腸脛束形態在無症狀自願受試者於歐柏測試及修飾型歐柏測試下之超音波測量變化

Abstract

研究背景與動機：臨床上歐柏測試及修飾型歐柏測試手法為評估腸脛帶是否過緊，以及此症治療的方法，但至目前為止，此兩種手法並無直接證據證明腸脛帶（束）是否被牽拉（stretch），及被牽拉程度與髖關節內收角度間之關係。研究目的：本研究目的為1.提供腸脛束在歐柏測試及修飾型歐柏測試時形態改變之證據。2.分析歐柏測試及修飾型歐柏測試姿勢下，腸脛束形態改變與髖關節內收角度之關係。3.並評估可能干擾因子對本研究之影響。研究方法：以超音波、傾斜儀、肌電圖儀為測量工具，受試者人數40位（20位男性與20位女性；男性24.3±4.9歲，女性24.7±3.4歲），在歐柏測試及修飾型歐柏測試手法，即膝關節在彎曲90°姿勢以及伸直姿勢的情況下，測量腸脛束寬度、厚度及髖關節內收角度，再由40位受試者中隨機選取20位，測量歐柏測試及修飾型歐柏測試手法中，闊筋膜張肌及臀大肌之肌肉活動。結果：歐柏測試手法下，受測肢髖關節內收角度，比修飾型歐柏測試手法小，且具統計意義（p=0.027）；男女髖關節內收角度及腸脛束寬度、厚度，在歐柏測試及修飾型歐柏測試手法下，都無統計差異；在修飾型歐柏測試手法，腸脛束寬度與髖關節內收角度之相關性大於歐柏測試手法（r=-0.508，p<0.001 VS. r=-0.377，p<0.001），兩手法在腸脛束厚度與髖關節內收角度間則皆無相關性（p=0.414，0.424）。此外，身高、體重、腿長三變項與腸脛束寬度、厚度、受測肢髖關節內收角度之間則無明顯相關性(p＞0.05)，在放鬆情況下，闊筋膜張肌及臀大肌之肌肉活動，不受歐柏測試及修飾型歐柏測試手法影響（p=0.733，0.916）。結論：本研究提供了腸脛束在歐柏測試及修飾型歐柏測試時形態改變之初步證據，並證實腸脛束寬度、厚度及髖關節內收角度大小，與體型無關。歐柏測試及修飾型歐柏測試手法對腸脛束都產生牽拉的效果，但修飾型歐柏測試手法下，對腸脛束牽拉效率可能大於歐柏測試姿勢。

Background: Ober’s test and modified Ober’s test are methods which commonly used to assess the iliotibial band(ITB) tightness and also the techniques in stretching a tight ITB in the clinic. But there are not enough scientific evidences to prove whether the ITB is under stretch in these testing manuvers. And correlations between the effectiveness of stretch and angle of hip adduction have not yet been evaluated. Purposes: The aims of this study were: 1.To provide evidences on sonographic morphologic changes of the ITB under Ober’s test and modified Ober’s test. 2.To analyze correlations between morphologic changes of the ITB and hip adduction angle in Ober’s test and modified Ober’s test positions. 3.To evaluate effects of possible confounding factors in this study. Methods: The instruments included a ultrasound , a inclinometer and an electromyography. 40 volunteers (20 males, mean age 24.3±4.9 years old and 20 females, mean age 24.7±3.4 years old) anticipated in this study, and the ITB width, thickness and hip adduction angle in Ober’s and modified Ober’s test ( knee joint flexion 90° and extension) were measured. Twenty subjects were randomly selected from these 40 volunteers to measure the muscle activities of tensor fascia lata and gluteus maximus muscle in Ober’s and modified Ober’s test . Results: In Ober’s test, hip adduction angle was significantly smaller than that of modified Ober’s test (p=0.027). There were no significant differences between male and female in hip adduction angles, ITB thickness and width in each Ober’s and modified Ober’s test. The correlation between the ITB width and hip adduction angle was significant both in Ober’s test and in modified Ober’s test （r=-0.508，p<0.001 ； r=-0.377，p<0.001）, but there was not significant correlation between the ITB thickness and hip adduction angle in Ober’s and modified Ober’s test. Height, weight, and thigh length of subjects did not significantly correlate with ITB width , thickness and hip adduction angle. (p＞0.05). The muscle activities of tensor fascia lata and gluteus maximus were not affected by Ober’s and modified Ober’s tests when the subjects were relaxed（p=0.733，0.916）. Conclusion: This study provided the preliminary evidences of morphologic changes of the ITB in Ober’s test and modified Ober’s test, and had shown that ITB width, thickness and hip adduction angle did not correlate significantly with demographic features. ITB is stretched in Ober’s test and modified Ober’s test, but the efficacy may be higher in modified Ober’s test when comparing to Ober’s test.