頸部多裂肌於頭部抗靜態後移阻力過程之肌肉形態變化 -超音波影像量測

Cervical Multifidus Architecture During Head Retraction Manoeuvre -an Ultrasonographic Study

李若屏(Jo-Ping Lee)

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(2004年)

https://doi.org/10.6342/NTU.2004.01883

摘要

研究背景：頸部背側深層肌肉多裂肌具有獨特之感覺與動作功能；然而多節頸部多裂肌肌肉形態變化模式仍不清楚，而該模式可反應肌肉組成和肌肉動作變化。且以具非侵入性、可紀錄即時影像等特性之超音波影像來量測頸部多裂肌之效度及用力時之量測信度亦尚未獲證實。目的：(1)前驅實驗為探討超音波量測頸部多裂肌之效度及用力時之量測信度及(2)主要實驗透過超音波影像紀錄頸椎第四至第六節頸部多裂肌於頭部抗靜態後移阻力用力及放鬆過程中不同用力程度時的肌肉形態。方法：前驅實驗以核磁共振影像和超音波影像頸椎第四至第六節頸部多裂肌之肌肉面積、厚度和寬度；並以平均差值和線性回歸分析比較兩種影像之量測結果；並於同一天由同一施測者以超音波重複量測頸部多裂肌於靜態和頭部抗最大靜態後移阻力時肌肉厚度，以量測變異量之CVw和CVb檢定其信度。主要實驗共徵召20名無頸部疼痛症狀之受試者（平均年齡24.3±4.7歲，5名女性和15名男性），以10MHz線型探頭擷取超音波影像，同步紀錄頸椎第四至第六節頸部多裂肌於頭部抗靜態後移阻力用力及放鬆過程中的肌肉形態與阻力之連續變化；以3x5重覆量測變異數分析和多重分析比較不同節頸椎和阻力之間差異。結果：前驅實驗顯示肌肉厚度於核磁共振和超音波影像之平均差值為±0.20公分，並為中等程度相關(R2範圍為0.42~0.64)；且於用力及放鬆下CVw均小於10%。主要實驗則顯示肌肉厚度變化量與阻力呈曲-線性關係，且二次多項式為較佳預測曲線 (y=ax2+bx+c)；用力過程中肌肉厚度變化量於50%之頭部抗最大靜態後移阻力內有明顯變化，而比較三節頸部多裂肌間之肌肉厚度變化量並無明顯差異，僅第六節頸部多裂肌於放鬆過程中呈現較慢放鬆。結論：本研究建立以超音波影像量測頸部多裂肌連續且動態之厚度變化為具效度和信度。結果支持頸部多裂肌主要功能為維持頸椎椎體穩定度；而非參與產生力量 (force production)。
關鍵字：超音波、頸部多裂肌、肌肉形態、頭部抗後移阻力

關鍵字

頭部抗後移阻力 ； 超音波 ； 肌肉形態 ； 頸部多裂肌

並列摘要

Study Design. An in-vivo study of muscle architecture of cervical multifidus at C4, C5 and C6 levels during head retraction manoeuvre using ultrasonography.
Objectives. The pilot study is to investigate the validity and reliability of measurement for cervical multifidus using ultrasonography. The main study is to investigate cervical multifidus muscle function by the change pattern of multifidus thickness, and to compare the changes in muscle thickness among different resistance levels (rest, 25%, 50%, 75% and 100%) and different cervical levels (C4, C5 and C6).
Summary of Background. Cervical multifidus has specific sensory and motion function. However, it was unclear about muscle architectural change of cervical multifidus during head retraction manoeuvre with progressive resistance. The validity and reliability of measuring cervical multifidus using ultrasonography hasn’t been proven.
Methods. In the pilot study, thickness, width and area of multifidus were measured at C4, C5 and C6 were measured using MRI and ultrasonography. The limit of agreement and the regression analysis were used to compare the results of two modalities. Besides, muscle thickness was repeatedly measured during the static and head retraction manoeuvre using ultrasonography by the same rater on the same day; the CVw and CVb were used to investigate reliability. In the main study, multifidus architecture measured in twenty asymptomatic subjects (24.3±4.7 yo, 5 women and 15 men) during head retraction manoeuvre with progressive resistance and during relaxation using ultrasonography apparatus with 10MHz linear transducer. ANOVA with repeated measurement and post-hoc analysis were to investigate the difference among different cervical levels and resistance force levels.
Results. The pilot study showed that the limit of agreement was ±0.20 cm and the moderate level of correlation (R2 ranged in 0.42~0.64) for muscle thickness measured between MRI and ultrasonography. For muscle thickness, the CVw values under static and under head retraction against maximum resistance were lower than 10%. In the main study, there was a curvilinear relationship between muscle thickness change and resistance, and the quadratic equations were the proper curves for estimation. There was significant difference of muscle thickness change within 50% of maximum retraction against resistance; and there was no significant difference among three cervical levels. It was suggested that muscle at C6 relaxed more slowly during the period from the beginning of relaxation.
Conclusion. The present study built a valid and reliable method for measuring continuous and dynamic changes of muscle thickness using ultrasonography. The results supported muscle function of cervical multifidus for segmental stability but not for force production.

Key words: ultrasonography, cervical multifidus, muscle architecture, head retraction against resistance

並列關鍵字

muscle architecture ； cervical multifidus ； ultrasonography ； head retraction against resistance

參考文獻

Reference List

1. Cote P, Cassidy JD, Carroll L. The factors associated with neck pain and its related disability in the Saskatchewan population. Spine 2000;25:1109-17.

2. Bovim G, Schrader H, Sand T. Neck pain in the general population. Spine 1994;19:1307-9.

3. Sjogaard G, Lundberg U, Kadefors R. The role of muscle activity and mental load in the development of pain and degenerative processes at the muscle cell level during computer work. Eur J Appl Physiol 2000;83:99-105.

4. Kristjansson E, Jonsson H, Jr. Is the sagittal configuration of the cervical spine changed in women with chronic whiplash syndrome? A comparative computer-assisted radiographic assessment. J Manipulative Physiol Ther 2002;25:550-5.