Objective. To evaluate ultrasound-guided inactivation of myofascial trigger points (MTrPs) combined with abdominal muscle fascia stripping by liquid knife in the treatment of postherpetic neuralgia (PHN) complicated with abdominal myofascial pain syndrome (AMPS). Methods. From January 2015 to July 2018, non-head-and-neck PHN patients in the Pain Department, The First Affiliated Hospital of Soochow University, were treated with routine oral drugs and weekly paraspinal nerve block for two weeks. Patients with 2 < VAS (visual analogue scale) score < 6 were subjects of the study. They were assigned into control group 1 (C1, n = 33) including those with PHN and without myofascial pain syndrome (MPS) and control group 2 (C2, n = 33) including those with PHN complicated with MPS and observation group 1 (PL, n = 33) including those with PHN complicated with limb myofascial pain syndrome (LMPS) and observation group 2 (PA, n = 33) including those with PHN complicated with AMPS. All groups received zero-grade treatment: routine oral drugs and weekly paraspinal nerve block. PL and PA groups were also treated step by step once a week: primary ultrasound-guided inactivation of MTrPs with dry needling, secondary ultrasound-guided inactivation of MTrPs with dry and wet needling, and tertiary ultrasound-guided dry and wet needling combined with muscle fascia stripping by liquid knife. At one week after primary treatment, patients with a VAS score > 2 proceeded to secondary treatment. If the VAS score was <2, the treatment was maintained, and so on, until the end of the four treatment cycles. Pain assessment was performed by specialized nurses at one week after each treatment, including VAS score, McGill pain questionnaire (MPQ) score, pressure pain sensory threshold (PPST), and pressure pain tolerance threshold (PPTT). VAS score was used as the main index and VAS <2 indicated effective treatment. At 3 months after treatment, outpatient and/or telephone follow-up was performed. The recurrence rate was observed and VAS > 2 was regarded as recurrence. Results. At one week after primary treatment, the effective rate was 66.7% in PL group, significantly higher than that in PA group (15.2%, ). At one week after secondary treatment, the effective rate was 100% and 37.5% in PL and PA groups, respectively, with significant difference between the groups (). The effective rate increased to 90.6% in PA group at one week after tertiary treatment. At one week after the end of treatment cycles, the scores of VAS and MPQ were significantly lower in C1, PL, and PA groups than in C2 group (), while PPST and PPTT were significantly higher than in C2 group (). There was no significant difference between C1 group and PL group (). At follow-up at 3 months after treatment, the recurrence rate was low in each group, with no significant difference between the groups (). Conclusion. About 57% of PHN patients with mild to moderate pain are complicated with MPS, and ultrasound-guided inactivation of MTrPs with dry and wet needling can effectively treat PHN patients complicated with LMPS. However, patients with PHN complicated with AMPS need to be treated with ultrasound-guided MTrPs inactivation combined with muscle fascia stripping by liquid knife as soon as possible.

中文翻译：

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超声引导的触发点失活结合液体刀肌肉筋膜剥离术治疗带状疱疹后神经痛并发腹肌筋膜痛综合征的前瞻性和对照临床研究。

目的。评价超声引导的肌筋膜触发点（MTrPs）的失活结合液体刀剥离腹肌筋膜剥脱术治疗带状疱疹后神经痛（PHN）并发腹肌筋膜疼痛综合征（AMPS）。方法。从2015年1月至2018年7月，苏州大学第一附属医院疼痛科的非头颈PHN患者接受常规口服药物和每周的椎旁神经阻滞治疗2周。2 <VAS（视觉模拟量表）得分<6的患者为研究对象。将他们分为对照组1（C1，n  = 33），包括患有PHN且无肌筋膜疼痛综合征（MPS）的对照组和对照组2（C2，n = 33）包括PHN合并MPS的患者和观察组1（PL，n  = 33）包括PHN合并肢体肌筋膜疼痛综合征（LMPS）的患者和观察组2（PA，n = 33），包括那些合并PHN和AMPS的患者。所有组均接受零级治疗：常规口服药物和每周一次的椎旁神经阻滞。PL和PA组也每周一次进行逐步治疗：干针法对MTrPs进行初次超声引导灭活，干湿针法对MTrPs进行二次超声引导灭活，以及三重超声法对肌肉进行干湿混动指导用液刀剥离筋膜。初次治疗后第一个星期，VAS评分> 2的患者开始二次治疗。如果VAS分数<2，则维持治疗，依此类推，直到四个治疗周期结束。在每次治疗后的一周，由专业护士进行疼痛评估，包括VAS评分，麦吉尔疼痛问卷（MPQ）评分，压力疼痛感官阈值（PPST）和压力疼痛耐受性阈值（PPTT）。以VAS评分为主要指标，VAS <2表示有效治疗。治疗后3个月，进行了门诊和/或电话随访。观察到复发率，VAS＞ 2被认为是复发。结果。初次治疗后1周，PL组的有效率为66.7％，显着高于PA组的有效率（15.2％，）。二级治疗后第一个星期，PL组和PA组的有效率分别为100％和37.5％，各组之间有显着差异（）。三级治疗后第1周，PA组的有效率提高到90.6％。在治疗周期结束后的一周，C1，PL和PA组的VAS和MPQ得分明显低于C2组（），而PPST和PPTT显着高于C2组（）。C1组和PL组之间无显着性差异（）。治疗后3个月随访时，各组的复发率均较低，各组之间无显着性差异（）。 结论。约有57％的PHN轻度至中度疼痛患者并发MPS，而超声引导的干，湿针刺MTrPs失活可以有效治疗并发LMPS的PHN患者。但是，PHN并发AMPS的患者需要尽快接受超声引导的MTrPs失活结合液体刀的肌筋膜剥离治疗。