肌筋膜触发点是马跛行的主要原因：生物力学、神经生理学和筋膜综述

摘要(中文译文)

马跛行的诊断目前以关节和肌腱为中心的范式为主导。标准诊断流程依赖于步态观察、神经周围麻醉和关节内麻醉以及横断面影像学检查，几乎完全针对骨骼和关节结构。肌筋膜触发点（MTrPs）是骨骼肌紧张带内的高敏、易激惹位点，在受压或收缩时产生局部疼痛和牵涉痛。在马中，MTrPs是临床相关但被系统性忽视的原发性跛行来源。本综述综合了马属动物及比较医学研究的证据，认为MTrPs可作为马步态不对称、运动表现下降和疼痛行为的主要病因——而不仅仅是次要病因。关键机制包括MTrP形成的能量危机模型、外周和中枢敏化、模拟远端肢体病变的牵涉痛投射，以及MTrP诱导的肌肉抑制对步态的生物力学后果。电生理研究证实，马MTrPs表现出与人类和动物MTrPs相同的自发电活动。患病率研究表明，MTrPs存在于许多运动马中。盛装舞步马在颈部和胸腰段肌肉组织中患病率尤其高。具有临床重要性的是牵涉痛现象：臀中肌、腰最长肌和股二头肌等近端肌肉中的MTrPs可产生明显的远端肢体疼痛。此类疼痛在临床上难以与关节或肌腱病变相区分，这对诊断准确性具有直接但未被充分认识的影响。我们建议将系统性肌筋膜触诊作为一线诊断步骤整合到常规马跛行检查中。靶向MTrP治疗后步态不对称的快速缓解应被解释为肌筋膜来源的支持性证据。我们进一步描述了从活跃状态到潜伏状态的临床相关触发点活动谱，讨论了莱姆病相关弥漫性肌痛和原发性肌病（PSSM2、MIM、IMM）等鉴别诊断，总结了马MTrP管理中使用的主要治疗方式，并探讨了生物张拉整体作为解释肌筋膜功能障碍多节段筋膜效应的力学生物学框架。

Abstract

Equine lameness diagnosis is dominated by a joint- and tendon-centric paradigm. The standard diagnostic algorithm relies on gait observation, perineural and intrasynovial anesthesia, and cross-sectional imaging. It is directed almost exclusively at skeletal and articular structures. Myofascial trigger points (MTrPs) are hypersensitive, hyperirritable loci within taut bands of skeletal muscle. They produce local and referred pain on compression or contraction. In horses, MTrPs are a clinically relevant but systematically overlooked source of primary lameness. This review synthesises evidence from equine and comparative research. We argue that MTrPs can act as the primary-not merely secondary-cause of gait asymmetry, performance deficits, and pain behavior in horses. Key mechanisms include the energy crisis model of MTrP formation, peripheral and central sensitization, referred pain projection mimicking distal limb pathology, and the biomechanical consequences of MTrP-induced muscle inhibition on gait. Electrophysiological studies confirm that equine MTrPs show the same spontaneous electrical activity as human and animal MTrPs. Prevalence studies indicate that MTrPs are present in many sport horses. Dressage horses show particularly high prevalence in the cervical and thoracolumbar musculature. Of clinical importance is the referred pain phenomenon: MTrPs in proximal muscles such as the gluteus medius, longissimus lumborum, and biceps femoris may produce apparent distal limb pain. Such pain can be clinically indistinguishable from joint or tendon pathology. This has direct and underappreciated implications for diagnostic accuracy. We propose that systematic myofascial palpation should be integrated into the routine equine lameness workup as a first-tier diagnostic step. Rapid resolution of gait asymmetry following targeted MTrP treatment should be interpreted as supportive evidence of myofascial origin. We further delineate the clinically relevant trigger point activity spectrum from active to latent states, address differential diagnoses such as Lyme-associated diffuse myalgia and primary myopathies (PSSM2, MIM, IMM), summarise the principal therapeutic modalities used in equine MTrP management, and examine biotensegrity as a mechanobiological framework explaining the multisegmental fascial effects of myofascial dysfunction.

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