遠紅外線溫度攝影顯像偵測筋膜炎症候群之探討

Infrared Thermogram for Detection of

陳弘欣(Hong-Shin Chen)

指導教授 ： 潘力誠 ； 李勝揚

臺北醫學大學/口腔學院/牙醫學系碩博士班/碩士(2002年)

摘要

筋膜炎症候群（myofascial pain syndrome）常伴隨複雜的交感神經系統障礙。交感神經系統是控制皮膚微循環的機制，皮膚循環的改變是反應在皮膚淺層溫度的發散，這些現象是可以用紅外線熱影像來觀察。本研究目的是利用遠紅外溫度攝影顯像技術分析評估筋膜炎症候群，是否可成為臨床的評估工具。方法首先是將筋膜炎症候群與正常成人對照觀察在頸椎做觸診矯正治療（spinal mobilization）前後二組受試者所偵測到的皮膚表面溫度與視覺分析痛覺（visual analog scale）、頸部關節活動度、激痛點疼痛閥值（pain threshold）等資料作前後比較分析其差異性。再來是將二組受試者二側上斜方肌激痛點（trigger point）表面溫度及其傳導痛區域表面溫度兩者間的相關性。最後是將二者所偵測到的皮膚表面溫度變化與視覺分析痛覺（visual analog scale）、頸部關節活動度、激痛點疼痛閥值（pain threshold）等三項測試的差別，比較之間的關係。 結果發現：（1）T-test得到對照組在治療前後左側、右側激痛點和傳導痛區域的溫度變化均有其差異性；實驗組在治療前後左側、右側激痛點和右側傳導痛區域的溫度變化有其差異性，在左側及右側激痛點疼痛閥值治療前後亦有差異性。二組在視覺分析痛覺與頸部關節活動度的測試項目則沒有差異。（2）實驗組激痛點的溫度變化與其傳導痛區域溫度的前後變化成高度正相關；對照組有差異但沒有相關。（3）實驗組與對照組在頸部關節活動度方面，六個方向角度變化與激痛點的溫度變化並無明顯相關。（4）實驗組與對照組在視覺分析痛覺前後變化與激痛點的溫度變化也無明顯相關。（5）在疼痛閥值方面，實驗組其右側激痛點的疼痛閥值前後變化與左右側激痛點及左右側傳導痛區域溫度的前後變化成負相關。而左側激痛點的疼痛閥值前後變化與左右側激痛點及右側傳導痛區域溫度的前後變化成負相關，與左側傳導痛區域溫度的前後變化的相關性在統計上沒有意義（p>0.05）；但在對照組中發現右側激痛點的疼痛閥值前後變化與左右側傳導痛區域溫度的前後變化成負相關。 研究結果可提供筋膜炎症候群患者一種新的且客觀的臨床診斷工具，當作確切診斷的基礎，作為治療進步的依據和及早預防之參考，同時給臨床醫療人員更大的便利性。 關鍵詞：筋膜炎症候群、遠紅外溫度攝影顯像技術、頸椎做觸診矯正、視覺分析痛覺、頸部關節活動度、激痛點、疼痛閥值

關鍵字

筋膜炎症候群 ； 遠紅外溫度攝影顯像技術 ； 頸椎做觸診矯正 ； 視覺分析痛覺 ； 頸部關節活動度 ； 激痛點 ； 疼痛閥值

並列摘要

It is known that myofascial pain syndrome（MPS） shares the same neural pathway with sympathetic nerve system, but the mechanisms is not clear. Sympathetic nerve system control the microcirculation of the skin. The change of the microcirculation below the skin will reflect on the temperature of the skin. Infrared thermogram can detect the changing. Abnormal infrared thermogram always match the dermotomes including upper back, lower back or extremities. Someone who suffered from MPS will be noted the sign. However, the relationship between skin temperature regulation over the area with trigger points and referred pain is still unknown. Therefore, to implement the use of infrared thermogram as a plausible tool for the clinical assessment of referred pain in MPS and treatment assessment, current study will propose a human experiment based on the thermo-changes in skin temperature for patient with MPS. The study first compares the differences of patients with MPS and normal adult in changes respects to skin temperature, visual analog scale（VAS）, cervical range of motion（ROM）, and pain threshold on trigger point over upper trapezius muscle before and after cervical spinal mobilization. Then investigate the relation between data from skin temperature of bilateral trigger point over upper trapezius muscles and its referred pain area. Finally we analyze the correlation between the detected change of skin temperature and visual analog scale, cervical ROM and pain threshold on trigger point. We found that: 1) The control group who had different temperature on bilateral trigger point and referred pain area before and after treatment are significantly noted by using T-test. Significant changes are also noted in temperature on bilateral trigger point and right side referred pain area before and after treatment with experimental group. Bilateral pain threshold are found differently before and after treatment. No difference found on VAS and cervical ROM between two groups. 2) High degree of positive correlation found between change of skin temperature on trigger point and its referred pain area with experimental group, but no significant finding on control group. 3) There is no significant relation on cervical ROM changes with the temperature change on bilateral trigger points in both experimental and control groups. 4) There is also no significant relation on VAS change with the temperature change on bilateral trigger points in both experimental and control groups. 5) Negative correlation was noted between change of pain threshold on right trigger point and change of skin temperature on bilateral trigger point and its referred pain area with experimental group, but no significant finding on control group. Negative relation were found between change of pain threshold on left trigger point and change of skin temperature on bilateral trigger point and only right referred pain area with experimental group, but no significant finding on control group. There is no significant relation on change of pain threshold on left trigger point with change of skin temperature on left trigger point ( p>0.05 ). But negative correlation was noted between change of pain threshold on right trigger point and change of skin temperature on bilateral trigger point and its referred pain area with control group. According these results, we can provide a new clinical evaluative tool for MPS for comparing the differences after treatment or therapy. Key words：Myofascial pain syndrome, Infrared thermogram, Cervical spinal mobilization, Visual analog scale, Cervical range of motion, Trigger point, Pain threshold

並列關鍵字

Myofascial pain syndrome ； Infrared thermogram ； Cervical spinal mobilization ； Visual analog scale ； Cervical range of motion ； Trigger point ； Pain threshold

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