The Basic Unit of a Myofascial Trigger Point

肌筋膜引痛點的基本單元

官大紳(Ta-Shen Kuan) ； 程琡敏(Shu-Min Chen) ； 陳若佟(Jo-Tong Chen) ； 洪章仁(Chang-Zern Hong)

《中華民國復健醫學會雜誌》 26卷4期 (1998/12) Pp. 161-168

摘要

本文總結最近關於肌筋膜引痛點的研究。肌筋膜引痛點是位於骨骼肌肉上可觸摸的緊繃肌帶中的過度敏感小點。觸痛點、固定型式的疼痛、及緊繃肌帶目前已被用來做為肌筋膜引痛點的可靠診斷標準，而引傳痛與局部抽搐反應則是肌筋膜引痛點的確認病徵。每個肌筋膜引痛點區域內含有多個小點，這些肌筋膜引痛小點就是構成肌筋膜引痛點的基本單元，它們都包含有感覺部分（感覺小點sensitive locus）與運動部分（活動小點active locus）。感覺小點的所在就是經由針刺激而能產生局部疼痛、引傳痛與局部抽搐反應的部位，感覺小點很可能就是敏感化的神經纖維（疼痛感受器）。它們廣泛地分佈於肌肉當中，但多集中在肌筋膜引痛點區域裡。近年來在人類與兔子的骨骼肌上所做的電生理學研究顯示，引傳痛與局部抽搐反應兩者皆和脊髓整合機制有關聯。活動小點就是自發性電位活動(spontaneous electrical activity; SEA)可以被紀錄到的地方，自發性電位活動是一種終末板不正常的電位，可能來自於過度的釋放乙醯膽素(acetylcholine)，並且會導致緊繃肌帶的產生。最近的組織學研究顯示，在兔子骨骼肌中的感覺小點或活動小點附近可以找到神經纖維的存在。肌筋膜引痛點的病理機轉可能與激化的神經纖維和不正常的終末板有關，再經由脊髓的整合機制產生而成。

關鍵字

電生理學 ； 注射 ； 肌肉 ； 疼痛 ； 引痛點

並列摘要

This report summarized recent studies on the basic structures of a myofascial trigger point (MTrP). A MTrP is a hyperirritable spot in a palpable taut band of skeletal muscle fibers. Spot tenderness, recognized pain, and taut band are now demonstrated to be reliable diagnostic criteria of an MTrP. Referred pain (ReP) or local twitch response (LTR) is a confirmatory sign of MTrP. There are multiple loci in an MTrP region. The basic unit of an MTrP is the MTrP locus which contains a sensory component (the sensitive locus) and a motor component (the active locus). A sensitive locus is the site from where a local pain, an ReP, or an LTR can be elicited by needle stimulation to that site. The sensitive loci are probably sensitized nerve fibers (nociceptors). They are widely distributed in the whole muscle, but concentrated in the MTrP region. Recent electrophysiological studies on both human and rabbit skeletal muscles suggested that both ReP and LTR are related to the spinal cord mechanism. An active locus is the site from where spontaneous electrical activity (SEA) can be recorded. SEA is abnormal endplate potentials due to excessive release of acetylcholine, which may cause the formation of a taut band. Recent histological studies have demonstrated a nerve fiber at the vicinity of a sensitive locus or an active locus in rabbit skeletal muscle. The pathogenesis of MTrPs is probably related to integrative mechanisms in the spinal cord in response to sensitized nerve fibers associated with abnormal endplates.

並列關鍵字

electrophysiology ； injection ； muscle ； pain ； trigger points