺激联合盆底肌康复训练治疗女性慢性盆腔痛的效果观察

周晓红; 张琳; 苏爱芳

doi:10.16766/j.cnki.issn.1674-4152.003252

骶神经磁刺激联合盆底肌康复训练治疗女性慢性盆腔痛的效果观察

doi: 10.16766/j.cnki.issn.1674-4152.003252

金华市妇幼保健院妇科，浙江金华 321000

基金项目:

浙江省金华市科技计划项目 2022-3-127

浙江省医药卫生科技计划项目 2022KY1336

详细信息

通讯作者:
张琳, E-mail：bing315205zei@163.com

中图分类号: R711.33
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- 被引次数: 0
出版历程
- 收稿日期: 2023-06-28
- 网络出版日期: 2024-01-13

Observation study of the therapeutic effect of sacral nerve magnetic stimulation combined with pelvic floor muscle rehabilitation training on chronic pelvic pain in women

Gynecology Department of Jinhua Maternal and Child Health Hospital, Jinhua, Zhejiang 321000, China

摘要

摘要: 目的骶神经干预靶点在慢性盆腔痛(CPP)中的应用备受关注，本研究探讨骶神经磁刺激联合盆底肌康复训练治疗女性CPP的效果。方法选取2022年6月—2023年4月金华市妇幼保健院盆底门诊收治的女性慢性盆腔痛患者共92例，采用随机数字表法分为对照组和研究组，各46例。对照组给予肌筋膜手法联合生物反馈的盆底肌康复训练，研究组给予骶神经磁刺激联合盆底肌康复训练。比较2组治疗前后改良牛津肌力分级法(MOS)、盆底肌压痛检查、盆底表面肌电Glazer评估和不良反应。结果 2组治疗后盆底肌MOS分级均较治疗前提高(均P<0.05)，盆底肌筋膜扳机点(MTrP)的视觉模拟疼痛评分(VAS)均较治疗前明显降低(均P<0.05)，且研究组治疗后盆底肌MOS分级、VAS评分[(2.38±0.74)分vs.(3.51±1.16)分，t=5.570，P<0.001]均优于对照组。2组治疗后前静息平均肌电值、后静息平均肌电值、快速收缩放松时间均较治疗前下降(均P<0.05)，快肌最大肌电值、慢肌平均肌电值较治疗前升高(均P<0.05)，研究组治疗后上述盆腔肌电生理指标均优于对照组(均P<0.05)。2组均未出现明显不良反应。结论骶神经磁刺激联合盆底肌康复训练能明显减轻女性CPP患者的疼痛，改善盆底肌力和肌电生理指标，是一种疗效显著且安全性好的康复治疗方案。
- 女性慢性盆腔痛 /
- 骶神经磁刺激 /
- 盆底肌康复训练 /
- Glazer评估
Abstract: Objective The use of sacral nerve intervention targets in chronic pelvic pain (CPP) has received much attention. This study aims to investigate the effectiveness of sacral nerve magnetic stimulation combined with pelvic floor muscle rehabilitation training in the treatment of female CPP. Methods A total of 92 female patients with chronic pelvic pain admitted to the pelvic floor clinic of Jinhua Maternal and Child Health Hospital from June 2022 to April 2023 were selected and randomly divided into a control group and a study group using a random number table method, with 46 cases each. The control group received myofascial manipulation combined with biofeedback pelvic floor muscle rehabilitation training, and the study group received sacral nerve magnetic stimulation combined with pelvic floor muscle rehabilitation training. Modified Oxford muscle strength grading (MOS), pelvic floor muscle tenderness examination, pelvic floor surface electromyography Glazer assessment and adverse reactions were compared between the two groups before and after treatment. Results After treatment, the MOS grading of the pelvic floor muscles was significantly improved in both groups compared with before treatment (all P<0.05), and the visual analogue pain score (VAS) of the pelvic floor myofascial trigger point (MTrP) was significantly reduced compared with before treatment (all P<0.05). In addition, the MOS grading of the pelvic floor muscles and the VAS score [(2.38±0.74) points vs. (3.51±1.16) points, t=5.570, P<0.001]in the study group were better than those in the control group. After treatment, the average pre resting electromyographic value, post resting average electromyographic value and rapid contraction relaxation time in both groups decreased compared to before treatment, while the maximum electromyographic values of the fast muscles and the average electromyographic values of the slow muscles increased compared to before treatment (all P<0.05). After treatment, the above pelvic electromyographic indicators were better in the study group than in the control group (all P<0.05). No significant side effects were observed in either groups. Conclusion Sacral nerve magnetic stimulation combined with pelvic floor rehabilitation training can significantly reduce pain, improve pelvic floor muscle strength and electrophysiological indicators in female patients with CPP and is a significant and safe rehabilitation treatment plan.
- Chronic pelvic pain in women /
- Sacral nerve magnetic stimulation /
- Pelvic floor muscle rehabilitation training /
- Glazer assessment

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表 1 2组女性CPP患者一般资料比较

Table 1. Comparison of general information between two groups of female CPP patients

组别	例数	年龄 (x±s，岁)	病程 (x±s，年)	体重指数 (x±s)	分娩史 [例(%)]	阴道分娩史 [例(%)]
对照组	46	33.58±7.36	1.17±0.31	24.03±2.37	37(80.43)	23(50.00)
研究组	46	34.12±7.59	1.20±0.34	23.98±2.35	35(76.09)	20(43.48)
统计量		0.346^a	0.442^a	0.102^a	0.256^b	0.393^b
P值		0.730	0.659	0.919	0.613	0.531
注：^a为t值，^b为χ²值。

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表 2 2组女性CPP患者治疗前后盆底肌MOS分级结果比较(例)

Table 2. Comparison of MOS grading results of pelvic floor muscles between two groups of female CPP patients before and after treatment (cases)

组别	例数	时间	0级	1级	2级	3级	4级	5级
对照组	46	治疗前	3	12	16	8	4	3
		治疗后	1	8	12	13	7	5
研究组	46	治疗前	4	10	14	10	4	4
		治疗后	0	5	9	15	9	8

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表 3 2组女性CPP患者治疗前后盆底MTrP的VAS评分比较(x±s，分)

Table 3. Comparison of VAS scores of pelvic floor MTrP between two groups of female CPP patients before and after treatment (x±s, points)

组别	例数	治疗前	治疗后	t值	P值
对照组	46	5.59±1.68	3.51±1.16	5.939	<0.001
研究组	46	5.65±1.75	2.38±0.74	10.283	<0.001
t值		0.168	5.570
P值		0.867	<0.001

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表 4 2组女性CPP患者治疗前后盆底表面肌电Glazer评估比较(x±s)

Table 4. Comparison of Glazer evaluation of pelvic floor surface electromyography between two groups of female CPP patients before and after treatment (x±s)

组别	例数	前静息平均肌电值(μV)		后静息平均肌电值(μV)		快肌最大肌电值(μV)		慢肌平均肌电值(μV)		快速收缩放松时间(s)
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
对照组	46	6.59±1.87	5.75±1.76^a	5.43±1.07	4.87±0.96^a	30.47±6.48	33.59±7.03^a	25.96±5.72	29.30±6.18^a	4.91±1.50	3.92±1.16^a
研究组	46	6.56±1.90	4.98±1.53^a	5.42±1.12	4.21±0.83^a	31.03±6.75	36.85±7.12^a	26.04±5.89	33.27±6.52^a	4.94±1.53	3.14±0.89^a
t值		0.076	2.239	0.044	3.527	0.406	2.210	0.066	2.997	0.095	3.618
P值		0.939	0.028	0.965	<0.001	0.686	0.030	0.948	0.004	0.925	0.001
注：与同组治疗前比较，^aP<0.05。

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参考文献(16)

[1]	BIASI G, DI S V, GHIZZANI A, et al. Chronic pelvic pain: comorbidity between chronic musculoskeletal pain and vulvodynia[J]. Reumatismo, 2014, 66(1): 87-91. doi: 10.4081/reumatismo.2014.768
[2]	陶沐珩, 肖培娜, 叶明珠. 慢性盆腔疼痛发病机制及治疗的研究进展[J]. 医学综述, 2022, 28(4): 736-741. TAO M H, XIAO P B, YE M Z, et al. Research progress in pathogenesis and treatment of chronic pelvic pain[J]. Medical Recapitulate, 2022, 28(4): 736-741.
[3]	KOLODZIEJ M, UHL E, SCHWARM F, et al. Interdisciplinary laparoscopic implantation of neuromodulation leads to the sacral plexus for therapy of chronic pelvic pain and neurogenic bladder dysfunctions[J]. Neuromodulation, 2020, 23(8): 131-139.
[4]	王莎, 贺豪杰, 郭红燕. 骶神经调节治疗慢性盆腔痛的研究进展[J]. 实用妇产科杂志, 2019, 35(7): 502-504. WANG S, HE H J, GUO H Y. Research progress on sacral nerve regulation in the treatment of chronic pelvic pain[J]. Journal of Practical Obstetrics and Gynecology, 2019, 35(7): 502-504.
[5]	中华医学会妇产科学分会感染性疾病协作组. 盆腔炎症性疾病诊治规范(2019修订版)[J]. 中华妇产科杂志, 2019, 54(7): 433-437. doi: 10.3760/cma.j.issn.0529-567x.2019.07.001 Infectious Diseases Cooperation Group of Obstetrics and Gynecology Branch of Chinese Medical Association. Guideline of pelvic inflammatory disease (2019 revised edition)[J]. Chinese Journal of Obstetrics and Gynecology, 2019, 54(7): 433-437. doi: 10.3760/cma.j.issn.0529-567x.2019.07.001
[6]	陈娟, 任远, 朱兰. 改良牛津肌力分级和盆底表面肌电评估女性压力性尿失禁患者盆底肌功能的相关性[J]. 中华医学杂志, 2020, 100(37): 2908-2912. doi: 10.3760/cma.j.cn112137-20200301-00525 CHEN J, REN Y, ZHU L. Correlation between modified Oxford grading scale and pelvic floor surface electromyography in assessment of pelvic floor muscle function in female patients with stress urinary incontinence[J]. National Medical Journal of China, 2020, 100(37): 2908-2912. doi: 10.3760/cma.j.cn112137-20200301-00525
[7]	刘艳敏, 江秀秀. 女性慢性盆腔痛的神经生物学研究进展[J]. 国际妇产科学杂志, 2019, 46(1): 32-36. LIU Y M, JIANG X X. Advances in the neurobiology of women with chronic pelvic pain[J]. Journal of International Obstetrics and Gynecology, 2019, 46(1): 32-36.
[8]	山东省疼痛医学会. 女性慢性盆腔疼痛临床管理的专家共识(2021年版)[J]. 北京医学, 2021, 43(7): 650-659. Shandong Provincial Pain Medicine Association. Expert consensus on clinical management of chronic pelvic pain in women (2021 edition)[J]. Beijing Medical Journal, 2021, 43(7): 650-659.
[9]	焦伟. 慢性盆腔疼痛综合征的治疗进展[J]. 国际泌尿系统杂志, 2019, 39(3): 556-558. JIAO W. Progress in the treatment of chronic pelvic pain syndrome[J]. International Journal of Urology and Nephrology, 2019, 39(3): 556-558.
[10]	程菡莹, 郭汉青, 王业美, 等. 生物反馈电刺激技术治疗慢性盆腔痛研究进展[J]. 中国实用妇科与产科杂志, 2021, 37(4): 502-504. CHENG H Y, GUO H Q, WANG Y M, et al. Progress in the treatment of chronic pelvic pain with biofeedback electrical stimulation technology[J]. Chinese Journal of Practical Gynecology and Obstetrics, 2021, 37(4): 502-504.
[11]	YIANNAKOU Y, ETHERSON K, CLOSE H, et al. A randomized double-blinded sham-controlled cross-over trial of tined-lead sacral nerve stimulation testing for chronic constipation[J]. Eur J Gastroen Hepat, 2019, 31(6): 653-660.
[12]	DUARTE T B, KARI B, BRITO L G O, et al. Ferreira. Perioperative pelvic floor muscle training did not improve outcomes in women undergoing pelvic organ prolapse surgery: a randomised trial[J]. J Physiother, 2020, 66(1): 27-32.
[13]	王婷婷, 王加颖, 周晓明, 等. 生物反馈电刺激联合盆底肌康复训练对子宫切除术患者盆底功能的影响[J]. 中华全科医学, 2023, 21(1): 127-130. doi: 10.16766/j.cnki.issn.1674-4152.002828 WANG T T, WANG J Y, ZHOU X M, et al. Effects of biofeedback electrical combined with pelvic floor muscle rehabilitation training on pelvic floor function in patients with hysterectomy[J]. Chinese Journal of General Practice, 2023, 21(1): 127-130. doi: 10.16766/j.cnki.issn.1674-4152.002828
[14]	陈鑫, 牛翠枝, 黄华伟, 等. 盆底磁刺激联合骶神经根磁刺激治疗慢性前列腺炎/慢性盆腔疼痛综合征的疗效观察[J]. 中华物理医学与康复杂志, 2021, 43(1): 43-45. CHEN X, NIU C Z, HUANG H W, et al. Observation of the therapeutic effect of pelvic floor magnetic stimulation combined with sacral nerve root magnetic stimulation on chronic prostatitis/chronic pelvic pain syndrome[J]. Chinese Journal of Physical Medicine and Rehabilitation, 2021, 43(1): 43-45.
[15]	ROSS V, DETTERMAN C, HALLISEY A. Myofascial pelvic pain: an overlooked and treatable cause of chronic pelvic pain[J]. J Midwifery Wom Heal, 2021, 66(2): 148-130.
[16]	SONG S, EVERIST R, DEANS R, et al. Using physical therapy as an adjunct for women with chronic pelvic pain and pelvic floor myalgia[J]. J Minim Invas Gyn, 2018, 25(7): S214. DOI: 10.1016/j.jmig.2018.09.631.