定量評估缺血式按摩、增生療法及肌力訓練對頸因性頭臉症候群的療效

Quantitative Assessment of the Effects of Ischemic Compression, Prolotherapy, and Strengthening Exercises on Cervicogenic Cephalic Syndrome

林瀛洲(Lin Yin-Chou)

指導教授 ： 林正常

國立臺灣師範大學/運動與休閒學院/體育學系/博士(2011年)

摘要

「頸因性頭臉症候群」是一群導因於頸因性頭痛及頸因性頭暈的疾病。患者除了頭痛、頭暈、平衡失調，還可能造成眼睛、鼻子及喉嚨的症狀。這些症狀比起其他類型的頭痛及頭暈更容易造成失能的狀態。本研究針對頸因性頭臉症候群的患者進行了兩階段的臨床試驗以了解增生療法、缺血式按摩及肌力強化的治療效果。目前為止的文獻報告對於頸椎病變治療及復健的效果評估多是以定性的方式為主，本研究將以定量的平衡測量來當作是治療結果的評估工具。第一階段的研究旨在檢驗缺血式按摩的立即效果，共收錄27位符合診斷條件的頸因性頭臉症候群患者及26位健康志願者做為控制組。納入的標準包括：(1)頸椎疼痛超過三個月；(2)患者有超過一個以上頸因性頭臉症候群的症狀，如頭痛、眩暈、失衡等；(3)頸椎x光檢查有列位不正。患者有耳、鼻、喉及中樞神經病變者則排除在外。受試者在接受缺血式按摩前需先接受電子式的向度測量及肌力測試。另外需要接受電腦化定量的平衡測試(Sensory Organization Test)，測試(1)張眼；(2)閉眼；(3)視覺干擾；(4)張眼地板動；(5)閉眼地板動；(6)地板及視覺參考同時擾動等6種狀況。患者在治療及接受冰敷15分鐘後立即進行後測。本研究第二階段旨在檢驗增生療法及肌力強化的長期療效，共收錄40位符合診斷條件的頸因性頭臉症候群的患者。這些患者將隨機被分配到(I) 增生療法組；(II)肌力強化組；(III) 增生療法加肌力強化組；(IV)控制組，共4組，每組十人。並於4週及8週後再接受同樣的檢測以評估治療效果。所得資料以配對t考驗及混合設計二因子變異數進行分析。結果顯示實驗組在接受缺血式按摩後頸椎的肌力、活動度及地板晃動狀態下的平衡控制獲得明顯改善，代表視覺及前庭覺的感覺比值也明顯獲得改善。第二階段的研究結果顯示I、II、III組對於頸椎功能（活動度、肌力、平衡功能）的復健皆有長期療效，唯獨增生療法組並無法明顯改善肌力，而增生療法加肌力強化組對平衡功能的增進則較為明顯。本研究的結論如下：缺血式按摩可以立即改善頸因性頭臉症候群患者的頸椎功能，其簡單容易施作的特性可廣於臨床上運用。長期的治療效果還是以增生療法配合頸椎肌力強化的方式效果最為明顯，可適用於慢性頭頸疼痛的患者。

關鍵字

頭痛 ； 頭暈 ； 增生療法 ； 按摩 ； 肌力強化 ； 姿態平衡

並列摘要

Purpose: Cervicogenic cephalic syndrome (CCS) is a group of diseases consisting of cervicogenic headache, dizziness, and disequilibrium. In addition, cervical lesions may also result in ophthalmic, olfactory, and throat complaints; these symptoms have a greater potential of causing loss of physical function than other types of headache and dizziness disorders. We conducted 2 clinical trials to access the treatment effects of ischemic compression (IC), prolotherapy, strengthening exercises, and prolotherapy plus strengthening exercises on patients with CCS. A review of literature reveals a lack of quantitative outcome measurements to access the effects of treatments. We therefore introduced a quantitative balance performance test to measure CCS rehabilitation outcomes. Methods: Twenty-seven subjects with chronic neck pain (persisting for more than 3 months) and 26 healthy volunteers were recruited in part I of this study. Subjects with any organic lesion of the peripheral ear, nose, throat, eye, or central nervous system were excluded. The CCS group received ischemic compression at points of maximal tenderness in the origin of the posterior nuchal muscle. Sensory organization test (SOT) scores, cervical range of motion (ROM), and isometric strength of the neck were measured pre- and post-IC. Forty subjects with chronic neck pain were recruited in part II of this study and randomly assigned to 4 groups of 10 patients each. Each group underwent therapy as follows: group I, prolotherapy; group II, strengthening exercises; group III, prolotherapy plus strengthening exercises; and group IV, control. SOT scores, cervical ROM, and isometric strength of the neck were measured by a blinded assistant before treatment, and at 4- and 8-week follow-ups. Data were analyzed using paired-t test and split-plot two-way ANOVA. Results: The ROM of the cervical spine and isometric strength increased in all directions, and the SOT showed increased postural stability under conditions with swayed reference support after IC in the CCS group. The ratios for vestibular and visual function also increased after IC in the CCS group. Groups I, II, and III showed improved neck function (ROM, strength, and balance) at 4- and 8-week follow-ups, except for a lack of significant improvement in neck strength in the prolotherapy group. Patients exposed to prolotherapy combined with strengthening exercises exhibited better balance performance than others. We conclude that IC is simple for a therapist or patient to apply clinically and is an effective treatment option for CCS. Prolotherapy combined with strengthening exercises is more effective in the long-term on neck rehabilitation, and is a potential treatment option for chronic headache and neck pain patients.

並列關鍵字

headache ； dizziness ； prolotherapy ； massage ； strengthening exercises ； postural balance

參考文獻

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