頸因性頭痛者之頭下斜肌肌肉厚度和頸部本體感覺

Thickness of Oblique Capitis Inferior and Cervical Kinesthesia in Patients with Cervicogenic Headache

陳奕穎(Yi-Ying Chen)

指導教授 ： 王淑芬

國立臺灣大學/醫學院/物理治療學研究所/碩士(2011年)

https://doi.org/10.6342/NTU.2011.02296

摘要

背景：頸因性頭痛者有上頸椎肌肉骨骼系統異常的問題，可能會引起深層肌肉及頸部本體感覺異常，前人以影像超音波觀察頸椎第二節處肌肉型態學，但只有觀察淺層肌肉卻沒有觀察該節的深層肌肉--頭下斜肌的型態學。前人沒有考慮主要頭痛邊和非主要頭痛邊的理學檢查表現是否相同。並無發現頸因性頭痛者頸部本體感覺異常的現象。前人發現持續等長收縮可強化健康人的頸部本體感覺。惟肌肉收縮後對於頸因性頭痛的患者本體感覺的影響仍未知。
目的：比較頭部復位測試誤差及頭下斜肌的厚度於1)頸因性頭痛者主要頭痛邊和非主要頭痛邊側是否有差異，2) 頸因性頭痛者與健康人是否有差異，最後3) 在頸部肌肉等長收縮後，於頸因性頭痛患者及健康人是否會有變化。
方法：十三位頸因性頭痛者 (24.5±4.8歲) 及十四位無頭頸痛者 (23.9±2.7歲) 加入此實驗，病人組屬輕微失能 (頸部失能量表：Neck disability index：7.3±2.1分；平均頭痛視覺類比尺度：Visual Analogue Scale：4.2±1.5分；平均頸痛視覺類比尺度：3.0±1.7分) 。頸因性頭痛者符合Cervicogenic Headache International Study Group之條件，但沒有麻醉測試驗證，無頭頸痛者須於近三個月內無頭頸痛的現象。使用儀器：頭部復位測試使用3D動作分析系統 (CMS-70P，Zebris) 記錄受測者於閉眼時，頭部旋轉到30度及回正的能力；肌肉厚度將以動態影像超音波 (Terason t3000, USA) 記錄頭下斜肌在休息時及在最大轉頭的等長收縮時肌肉厚度及其變化的比例。以二因子變數分析 (左右*頭痛側) 比較頸因性頭痛患者兩側之頭下斜肌厚度及頭部復位測試誤差於主要頭痛側及非主要頭痛側之差異。以二因子變數分析(組別*頭痛側)比較無頭頸痛者和頸因性頭痛者之頭下斜肌厚度及頭部復位測試誤差。以二因子變數分析(時間*組別)測試無頭頸痛者及頸因性頭痛者接受20~30%頸部旋轉肌肉等長收縮六次後，頭部復位測試誤差及頭下斜肌厚度之變化。以上實驗之α為0.05。
結果：頸因性頭痛者主要頭痛邊的頭下斜肌休息時厚度 (9.92±2.31mm) 較非主要頭痛邊的厚度 (10.56±2.24mm) 小 (二因子變異數分析：p=0.03；配對t檢驗：p =0.002)。頸因性頭痛者有轉向非主要頭痛側之頭部復位測試常數誤差較轉向主要頭痛側小的趨勢 (二因子變異數分析：p=0.07)。 頸因性頭痛與無頭頸痛者的頭下斜肌厚度無顯著差異 (二因子變異數分析：p=0.16~0.55)。頸因性頭痛者往非頭痛側目標的頭部復位測試常數誤差 (-1.6±4.3°) 較無頭頸痛者 (3.3±3.7°) 小 (單因子變異數分析：p =0.02；獨立t檢定：p =0.005)。頸部肌肉等長旋轉後，頭下斜肌的肌肉厚度及其變化 (二因子變異數分析：p = 0.31 ~ 0.96) 及頭部復位測試的常數誤差則無顯著變化 (二因子變異數分析：p =0.21 ~ 0.99) ，但兩組回到正中位置的頭部復位測試絕對誤差有下降的趨勢 (時間的主要效果：p =0.06 ~ 0.09) 。
結語：測試頸因性頭痛者的頭部復位測試及頭下斜肌肌肉厚度時，須考慮主要頭痛側及非主要頭痛側有不同的趨勢。測試頸因性頭痛者的頭部復位測試時，常數誤差能反映組間差異，顯示誤差的方向性亦需考慮。作20~30%頸部肌肉等長旋轉後，兩組回到正中位置的頭部復位測試之絕對誤差有下降的趨勢。本實驗的結果適用於年輕的頸因性頭痛族群。未來研究將探討頸因性頭痛者主要頭痛側及非主要頭痛肌肉厚度及復位測試誤差之原因及以徒手及運動治療的可行方法。

關鍵字

超音波 ； 本體感覺 ； 復位測試 ； 頭下斜肌 ； 頸因性頭痛

並列摘要

Background: The patients with cervicogenic headache (CeH) suffered from impaired musculoskeletal system in the upper cervical spine, which might possibly relate to dysfunction of sensory motor system. Previous studies have examined the morphological change of superficial neck muscles at the C2 level. No examination of the deep neck muscle of this area has been performed. The previous studies did not distinguish the difference on the painful (dominant) and the non-painful (non-dominant) sides. No significant differences were found in the patients with CeH while comparing with the asymptomatic participants. Isometric contraction was proved to improve the CK of asymptomatic participants immediately, but the results are still unknown in the patients with CeH. Purposes: We compared the thickness of the OCI and the error of the head reposition test 1) between the painful and non-painful sides of the patients, 2) between the patients and the asymptomatic group, and 3) between before and after receiving isometric head rotation in both groups. Methods: Thirteen patients (24.5±4.8 yrs) and fourteen asymptomatic participants (23.9±2.7yrs) were included in this study. The patients suffered from mild disabilities (Neck disability index: 7.3±2.1; averaged Visual Analogue Scale of headache: 4.2±1.5 ; averaged Visual Analogue Scale of neck pain: 3.0±1.7) . The criteria of the patients were according to the Cervicogenic Headache International Study Group without anesthetic block. The head reposition test was recorded by a 3D motion analysis system (CMS-70P, Zebris, Germany), which tested the ability to relocate head to 30° head rotation and neutral head position with eyes closed. The thickness of the OCI was recorded by ultrasonography (Terason t3000, USA) during rest and under maximal contraction conditions and the ratio of change of both conditions. The thickness of the OCI and the error of head reposition test were compared between the painful and non-painful sides in the patients group by two way ANOVA (side*pain). The comparisons of the thickness of the OCI and the error of the head reposition test between the asymptomatic participants and the patients with CeH was tested by two way ANOVA (group*pain). The comparisons of the thickness of the OCI and the error of head reposition test between before and after performing the 20~30% maximal isometric head rotation (MIHR) for six trials was performed by two way ANOVA (time*group) in both groups. The α was 0.05 for all of the ANOVA tests. Results: The thickness of the OCI in the rest condition on the painful side (9.92±2.31mm) was smaller than that of the non-painful side (10.56±2.24mm) in the patients with right CeH. (p=0.03 for two way ANOVA; p=0.002 for paired t-test). The constant error (CE) of the Head-to-target test in the patient group showed a tendency of smaller error toward the non-painful side than that toward the painful side (p=0.07 for two way ANOVA). When comparing the differences between the asymptomatic group and the patients with CeH, no significant interactions of the thickness of the OCI were found (p=0.16 ~ 0.55 for two way ANOVA). The CE of the Head-to-target test toward the non-painful side was smaller in the patients with CeH (-1.6±4.3°) than that in the asymptomatic group (3.3±3.7°) (p =0.02 for two way ANOVA; p =0.005 for independent t-test). No change was shown in the thickness and the change of the OCI (p = 0.31~0.96 for two way ANOVA) and the CE of the head reposition test (p =0.21 to 0.99 for two way ANOVA) after 20~30% MIHR in both groups. The AE when rotating the head to a neutral head position showed a decreased tendency after 20~30% MIHR for both groups (p =0.06~0.09 for main effect of time). Conclusions: The different tendency between the painful and non-painful side in the patients with CeH should be considered during measuring the head reposition test and the thickness of the OCI. During examining the head reposition test, CE could reveal the difference between groups, not AE, indicating that overshooting or undershooting might be considered. After performing 20~30% MIHR, there was a tendency of decreased AE in both groups. The result of present study limited to the CeH in young population. Future studies included the investigation of the possible cause of difference in the painful and non-painful sides, and the effect of manual therapy and therapeutic exercise in CeH.

並列關鍵字

Ultrasonography ； Kinesthesia ； Reposition test ； Oblique capitis inferior ； Cervicogenic headache

參考文獻

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