頸部多裂肌收縮型態之動態超音波研究-探討慢性頸痛的影響

Cervical Multifidus Contraction Pattern during Head Retraction Manoeuvre in Adults with and without Cervical Symptom-an Ultrasonography Study

吳瑞屏(Jui-Ping Wu)

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(2006年)

https://doi.org/10.6342/NTU.2006.02357

摘要

研究背景：經由分析背側深層多裂肌解剖位置、型態結構以及生物力學模式可以證實頸部多裂肌於感覺與動作皆佔有重要地位；然而， 受限於研究方法與儀器，過去少有研究調查頸部多裂肌受疼痛影響。目的：本研究主要是運用超音波影像記錄第四至第六節頸椎於頭部抗靜態後移阻力下，收縮與放鬆過程中肌肉厚度的變化。方法：徵召五十九名志願參與本研究之受試者（二十九名無頸部疼痛症狀，十三名男性、十六名女性、平均年齡29.4±6.4歲；三十名頸部疼痛病患，十五名男性、十五名女性，平均年齡29.4±6.4歲），利用超音波影像系統(HDI 5000, ATL, USA)與力量換能器（strain gauge, U3B1- 50K- B, Minebea Co., Ltd., Singapore）同步記錄由休息時到對抗最大頭部靜態後移阻力，以及最大用力至放鬆之整個過程中的力量與頸部多裂肌肌肉厚度變化，進一步利用最佳預測二次曲線（best fitted equation, y=ax2+bx+c）來表示此動態變化，X值代表頭部力量變化、Y值表示多裂肌厚度變化量。統計分析則使用SPSS11.0.版統計分析軟體中的混合效應模式（Mixed analysis of Variance Models）比較頸部疼痛、不同用力狀況（收縮與放鬆）、不同節頸椎(C4-6)多裂肌厚度之變化；同時比較上述參數對最佳預測二次曲線之各次項係數 (coefficients of best fitted equation; a, b, c)之影響。 結果：多裂肌厚度不論有無經體重標準化過之在休息時無明顯組間差異，同時多裂肌厚度於最大用力時與變化量具組間顯著差異。此外，無疼痛組最佳預測曲線結果(y=ax2+bx+c, a:-0.0018- -.0033; b: 0.41-0.51; c: 1.05-14.09; R2: 0.28-0.98)，頸部疼痛組之最佳預測曲線範圍如下(y=ax2+bx+c, a:-0.00005- -.0031; b: 0.22-0.41; c: 1.33-13.35, R2: 0.25 -0.98)，經統計分析之比較，疼痛組的二次項係數絕對值與非疼痛組有顯著差異(p<0.05)，一次項係數組間也同樣具顯著差異，放鬆時的常數項係數明顯大於用力時。結論：頸部疼痛與多裂肌厚度增加量減少有關，預測曲線的係數變化，表示頸部疼痛病患之多裂肌肌肉厚度增加量於低、高阻力時，表現不同。應用於臨床，可作為早期診斷頸部肌肉功能與評估運動訓練效果之用途。

關鍵字

超音波 ； 頸部多裂肌 ； 頭部抗後移阻力 ； 肌肉厚度 ； 厚度力量變化曲線

並列摘要

Background: The important role of cervical multifidus has been demonstrated by anatomical, morphological and biomechanical models. However, fewer studies have investigated the dynamic function of cervical multifidus which might be disturbed by the present of chronic pain. Purpose: The present study was to investigate the thickness changes of cervical multifidus during contraction and relaxation; and to compare the differences in activation patterns of cervical multifidus between participants with and without cervical symptoms. Method: Thirty participants (29.1±5.3 years old, 15 women and 15 men; 29.4±6.4 years old, 16 women and 13 men) were recruited to investigate the multifidus activation patterns during retraction against a fixed strain gauge (U3B1- 50K- B, Minebea Co., Ltd., Singapore). This force recording system was synchronized with ultrasonographic system (HDI 5000, ATL, USA). The mathematical relationship of instantaneous force (x) and changes of muscle thickness (y) during contraction (and relaxation) was estimated by quadratic models and the R2 values were calculated. Mixed models were used to examine the interaction and main effect of group (symptomatic and asymptomatic), contraction (contraction and relaxation) and levels (C4-C6). Results: Muscle thickness at resting condition showed no significantly smaller in participants with cervical symptom than those without symptoms. Muscle thickness, as well as the change from resting to maximal contraction, were significantly smaller than those of asymptomatic one (p<0.05). The best estimation equations during contraction and relaxation between the thickness-force relationship in asymptomatic participants (y=ax2+bx+c, a: range from -0.0018 to -.0033; b: from 0.41 to 0.51; c: from 1.05 to 14.09) showed significant curvilinear relationship (R2: 0.28-0.98). Compared to those of the asymptomatic participants, the symptomatic ones (y=ax2+bx+c, a: from -0.00005 to-.0031; b: from 0.22 to 0.41; c: range 1.33 to 13.35, R2: 0.25 -0.98) showed significantly smaller absolute value of a (p<0.05) and b values (p<0.05). Significant smaller c was observed during contraction than relaxation. Conclusion: Inability of increasing muscle thickness during maximal head retraction resistance was observed in symptomatic participants. Furthermore, the curvature of the thickness-force curve during contraction of the symptomatic participants was different from the asymptomatic participants, indicating the change of contraction in low load and high load condition was not consistent. Clinical application of this approaching might involve in early diagnosis and monitoring treatment effect of exercise.

並列關鍵字

Ultrasonography ； Cervical multifidus ； Head retraction against resistance ； Muscle thickness ； Thickness-resistance curve

參考文獻

1. Anderson JS, Hsu AW, Vasavada AN. Morphology, architecture, and biomechanics of human cervical multifidus. Spine 2005;30:E86-E91.

2. Barton PM, Hayes KC. Neck flexor muscle strength, efficiency, and relaxation times in normal subjects and subjects with unilateral neck pain and headache. Arch.Phys.Med.Rehabil. 1996;77:680-7.

3. Beck AT, Ward CH, Mendelson M et al. An inventory for measuring depression. Arch.Gen.Psychiatry. 1961;4:561-71.:561-71.

4. Borghouts JA, Koes BW, Bouter LM. The clinical course and prognostic factors of non-specific neck pain: a systematic review. Pain 1998;77:1-13.

5. Boyd-Clark LC, Briggs CA, Galea MP. Muscle spindle distribution, morphology, and density in longus colli and multifidus muscles of the cervical spine. Spine 2002;27:694-701.