.
Hong Cai
Abstract：In recent years, the application of ultrasound medicine in conjunction with traditional Chinese medicine diagnosis and treatment techniques has become increasingly widespread in clinical practice. Under ultrasound guidance, some traditional Chinese medicine diagnostic and treatment techniques have transitioned from “blind procedures” to “visualization,” making invasive procedures in traditional Chinese medicine more precise, safer, and more effective. This can provide clinical evidence for the effectiveness and safety of traditional Chinese medicine diagnostic and treatment techniques.
Key words: Ultrasound guidance; visualization; traditional Chinese medicine; acupuncture; surgical techniques
Editor’s Note: The “needle knife” mentioned here is an acupotomy needle, which is a heavier gauge of the needle with a sharpened edge at the tip. They are employed to cut or disrupt tissue at deep locations. While their use is widespread in China, in the US they are generally not in our scope of practice.
Traditional Chinese medicine diagnostic and treatment techniques are based on solid knowledge of traditional Chinese medicine theory and extensive clinical experience, to diagnose and treat diseases without relying on any modern medical facilities or equipment. However, due to differences in the mindset and accumulated experience of practitioners, there can be significant variations in diagnostic and treatment methods for the same disease, making it challenging to establish a unified understanding and treatment standard. In recent years, the application of ultrasound medicine in conjunction with traditional Chinese medicine diagnosis and treatment techniques has become increasingly widespread in clinical practice. Under ultrasound guidance, some traditional Chinese medicine diagnostic and treatment techniques have transitioned from “blind procedures” to “visualization.” This transformation not only reduces the risks associated with “blind procedures” but also significantly enhances clinical efficacy. As a result, it has gained favor among healthcare professionals.
Clinical research on the application of ultrasound guidance to the nervous system
Li Yunan［1］and colleagues conducted a study on 14 patients with allergic rhinitis who received treatment involving ultrasound-guided bilateral sphenopalatine ganglion acupuncture. This study evaluated the clinical efficacy, rhinitis symptom scores, and Visual Analog Scale (VAS) scores before treatment, immediately after treatment, and 6 months post-treatment. The results showed that ultrasound-guided acupuncture of the bilateral sphenopalatine ganglion had stable short-term and long-term effects on allergic rhinitis. It also maximally avoided adverse reactions such as facial hematoma and persistent pain caused by blind needling.
Lin Bing［2］et al randomly divided 46 stroke patients into an ultrasound treatment control group and an ultrasound combined with an acupuncture group. They assessed patients’ neurological function using the National Institutes of Health Stroke Scale (NIHSS) before and after treatment. The results showed that the observation group had a better improvement in neurological function compared to the control group. Jin Haipeng［3］and colleagues divided 120 post-stroke dysphagia patients into an observation group, control group 1, and control group 2, each with 40 patients. The observation group received electro-acupuncture treatment of the tongue muscle group under ultrasound guidance. Control group 1 received conventional acupuncture treatment at specific acupoints (e.g., Lianquan, Wangu, Fengchi), while control group 2 received tongue muscle group electro-acupuncture based on anatomical positioning. The experimental conclusion indicated that ultrasound-guided electric acupuncture of the tongue muscle group could improve the swallowing function of post-stroke dysphagia patients by increasing the movement of the tongue-throat complex. Its effect and safety are better than conventional acupuncture and conventional suprahyoid muscle group electroacupuncture. Liao Yue［4］and colleagues divided 60 patients with post-stroke limb spasticity into a control group and an observation group, each with 30 patients. The control group received treatment with a small needle knife, while the observation group received treatment with a small needle knife combined with shockwave therapy under ultrasound guidance. The study results showed that the combination of small needle knife therapy and shockwave therapy under ultrasound guidance was more effective in treating post-stroke limb spasticity compared to the control group. It had a positive effect on muscle tone and motor function in these patients.
Clinical Research on the Application of Ultrasound Guidance
in the Musculoskeletal System
Trunk Diseases
1.Neck Diseases
Liu Hong［5］and colleagues divided 200 patients with cervical spondylosis into a treatment group and a control group, with 100 patients in each group. The treatment group received ultrasound-guided acupuncture treatment with a needle knife, while the control group received traditional acupuncture treatment with a needle knife. The experimental results showed that ultrasound-guided. needle knife treatment significantly improved the neck function of patients with cervical spondylosis, reduced pain, and was more effective than traditional acupuncture therapy. Huang Bingxiang［6］divided 80 patients with nerve root cervical spondylosis into a needling group and a blade needle group, with 40 patients in each group. 〖JP2〗They then observed the clinical effects of ultrasound-guided blade needle decompression of cervical transverse processes for treating nerve root cervical spondylosis. The experimental conclusion 〖JP3〗indicated that ultrasound-guided blade needle decompression for treating nerve root cervical spondylosis was superior to fine needle acupuncture in relieving the patient’s symptoms, improving cervical mobility, and achieving clinical efficacy. Zhong Zhinian［7］divided 60 patients with vertebral artery-type cervical spondylosis into a treatment group and a control group, with 30 patients in each group. The treatment group underwent ultrasound-guided needle knife stimulation of the stellate ganglion, while the control group received stellate ganglion blockade treatment. The experimental results showed that ultrasound-guided needle knife stimulation of the stellate ganglion for treating vertebral artery-type cervical spondylosis was safe and effective in improving clinical symptoms and function, as well as increasing vertebral-basilar artery blood flow velocity. The incidence of hematoma and symptoms at the needle insertion site was significantly lower than in the control group.
2. Lumbar Diseases
Wang Yongqi［8］et al. studied the clinical efficacy of ultrasound-guided acupuncture of myofascial trigger points for the treatment of lumbar and hip myofascial pain syndrome. The experimental results showed that ultrasound-guided acupuncture of myofascial trigger points effectively improved the local tissue elasticity and altered the local deformation capability in patients with lumbar and hip myofascial pain syndrome, resulting in good treatment outcomes. Lin Xiuhua［9］divided 60 patients with lumbar disc herniation into a control group and a treatment group, with 30 patients in each group. The control group received conventional needle knife treatment under ultrasound guidance, while the treatment group added the release of the ligamentum flavum on the affected side of the herniated segment. The experimental results showed that ultrasound-guided needle knife release of the ligamentum flavum had better outcomes in the treatment of lumbar disc herniation. Liu Xin［10］and colleagues observed the effect of ultrasound-guided acupuncture at the Weizhong point on the side of lumbar pain in patients with acute lumbar sprain. The depth of ultrasound-guided acupuncture needed to reach the location near the deep fascia of the tibial nerve, followed by twisting and lifting techniques to achieve a therapeutic effect, which was significant. Liu Pengqun［11］divided 60 patients with third lumbar transverse process syndrome into an ultrasound group and a control group, with 30 patients in each group. The ultrasound group received acupuncture treatment with ultrasound guidance, while the control group received acupuncture treatment using an empirical trigger point technique. The experimental results showed that ultrasound-guided acupuncture treatment for the third lumbar transverse process syndrome was more effective in improving patients’ pain symptoms and lumbar spine mobility, compared to the control group. Yang Dan［12］observed the efficacy of ultrasound-guided needle knife treatment for chronic nonspecific low back pain. The study results indicated that ultrasound-guided needle knife treatment was more effective for chronic nonspecific low back pain compared to traditional needle knife treatment. There are also experimental studies suggesting that ultrasound-guided silver needle treatment can effectively relieve pain symptoms, improve lumbar function, and enhance the quality of life in patients with failed back surgery syndrome, with better outcomes than nerve blockade［13-14］.
Limb Diseases
1. Upper Limb Diseases
Zhou Bin［15］studied the efficacy of ultrasound-guided precise positioning for the treatment of subacromial impingement syndrome, targeting the coracoid process point, greater tuberosity of the humerus point, anterior medial acromion point, and lower edge of the acromion point. The conclusion pointed out that ultrasound-guided needle knife treatment with precise positioning was superior to the group without ultrasound guidance in relieving shoulder pain, improving shoulder joint mobility, and ensuring safety. Zhang Shulan［16］and colleagues conducted a study on the treatment of shoulder periarthritis by ultrasound-guided positioning of shoulder joint lesions (effusion, proliferation, calcification, and contracture adhesions). The conclusion indicated that the ultrasound-guided positioning group had better outcomes in the treatment of shoulder periarthritis compared to the traditional needle knife group. Qiao Ruoyu［17］treated 34 patients with long head of biceps tendonitis through ultrasound-guided positioning of their lesions and local needle knife release. The research results showed that ultrasound-guided needle knife release for the treatment of long head of biceps tendonitis had better effect, significantly improving shoulder pain and functional mobility in patients. Zhang Xu［18］divided 60 tennis elbow patients into a control group and a treatment group, with 30 patients in each group. The treatment group received blade needle acupuncture combined with blockade treatment under musculoskeletal ultrasound guidance, while the control group received only blockade treatment under musculoskeletal ultrasound guidance. The results showed that musculoskeletal ultrasound-guided bladed acupuncture combined with closure had better short-term and long-term effects in the treatment of tennis elbow. Feng Yan et al.［19］divided 60 patients with carpal tunnel syndrome into a study group and a control group, with 30 patients in each group. The study group received modified needle knife treatment with injection of lidocaine+triamcinolone+Vit12 suspension solution under ultrasound-guided fine needle puncture, while the control group received traditional needle knife treatment with the same injection. The research results showed that the ultrasound-guided modified needle knife treatment in the study group had an excellent effect on carpal tunnel syndrome compared to the control group. Fan Tianbing et al. ［20］used ultrasound guidance to accurately locate the stenotic and thickened tendon sheath of the flexor tendon and used acupotomy to treat stenosing tenosynovitis. The conclusion showed that ultrasound-guided acupuncture release was more effective than conventional acupuncture in the treatment of flexor tendon stenosing tenosynovitis. Knife release is more effective and safer.
2. Lower Limb Diseases
Li Luning et al.［21］divided 60 patients with knee osteoarthritis into an ultrasound-guided needle knife group and an acupuncture group, with 30 patients in each group. The experimental results indicated that ultrasound-guided needle knife treatment for knee osteoarthritis had better clinical outcomes than the acupuncture group. Xu Peifu et al.［22］used ultrasound to determine the anatomical shape of the iliotibial band in patients with iliotibial band syndrome, found tender points at the lower edge of tensor fascia lata and the lateral femoral condyle, and performed small acupotomy treatment under ultrasound guidance. The research results showed that ultrasound-guided acupotomy has good clinical efficacy in the treatment of iliotibial band syndrome.
Ma Muti Amuding［23］divided 60 patients with plantar fasciitis or plantar heel pain into a treatment group and a control group, with 30 patients in each group. In the treatment group, patients underwent soft tissue blockade under musculoskeletal ultrasound guidance, followed by blade needle release treatment. The control group received only soft tissue blockade under musculoskeletal ultrasound guidance. The experimental results showed that musculoskeletal ultrasound-guided blade needle release combined with blockade treatment had better short-term and long-term outcomes for plantar heel pain compared to the control group.
Zhao Shanxu et al.［24］conducted an observational study on the effectiveness of traditional Chinese medicine steaming and washing combined with ultrasound-guided needle knife release for plantar fasciitis. The experimental conclusion indicated that traditional Chinese medicine steaming and washing combined with ultrasound-guided needle knife release treatment for plantar fasciitis was more effective than either ultrasound-guided needle knife release treatment alone or traditional Chinese medicine steaming and washing treatment.
Clinical Research on the Application of Ultrasound Guidance in Other Systems
Chen Yingqi et al［25］divided 72 healthy subjects into an observation group and a control group, with 36 subjects in each group. They studied the gastric antral motility by assessing the depth of acupuncture at the Zusanli acupoint under ultrasound guidance and whether qi was obtained during acupuncture. The research results showed that acupuncture at the Zusanli acupoint with qi obtained under ultrasound guidance could to some extent change gastric antral motility.
Lang Yi［26］divided 120 insomnia patients into an acupuncture group, an ultrasound-guided stellate ganglion block group, and a combination therapy group, with 40 patients in each group. The research results showed that the acupuncture group and the ultrasound-guided stellate ganglion block group had similar treatment effects on insomnia, which are both lower than the stellate ganglion block combined with acupuncture treatment group.
Chu Kaiyun［27］and colleagues assessed and monitored the affected limbs before and after He’s fire needling therapy for lower limb varicose veins using ultrasound technology, providing clinical evidence for the safety and effectiveness of He’s fire needling.
Wang Yushuang et al.［28］used ultrasound follow-up to observe the changes in breast hyperplasia tissue and hyperplastic nodules during the treatment of breast hyperplasia with traditional Chinese medicine, and then used it to evaluate the efficacy of traditional Chinese medicine on breast hyperplasia, which improved the accuracy of the treatment effect.
Reflection:
With the ongoing improvement of medical technology, while ultrasound and TCM diagnosis and treatment technology are from two different medical systems, they can be integrated in the clinical process to good effect. Some TCM diagnostic and therapeutic techniques have evolved from empirical treatments in the past towards ultrasound-guided visualization. From the content of the research mentioned above, it is clear that TCM diagnostic and therapeutic techniques guided by ultrasound visualization mainly focus on techniques involving needle-knife treatment and regular acupuncture points. There is relatively little literature on other modalities such as silver needles, blade needles, fire needles, Chinese herbal medicine, etc. This is also from a certain point of view, in that, to an extent, it illustrates clinical medicine’s need for precision and safety for invasive operations of TCM diagnosis and treatment. Ultrasound can provide refined cross-section anatomy, allowing the practitioner to avoid blood vessels, nerves and other organs and tissues, and reach specific tissues with assurance, making TCM diagnosis and treatment more effective.
At the same time, ultrasound-guided TCM diagnostic and therapeutic techniques are mainly used to treat various pain conditions. This relies on the clear visualization of the anatomical structures in the corresponding areas during treatment under ultrasound guidance, facilitating the transformation of traditional TCM “blind procedures” into minimally invasive procedures. Ultrasound technology, as an important monitoring tool, also allows for a more intuitive and scientific demonstration of the effectiveness of TCM diagnostic and therapeutic techniques, avoiding claims of pseudoscience by some scholars. Therefore, the combination of TCM diagnostic and therapeutic techniques guided by ultrasound visualization represents both an opportunity and a challenge in the development of traditional Chinese medicine. The combination of the two will move forward through continuous exploration and will definitely bring new vitality to traditional medicine.
Author information:
Hong Cai, Doctor of Yubei District People’s Hospital of Chongqing
References
［1］Li Yunnan, Ou Yuyang, Lan Yangjing, et al. Preliminary efficacy observation of ultrasound-guided acupuncture of the sphenopalatine ganglion in the treatment of allergic rhinitis ［J］. Journal of China-Japan Friendship Hospital, 2023, 37(01): 25-28 + 2.
［2］Lin Bing, Gao Shangzhong, Ren Li. Clinical effect of ultrasound combined with acupuncture in the treatment of cerebral infarction and its impact on related indicators ［J］. Clinical Medical Research and Practice, 2020, 5(17): 126-127.
［3］Jin Haipeng, Wang Yong, Ye Qingjing, et al. Ultrasound-guided electroacupuncture of the suprahyoid muscles for the treatment of post-stroke pharyngeal dysphagia: a randomized controlled trial ［J］. Chinese Acupuncture, 2022, 42(03):251-256.
［4］Liao Yue, Liu Jisheng, Lan Caihong, etc. The effect of small acupotomy therapy combined with ultrasound-guided shock wave in the treatment of limb spasm after stroke and its impact on patients’ muscle tone and motor function ［J］. Chinese Contemporary Medicine, 2023, 30( 04):149-152.
［5］Liu Hong, Zhang Zesheng, Zhang Liangzhi, et al. Clinical effect of ultrasonic visual acupotomy technology in the treatment of cervical spondylosis ［J］. China Medical Herald, 2021, 18(15): 180-183+196.
［6］Huang Bingxiang. Observation on the clinical efficacy of ultrasonic-guided blade needle release of posterior cervical transverse process nodules in the treatment of radicular cervical spondylosis ［D］. Heilongjiang University of Traditional Chinese Medicine, 2023.
［7］Zhong Zhinian. Observation on the clinical efficacy of ultrasonic-guided acupuncture stimulation of the stellate ganglion in the treatment of vertebral artery-type cervical spondylosis ［D］. Beijing University of Chinese Medicine, 2015.
［8］Wang Yongqi, Xu Lei, Sun Qing, et al. Clinical study on ultrasound-guided acupuncture in the treatment of waist and hip myofascial pain syndrome ［J］. Chinese Journal of Orthopedics and Traumatology of Traditional Chinese Medicine, 2022, 30(03): 26-29 .
［9］Lin Xiuhua, Liu Cunbin, Geng Kai, et al. Clinical effect of ultrasonic-guided acupuncture release of ligamentum flavum in the treatment of lumbar disc herniation ［J］. China Medical Herald, 2022, 19(09): 157-160.
［10］Liu Xin, Sun Luyuan, Li Shanshan, et al. Clinical study on ultrasound-guided acupuncture at Weizhong point in the treatment of acute lumbar sprain ［J］. Chinese Journal of Traditional Chinese Medicine Emergencies, 2023, 32(05): 796-800.
［11］Liu Pengqun, Zhu Liguo, Chen Xin, et al. Clinical observation on the treatment of third lumbar transverse process syndrome with beryllium acupuncture under ultrasound guidance ［J］. Beijing Chinese Medicine, 2023, 42(06): 607-610.
［12］Yang Dan. Clinical observation of acupotomy under ultrasound guidance in the treatment of chronic non-specific low back pain ［D］. Chengdu Institute of Physical Education, 2023.
［13］Li Zhipeng, He Yuezhen, Gong Wenkui, et al. Effect of ultrasound-guided silver needles in the treatment of failure syndrome after lumbar spine surgery ［J］. Guangdong Medicine, 2017, 38(06): 872-874.
［14］Wang Zhigang, Peng Cheng. Effect of ultrasound-guided silver acupuncture in the treatment of failure syndrome after lumbar spine surgery ［J］. Famous Doctors, 2021(17):52-53.
［15］Zhou Bin. Observation on the clinical efficacy of ultrasonic-guided needle-knife precise positioning in the treatment of subacromial impingement syndrome ［D］. Fujian University of Traditional Chinese Medicine, 2020.
［16］Zhang Shulan, Bai Yu, Liu Yibing, et al. Observation on the efficacy of acupotomy in the treatment of frozen shoulder under ultrasonic positioning ［J］. Journal of Hubei Institute of Science and Technology (Medical Edition), 2020, 34(06): 483-486.
［17］Qiao Ruoyu. Clinical study on the treatment of long head of biceps tendonitis with ultrasonic positioning acupotomy ［D］. Beijing University of Chinese Medicine, 2019.
［18］Zhang Xu. Observation on the clinical efficacy of blade acupuncture combined with closure in the treatment of tennis elbow under musculoskeletal ultrasound guidance ［D］. Xinjiang Medical University, 2021.
［19］Feng Yan, Qin Xin, Xing Ruilin, et al. Application effect of modified small needle puncture under ultrasound in the treatment of carpal tunnel syndrome ［J］. Imaging Science and Photochemistry, 2022, 40(05): 1051-1055.
［20］Fan Tianbing, Wang Cheng. Research and analysis on the efficacy of ultrasound combined with small needle knife release in the treatment of flexor tendon stenosing tenosynovitis ［J］. Zhejiang Trauma Surgery, 2021, 26(05): 871-872.
［21］Li Luning, Hu Guoqiang, Gao Chengchao, et al. Clinical effect of acupotomy under ultrasound guidance in the treatment of knee osteoarthritis ［J］. China Medical Herald, 2018, 15(33): 138-141.
［22］Xu Peifu, Zhao Lina, Ren Shujun, et al. 60 cases of iliotibial band syndrome treated with small acupuncture under ultrasound guidance ［J］. Chinese Journal of Orthopedics and Traumatology of Traditional Chinese Medicine, 2022, 30(10): 57-60.
［23］Mamut Amudin. Analysis of the clinical efficacy of blade acupuncture combined with sealing in the treatment of heel pain under musculoskeletal ultrasound guidance ［D］. Xinjiang Medical University, 2021.
［24］Zhao Shanxu, Zhu Junchen. Observation on the efficacy of traditional Chinese medicine fumigation combined with ultrasound-guided acupuncture release in the treatment of plantar fasciitis ［J］. Journal of Shanxi University of Traditional Chinese Medicine, 2023, 24(02): 172-175+179.
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［27］Chu Kaiyun, Bao Chaohui, Liu Xuemei. Application of ultrasound in the treatment of varicose veins of lower limbs with He’s fire acupuncture ［J］. World Journal of Integrated Traditional Chinese and Western Medicine, 2018, 13(08): 1119-1122.
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超音波可視化引導下聯合中醫診療技術的應用進展
蔡虹
摘要：近年來,超音波醫學聯合中醫診療技術在臨床的應用越來越廣泛,部分中醫診療技術在超音波引導下實現了由“盲操”轉變為“可視化”，使中醫診療技術的有創操作更精準、更安全、更有效，可為中醫診療技術的有效性和安全性提供臨床依據。
傳統的中醫診療技術是在不借助任何現代醫學設施設備等輔助手段的情況下，醫者以紮實的中醫基礎理論知識為基礎，豐富的臨床實操經驗為指導以實現診治疾病的過程。 但因醫者思維方式及經驗累積的不同，同一疾病的診治方法差異較大，無法形成統一的認知和診療規範。
近年來,超音波醫學聯合中醫診療技術在臨床的應用越來越廣泛,部分中醫診療技術在超音波引導下實現了由“盲操”轉變為“可視化”，不僅降低了“盲操”風險，還大大提升了臨床療效,受到了廣大醫務工作者的青睞。
超音波引導應用於神經系統的臨床研究
李蘊楠［1］等將14例過敏性鼻炎患者在超音波引導下進行針刺雙側蝶腭神經節的治療，該研究通過對治療前後、治療6個月後的臨床療效、鼻炎症狀評分以及視覺模擬量表（VAS）評分的比較，結果顯示在超音波引導下進行針刺雙側蝶腭神經節對過敏性鼻炎的近期和遠期效果均穩定，最大限度的避免了因盲刺導致的面部血腫、持續疼痛等不良反應。林兵［2］等將46位腦梗塞患者隨機分為超音波治療對照組及超音波合併針灸治療觀察組，治療前後以美國國立衛生研究院中風量表（NIHSS）評估患者的神經功能，結果顯示觀察者改善腦梗塞神經功能的作用優於對照組。金海鵬［3］等將120例腦中風後咽期吞嚥障礙患者隨機分為觀察組、對照1組及對照2組，每組40例，觀察組予以超音波導引下舌骨上肌群電針治療，對照1組予以常規取穴（廉泉、完骨、風池等）電針治療，對照2組依解剖定位予以舌骨上肌群電針治療，實驗結論顯示：超音波導引下舌骨上肌群電針可藉由增加舌骨喉複合體運動度進而改善腦中風後咽期吞嚥障礙患者的吞嚥功能，其效果及安全均性優於常規針刺及常規舌骨上肌群電針。廖越［4］等將60例中風後肢體痙攣患者分成對照組和觀察組，每組30例，對照組採用小針刀治療，觀察組採用小針刀聯合超音波引導下衝擊波治療，研究結果表明小針刀療法合併超音波引導下衝擊波治療中風後肢體痙攣的效果優於觀察組，對患者的肌張力及運動功能均起到了較好的療效。
超音波引導應用於運動系統的臨床研究
軀幹疾病
1.頸部疾病
劉洪［5］等將200例頸型頸椎病變患者分為治療組及對照組，每組各100例,治療組採用超音波導引下針刀治療，對照組採用傳統針刀治療,實驗結果顯示超音波 可視化針刀治療技術可顯著改善頸型頸椎病變患者的頸部功能，減輕疼痛，療效優於傳統針刀療法。黃柄祥［6］將80例神經根型頸椎病變患者分為針刺組和刃針組，每組各40例，進而觀察超音波引導下刃針松解頸椎橫突後結節治療神經根型頸椎病的臨床效果，實驗結論表明，超音波引導下刃針松解頸椎橫突後結節治療神經根型頸椎病變在緩解患者症狀、改善頸椎活動度、中醫臨床有效率方面均優於毫針針刺。鐘志年［7］將60例椎動脈型頸椎病變患者分為治療組及對照組，每組各30例，治療組在超音波導引下針刀觸激星狀神經節治療，對照組予以星狀神經節阻斷治療，實驗結果表明，超音波引導下針刀觸激星狀神經節治療椎動脈型頸椎病變在改善患者臨床症狀及功能、增加椎-基底動脈血流速方面安全有效，血腫發生率、針刺部位疼痛等症狀明顯低於對照組。
2. 腰部疾病
王墉琦［8］等透過對超音波引導下針刺肌筋膜疼痛激痛點治療腰臀部肌筋膜疼痛症候群的臨床療效進行了研究，實驗結果表明，超音波引導下針刺肌筋膜疼痛激痛點能夠有效改善腰臀肌筋膜疼痛患者的局部軟組織彈性，改變局部形變能力，療效較佳。林秀華［9］等將60例腰椎間盤突出症患者分為對照組與治療組，每組30例，對照組採用超音波引導下常規針刀治療，治療組在對照組的基礎上加以突出節段患側黃韌帶的松解，實驗結果顯示超音波導引下針刀松解黃韌帶治療腰椎間盤突出的效果較佳。劉鑫［10］等透過觀察超音波引導下針刺急性腰扭傷患者腰痛側的委中穴，超音波引導下的針刺深度需達到脛神經附近深筋膜的位置，再施以捻轉提插手法使之得氣，其療效顯著。劉鵬群［11］等將60位第三腰椎橫突症候群患者分為超音波組和對照組，每組各30例，超音波組給予超音波引導下鈹針治療，對照組採用經驗痛點操作法進行鈹針治療，實驗結果顯示超音波導引下鈹針治療第三腰椎橫突症候群療效佳，且在改善患者的疼痛症狀和腰椎活動度方面較對照組優。陽丹［12］透過對超音波引導下針刀治療慢性非特異性下腰痛的療效進行觀察，研究結果表明，超音波引導下針刀治療慢性非特異性下腰痛的療效較傳統針刀更佳。也有實驗研究表明，超音波引導銀質針治療腰椎術後失敗症候群可有效緩解患者疼痛症狀，增強患者腰部功能，提高患者生存質量，其效果優於神經阻斷［13-14］。
四肢疾病
1. 上肢疾病
周斌［15］透過超音波導引精準定位喙突點、肱骨大結節點、肩峰前內側點、肩峰下緣點治療肩峰下撞擊症候群的療效進行了研究，結論指出超音波導引下針 刀精準定位治療肩峰下撞擊症候群在緩解肩痛、改善肩關節活動度、安全保障等方面較無超音波導引針刀組較好。張暑嵐［16］等透過超音波定位肩關節病灶（積水、增生肥厚、鈣化、攣縮黏連處）等治療肩周炎的療效進行了研究，結論顯示超音波定位組對肩周炎的療效優於傳統針刀組。喬若愚［17］將34位肱二頭肌長頭肌腱炎患者均以超音波定位其病變處，局部採用針刀松解治療，研究結果顯示超音波定位下針刀鬆解治療肱二頭肌長頭腱發炎的療效佳，此法可明顯改善患者肩部疼痛及運動功能。張旭［18］將60位網球肘患者分為對照組及治療組，每組30例，治療組在肌骨超音波導引下行刃針合併封閉治療，對照組在肌骨超音波導引下僅行封閉治療,結果顯示肌骨超音波導引下刃針合併封閉治療網球肘的近期及長期療效均較好。馮艷［19］等將60位腕隧道症候群患者分為研究組及對照組，每組各30例，研究組以利多卡因＋曲安奈德＋Vit12混懸液注射合併超音波下細針穿刺改良小針刀治療，對照組採用利多卡因＋曲安奈德＋Vit12混懸液注射合併傳統小針刀治療，研究結果顯示研究組超音波導引下細針穿刺改良小針刀對腕隧道症候群的效果優於對照組。範天兵［20］等以超音波導引下精準定位屈指肌腱狹窄增厚腱鞘的位置採用針刀鬆解治療狹窄性腱鞘炎，結論顯示超音波導引下針刀鬆解治療屈指肌腱狹窄性腱鞘炎的療效較常規針刀松解療效更佳，安全性也更高。
2.下肢疾病
李陸寧［21］等將60位膝骨關節炎患者分為超音波針刀組及針灸組，每組各30例，實驗結果指出，超音波導引下針刀治療膝骨性關節炎的臨床效果優於 針灸組。徐培福［22］等對髂脛束症候群的患者以超音波確定髂脛束的解剖形態，於闊筋膜張肌下緣及股骨外側髁處找出壓痛點，超音波引導下行小針刀治療，研究 結果顯示超音波引導下小針刀治療髂脛束症候群有較好的臨床療效。馬木提·阿木丁［23］將60例跟痛症或足底筋膜炎患者分為治療組和對照組，每組30例，治療組患者先通肌骨超音波引導下行軟組織封閉術,隨後進行刃針松解治療，對照組患者只採用肌骨超音波引導下的軟組織封閉術，實驗結果表明，肌骨超音波引導下刃針聯合封閉治療跟痛症的近期和遠期效果均優於對照組。趙善旭［24］等對中藥熏洗聯合超音波引導下針刀松解治療蹠筋膜炎的療效進行了觀察研究，實驗結論得出，中藥熏洗聯合超聲引導下針刀松解治療蹠筋膜發炎療效優於單純的超音波導引下的針刀松解治療及中藥燻洗治療。
超音波引導應用於其他系統的臨床研究
陳穎棋［25］等將72例健康受試者分為觀察組和對照組，每組36例，透過超音波引導下針刺深度的不同，足三里穴得氣與否進而研究胃竇收縮功能，該研究結果顯示針刺足三里穴得氣可一定程度改變胃竇運動功能。郎義［26］將120位失眠患者分為針灸組、超音波引導下的星狀神經節阻斷組及星狀神經節阻斷合併針灸治療組，每組40例，研究結果顯示，針灸組和超音波導引下的星狀神經節阻斷組對失眠的治療效果相當，且均低於星狀神經節阻斷合併針灸治療組。儲開昀［27］等透過超音波技術對賀氏火針法治療下肢靜脈曲張前後的患肢進行評估和監測，為賀氏火針的安全性和有效性提供了臨床證據。王玉雙［28］等透過超音波追蹤觀察中藥治療乳房增生症過程中乳腺增生體組織及增生結節的變化，進而用於中醫藥對乳腺增生症的療效評估，提高了治療效果的準確性。
體會：
隨著醫學技術的不斷進步與完善，超音波和中醫診療技術雖作為兩個不同的醫學體系，卻在臨床應用過程中實現了完美的融合。部分中醫診療技術已經從先前的經驗診治向超音波視覺化方向發展。從上述研究的內容不難看出，超音波視覺化引導下的中醫診療技術主要以針刀治療及普通針刺穴位為主，銀質針、鈹針、火針、中藥等文獻相對較少，這也從一定程度上說明了臨床醫學對中醫診療技術有創操作的精準化需求和安全需求，超音波醫學可以提供精細化的斷層解剖，避開重要的血管、神經以及其它臟器組織，使中醫診療技術的有創操作更精準、更安全、更有效。
同時，超音波可視化引導下的中醫診療技術主要用於治療各種疼痛性疾病，這也是依賴於超音波可視化引導下治療過程中可以清晰地觀察相應部位的解剖結構，使中醫傳統“盲操”診療技術轉變為微創手術。超音波技術作為重要的監測手段，也能讓中醫診療技術的有效性更直觀、科學的體現出來，避免了部分學者對中醫「偽科學」的論調。因此，在超音波視覺化引導下的中醫診療技術是中醫學發展中的機遇，也是挑戰，兩者的結合會在不斷的摸索中前行，也一定會為傳統醫學帶來新的活力。
作者簡介:
蔡虹,重慶市渝北區人民醫院醫生
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