Park Duk-Hoon, Yoon Seo-Gue, Kim Kuhn Uk, Hwang Do Yeon, Kim Hyun Shig, Lee Jong Kyun, Kim Kwang Yun
Department of Surgery, Song Do Medical Center, Seoul, South Korea.
Int J Colorectal Dis. 2005 May;20(3):272-6. doi: 10.1007/s00384-004-0662-9. Epub 2004 Oct 30.
Two theories have been reported for the pathophysiology of levator ani syndrome: the spastic cycle hypothesis and the local inflammation (Tendinitis) hypothesis. This study compared two treatment modalities in order to determine which of the two hypotheses is more appropriate.
In this prospective study, Group EGS (n=22) underwent electrogalvanic stimulation twice a week. Group LI (n=31) underwent a local injection of a 40-mg triamcinolone acetonide mix with 1 ml 2% lidocaine into the maximal tender point of the arcus tendon in the levator ani muscle.
The most common location of tenderness was the left anterior of the arcus tendon of the levator ani muscle. At the last follow-up (12 months), the LI group showed more relief, more improvement, and fewer failures than the EGS group. No difference was seen between the mean pain scores (verbal analog scale: 0-100) of the two groups at either the 1-week or the 12-month follow-up. However, the LI group showed better results at the 1-month, 3-month, and 6-month follow-ups.
The LI group showed better short-term results than the EGS group. Therefore, the tendinitis hypothesis seems to be the more reliable one for levator ani syndrome. However, because the subjective responses of the patients indicated that a sufficient level of patient satisfaction had not been achieved, we cannot positively conclude that the tendinitis hypothesis is the more reliable one for the pathophysiology of levator ani syndrome.
关于肛提肌综合征的病理生理学有两种理论报道：痉挛周期假说和局部炎症（肌腱炎）假说。本研究比较了两种治疗方式，以确定这两种假说中哪一种更合适。
在这项前瞻性研究中，电刺激组（EGS组，n = 22）每周接受两次电刺激。局部注射组（LI组，n = 31）将40mg曲安奈德与1ml 2%利多卡因混合后注射到肛提肌弓状肌腱的最大压痛点处。
压痛最常见的部位是肛提肌弓状肌腱的左前部。在最后一次随访（12个月）时，LI组比EGS组缓解更明显、改善更多且失败更少。在1周或12个月随访时，两组的平均疼痛评分（视觉模拟量表：0 - 100）没有差异。然而，LI组在1个月、3个月和6个月随访时结果更好。
LI组的短期结果比EGS组更好。因此，肌腱炎假说似乎是肛提肌综合征更可靠的一种假说。然而，由于患者的主观反应表明尚未达到足够的患者满意度水平，我们不能肯定地得出肌腱炎假说是肛提肌综合征病理生理学更可靠假说的结论。
