Hallgren R C, Greenman P E, Rechtien J J
Department of Osteopathic Medicine, Michigan State University College of Osteopathic Medicine, East Lansing 48824.
J Am Osteopath Assoc. 1994 Dec;94(12):1032-8.
Magnetic resonance imaging studies were performed in six patients with chronic head and neck pain and in five control subjects to determine whether irreversible atrophic changes resulting in destruction of muscle fibers have a role in patients with chronic pain specific to the cervical spine. Both groups of subjects had medical history obtained and underwent physical examination and proton density-weighted (PD-weighted) magnetic resonance imaging. Subjects with chronic pain had substantial restriction of motion. Axial proton density-weighted images of the rectus capitis major and minor muscles were examined. In the subjects with chronic pain, the muscles had high signal intensity, indicating replacement of dead suboccipital skeletal muscle with fatty tissue. This infiltration was not observed in the control subjects who were free of significant motion restrictions and had no history of recurring neck and head pain. Analysis of pixel intensity values confirmed this finding. The reduction in proprioceptive afferent activity in affected muscles may cause increased facilitation of neural activity that is perceived as pain. At least mean squares algorithm was used to define a linear estimating equation for each subject. Linear regression analysis, using an alpha level < .005, was used to determine how well each subject's data fit the estimating equation. This preliminary work indicates substantial infiltration of fatty tissue into suboccipital muscles of some subjects being treated for chronic head and neck pain.
对6例慢性头颈疼痛患者和5例对照者进行了磁共振成像研究，以确定导致肌纤维破坏的不可逆萎缩性改变是否在颈椎特异性慢性疼痛患者中起作用。两组受试者均获取了病史，并接受了体格检查和质子密度加权（PD加权）磁共振成像。慢性疼痛患者存在明显的运动受限。检查了头直肌（包括头最长肌和头最短肌）的轴向质子密度加权图像。在慢性疼痛患者中，肌肉呈高信号强度，表明枕下骨骼肌坏死被脂肪组织替代。在没有明显运动受限且无复发性颈部和头部疼痛病史的对照者中未观察到这种浸润。像素强度值分析证实了这一发现。受影响肌肉中本体感觉传入活动的减少可能会导致被感知为疼痛的神经活动的促进增加。使用最小均方算法为每个受试者定义一个线性估计方程。使用α水平<0.005的线性回归分析来确定每个受试者的数据与估计方程的拟合程度。这项初步研究表明，脂肪组织大量浸润到一些接受慢性头颈疼痛治疗的受试者的枕下肌肉中。
