2014-08-012024-05-14https://scholars.lib.ntu.edu.tw/handle/123456789/658011摘要：本研究乃針對頭頸部癌症患者接受放射線治療後，存遺頸部肌肉硬化、頸部關節活動度受限的程度，進行客觀量化的長期追蹤、傳統治療方式、及新興肉毒桿菌素治療的療效分析。頭頸部癌症患者接受放射線治療後，長期慢性的肩頸疼痛，難以靠藥物達到有效緩解，並會進展為頸部僵硬、攣縮，導致生活功能以及語言、吞嚥訓練的困難。過去此部分相關的研究，著重於患者主觀的症狀陳述以及問卷調查。本研究嘗試建立客觀的檢查標準，利用軟組織超音波檢查的彈性造影技術(sonoelastogram)，測量肌肉的相對硬度，使用音波放射力量衝擊技術(acoustic radiation force impulse, ARFI)，偵測肌肉的絕對硬度。個人在前驅試驗中（preliminary study），已確定這兩種超音波技術，可應用於正常人的頸部肌肉檢查。本研究第一年先建立常模，了解頭頸部癌症患者，在放射線治療前後，各區頸部肌肉的硬度，並進行長期追蹤。第二年研究傳統藥物及物理治療，對症狀、頸部關節活動度、頸部肌肉音波顯影度、頸部肌肉硬度的改善程度。第三年，讓傳統治療療效不佳的患者，接受新興的肉毒桿菌素治療，在超音波及肌電圖雙重導引下，同時檢查病變肌肉的肌電圖表現，並研究肉毒桿菌素治療，對症狀、頸部關節活動度、頸部肌肉音波顯影度、頸部肌肉硬度的改善程度。<br> Abstract: This longitudinal study is designed to measure the incidence and treatment effect for neck range ofmotion (ROM) limitation and neck musculature stiffness after radiation therapy in head and neckcancer patients. Head and neck cancer patients suffer from chronic and intractable shoulder-neckarea pain, which may progress to neck contracture and impair neck function and swallow therapy.Previous qualitative studies focused on the subjective symptoms with questionnaire presentation. Inthis study, we will apply the sonoelastogram to measure the relative stiffness of neck muscles, andthe new technique “acoustic radiation force impulse” (ARFI) for objective quantification ofabsolute muscle stiffness. In our preliminary study, sonoelastogram and ARFI are feasible formeasuring neck muscles stiffness in normal subjects. For the first year program of this research, weplan to set up the norm of ARFI values for head and neck cancer patients regarding different neckmuscles before and after radiation therapy. In the second year, patients with neck symptoms andneck ROM limitations will receive conventional medical and physical therapies. Both subjectiveand objective values will be collected for assessing treatment effect, including the neck symptoms,neck functional scores, quality of life scores, neck ROM, neck muscles echogenicity, and neckmuscle stiffness. Analysis will emphasize on whether these subjective and objective values arecorrelated, and whether these values improved with conventional therapies. In the third year,patients not responding to conventional therapies are injected with botulinum toxin into one of theneck muscles under ultrasound and electromyographic guidance. During injection,electromyograhic signals will be recorded for these irradiated muscles to indicate myopathy. Bothsubjective and objective values will be collected for assessing botulinum toxin treatment effect,including the neck symptoms, neck functional scores, quality of life scores, electromyographicsignals, neck ROM, neck muscles echogenicity, and neck muscle stiffness. Analysis will emphasizeon whether these subjective and objective values are correlated, and whether these values improvedwith botulinum toxin treatment.軟組織超音波彈性造影音波放射力量衝擊頭頸部癌症肉毒桿菌素頸部活 動度疼痛頸部功能生活品質musculoskeletal ultrasoundelasticity imaging techniquesacoustic radiation force impulsehead and neck cancerbotulinum toxinneck range of motionpainneck functionquality of life