2013-08-012024-05-13https://scholars.lib.ntu.edu.tw/handle/123456789/646447摘要：足底筋膜炎是造成足跟疼痛最常見的原因，且常對病人的生活品質有負面影響。造成足底筋膜炎的病因有很多，其中負荷過載（mechanical overload）及退化（degeneration）被認為是最重要的原因，由於足底筋膜扮演著穩定足弓的重要角色，若其彈性因過度使用或退化而變差（例如軟化），可能導致生物力學上之不穩定而引起症狀。若要對足底筋膜炎做更有效之治療，必需對其組織特性之變化有更進一步的了解。目前診斷足底筋膜炎最常使用的方式仍為臨床症狀，影像檢查如X 光、磁振造影等，主要用來排除其他疾病。傳統B 模超音波亦被用來診斷足底筋膜炎，其診斷標準包括厚度大於4 毫米及低迴音度變化（hypoechoic change），仍屬影像檢查。但在實務經驗上，部份臨床症狀十分典型之足底筋膜炎病人，並無B 模超音波影像上之異常。因此我們假設這群病人足底筋膜組織特性可能已有變化，但尚未造成型態上之變化。超音波彈性造影（sonoelastography）是一項最近十年才蓬勃發展的超音波技術，它是以非侵入性的方式估算物質之彈性，在某一方面可以代表組織特性。目前在許多領域包括肝硬化、乳房腫瘤、甲狀腺腫瘤已有一些研究成果，但在骨骼肌肉系統仍非常有限。我們在先期的研究已發現，超音波彈性造影可以清楚地呈現正常人的足底筋膜的彈性，且隨著年紀增加，有彈性變軟的趨勢，而且發現用超音波儀所提供的彈性造影工具，於測量足底肌膜有不錯之信度（reliability），但其效度（validity）尚未確認。因此在這個計畫中，第一年我們希望利用不同硬度之仿體（phantom），以不同原理之超音波彈性造影加以測試，加以迴歸分析及相關性檢定，得到有關超音波儀彈性造影對於測量組織特性（硬度）的效度。第二年將召集30 位足底筋膜炎病人，利用問卷及超音波彈性造影得到症狀、足底筋膜厚度及硬度之資料，分析三者之間的關係，以確認組織特性於臨床之重要性。第三年則為一追蹤性之研究，期望了解震波治療對病人的足底筋膜彈性（組織特性）會有什麼樣的影響。藉此三年計畫，我們將建立超音波彈性造影檢查之信度及效度，並瞭解足底筋膜患者其症狀和組織特性的相關性，更進一步，了解足底筋膜炎之彈性組織特性於治療後之變化。有了這樣的資料將可擴展至大部分之軟組織病變，而進一步瞭解各式肌腱韌帶病變除型態學外，組織特性的改變。<br> Abstract: Plantar fasciitis is the most common cause of heel pain, and it influences patients’ quality of life.It is multifactorial, with mechanical overload and degeneration being regarded as the most importantones. Since plantar fascia plays an important role in the stabilization of foot arch, changes of itselasticity (such as softening) due to overuse or degeneration may lead to biomechanical instability andthe symptoms. We should acquire a better understanding of its material properties in order to givemore effective treatment.The most common reference for the diagnosis of plantar fasciitis is clinical symptoms. Imagingstudies such as X-ray and MRI were mainly applied for exclusion of other diseases. ConventionalB-mode ultrasound was also used for diagnosis of plantar fasciitis, of which criteria include thicknessgreater than 4mm and hypoechoic change of plantar fascia. However, in clinical practice, we find noimaging abnormalities in those with typical symptoms of plantar fasciitis on B-mode ultrasound. Wethus hypothesize that material properties but not morphology may change in the plantar fascia of thesepatients.Sonoelastography is a newly developed ultrasonic technique in the recent decade. Itnon-invasively estimates elasticity of material, which represents tissue properties in some aspect.Many studies have been done in a wide range of fields, such as liver cirrhosis, breast cancer, andthyroid tumor. However it is still limited in the field of musculoskeletal medicine. In our preliminarystudy, sonoelastography revealed the elasticity of the plantar fascia in healthy people clearly andsoftening of the plantar fascia in the aged people. We also found a good reliability in sonoelastography,but its validity has not been confirmed. In the first year of this project, we plan to examine thephantoms with different stiffness by using sonoelastography of different principles. With regressionanalysis and testing of correlation, we aim to obtain validity of sonoelastography on tissue propertiessuch as stiffness.In the second year, we aim to recruit 30 patients with plantar fasciitis and analyze the relationshipamong symptoms, plantar fascia thickness and plantar fascia stiffness, which were obtained fromquestionnaire and sonoelastography. In the third year, we aim to conduct a longitudinal study, in orderto examine the effect of shock wave therapy on the elasticity (material properties) of the diseasedplantar fascia. With this 3-year project, we expect to obtain the reliability and validity ofsonoelastographic examination, so as to understand the relationship among the symptoms, thicknessand material properties of plantar fascia, and furthermore, to understand the shock wave therapy effecton the material properties of plantar fascia. With these data, our study may be expanded to otherdisorders of soft tissue, and thus facilitates a deeper exploration into the material properties of tendonsand ligaments, in addition to morphology.超音波彈性造影仿體楊氏係數影像分析ultrasoundelastographyphantomYoung’s modulushistogram analysis