2013-08-012024-05-14https://scholars.lib.ntu.edu.tw/handle/123456789/659064摘要：肩部粘黏性關節囊炎俗稱五十肩或冰凍肩，是臨床上非常常見的疾病，雖然是自限性疾病，但常嚴重影響病患的生活品質，且到目前為止，造成冰凍肩的病理機轉還不瞭解。曾有文獻提及冰凍肩可能和肩滑膜發炎或關節囊纖維化有關，但針對這些原因治療仍有很大部份病人無法獲得改善。最近少數研究指出喙肱韌帶(coracohumeralligament)攣縮會影響肩關節的外轉角度，亦有研究指出對此韌帶進行牽拉或韌帶鬆解術可使冰凍肩患者恢復其肩部外轉功能。因此部分學者認為喙肱韌帶的機械特性可能於冰凍肩扮演著重要角色，甚至懷疑喙肱韌帶的病變是造成冰凍肩的主因。雖有研究利用磁振造影及B 模超音波發現冰凍肩患者患測的喙肱韌帶明顯增厚，但目前針對其長度及彈性之研究則仍闕如，而由病理機轉思考，對於冰凍肩喙肱韌帶的彈性及長度應遠比厚度重要。本研究的假設是喙肱韌帶機械特性的改變是造成冰凍肩的主因。本研究的目的便是利用超音波的彈性影像來測量冰凍肩患者的喙肱韌帶的長度、厚度及機械特性，藉此探討冰凍肩的可能病理機轉，並利用類固醇注射來改變喙肱韌帶的機械特性，來驗證喙肱韌帶在冰凍肩的角色。本計畫將可解開冰凍肩的可能病理機轉。本計畫將以超音波彈性造影來估算物質之彈性（或硬度）。由於市面上超音波儀內設顯示軟硬度的方式乃採灰階或彩色圖像，由檢查者眼睛所見來判斷軟硬，過於主觀。我們將使用Image J 軟體做影像之色相分析(Hue histogram analysis)，以客觀之數字呈現喙肱韌帶之軟硬度。類似的方法我們曾使用於足底筋膜硬度測量，並發表於2011 年Radiology，得到認可。在三年計畫中，第一年我們將建立正常人喙肱韌帶長度、厚度及彈性之常模（30 名）；第二年我們將探討三十名冰凍肩患者與正常人喙肱韌帶長度、厚度及彈性之不同，並和臨床症狀及肩部功能做相關性分析；第三年我們將探討病人接受過超音波導引類固醇注射後，其喙肱韌帶長度、厚度、彈性及肩功能之改變狀況及臨床症狀的改善。本計畫之研究結果將對冰凍肩的致病機轉有進一步了解，並引入新的治療思維。<br> Abstract: Shoulder adhesive capsulitis, also known as frozen shoulder, is a very common diseasein clinical practice. It is self-limiting but negatively influences quality of life of patients. Sofar the mechanism of frozen shoulder has not been well understood. It may be related tosynovial inflammation or joint capsule fibrosis, but there were still some patients sufferingfrom persistent shoulder pain despite treatments focusing on these factors. Recently severalstudies showed shortening of the coracoacromial ligament (CHL) would influence the rangeof shoulder external rotation; other studies showed that stretching or releasing of the CHL ledto improvement in the range of shoulder external rotation. Therefore mechanical properties ofthe CHL may play an important role in frozen shoulder. While several studies using magneticresonance arthrography and B-mode ultrasound revealed thickening of the CHL in patientswith frozen shoulder, there has been no study focusing on its length and elasticity, which maybe more important than its thickness from the pathological points of view. We hypothesizethat change of elasticity of the CHL leads to frozen shoulder. We will utilize sonoelastographyto measure elasticity of the CHL, thus investigating the possible pathophysiology of frozenshoulder. We will also perform steroid injection to change elasticity of the CHL and confirmthe role of the CHL in frozen shoulder. This project will discover the possiblepathophysiology of frozen shoulder.Sonoelastography is an ultrasound-based technique which estimates elasticity of tissues.Commercialized machines showed the stiffness in gray scale of RGB scale. It would be toosubjective because determination of elasticity depends on the “eye-ball method”. We will usethe software “Image J” for hue histogram analysis of the sonoelastogram, which revealselasticity with a number in an objective way. We had used similar method for themeasurements of elasticity of the plantar fascia and published an article in Radiology, 2011. Inthe first year we will construct the norm of the length, thickness and elasticity of the CHL innormal population (30 participants). In the second year we will compare the differences of thelength, thickness and elasticity of the CHL between patients with frozen shoulder and normalparticipants, and will correlate these parameters with clinical symptoms and shoulder function.In the third year we will follow up the length, thickness and elasticity of the CHL, clinicalsymptoms and shoulder function for 6 months after sono-guided injection of steroid to theCHL. The results of this study will broaden our knowledge about the mechanism of frozenshoulder and bring about new ways of the treatments.肩部粘黏性關節囊炎喙肱韌帶超音波彈性造影類固醇adhesive capsulitiscoracoacromial ligamentsonoelastographysteroid