王淑芬臺灣大學：物理治療學研究所李若屏Lee, Jo-PingJo-PingLee2007-11-292018-07-082007-11-292018-07-082004http://ntur.lib.ntu.edu.tw//handle/246246/63509研究背景：頸部背側深層肌肉多裂肌具有獨特之感覺與動作功能；然而多節頸部多裂肌肌肉形態變化模式仍不清楚，而該模式可反應肌肉組成和肌肉動作變化。且以具非侵入性、可紀錄即時影像等特性之超音波影像來量測頸部多裂肌之效度及用力時之量測信度亦尚未獲證實。目的：(1)前驅實驗為探討超音波量測頸部多裂肌之效度及用力時之量測信度及(2)主要實驗透過超音波影像紀錄頸椎第四至第六節頸部多裂肌於頭部抗靜態後移阻力用力及放鬆過程中不同用力程度時的肌肉形態。方法：前驅實驗以核磁共振影像和超音波影像頸椎第四至第六節頸部多裂肌之肌肉面積、厚度和寬度；並以平均差值和線性回歸分析比較兩種影像之量測結果；並於同一天由同一施測者以超音波重複量測頸部多裂肌於靜態和頭部抗最大靜態後移阻力時肌肉厚度，以量測變異量之CVw和CVb檢定其信度。主要實驗共徵召20名無頸部疼痛症狀之受試者（平均年齡24.3±4.7歲，5名女性和15名男性），以10MHz線型探頭擷取超音波影像，同步紀錄頸椎第四至第六節頸部多裂肌於頭部抗靜態後移阻力用力及放鬆過程中的肌肉形態與阻力之連續變化；以3x5重覆量測變異數分析和多重分析比較不同節頸椎和阻力之間差異。結果：前驅實驗顯示肌肉厚度於核磁共振和超音波影像之平均差值為±0.20公分，並為中等程度相關(R2範圍為0.42~0.64)；且於用力及放鬆下CVw均小於10%。主要實驗則顯示肌肉厚度變化量與阻力呈曲-線性關係，且二次多項式為較佳預測曲線 (y=ax2+bx+c)；用力過程中肌肉厚度變化量於50%之頭部抗最大靜態後移阻力內有明顯變化，而比較三節頸部多裂肌間之肌肉厚度變化量並無明顯差異，僅第六節頸部多裂肌於放鬆過程中呈現較慢放鬆。結論：本研究建立以超音波影像量測頸部多裂肌連續且動態之厚度變化為具效度和信度。結果支持頸部多裂肌主要功能為維持頸椎椎體穩定度；而非參與產生力量 (force production)。 關鍵字：超音波、頸部多裂肌、肌肉形態、頭部抗後移阻力Study Design. An in-vivo study of muscle architecture of cervical multifidus at C4, C5 and C6 levels during head retraction manoeuvre using ultrasonography. Objectives. The pilot study is to investigate the validity and reliability of measurement for cervical multifidus using ultrasonography. The main study is to investigate cervical multifidus muscle function by the change pattern of multifidus thickness, and to compare the changes in muscle thickness among different resistance levels (rest, 25%, 50%, 75% and 100%) and different cervical levels (C4, C5 and C6). Summary of Background. Cervical multifidus has specific sensory and motion function. However, it was unclear about muscle architectural change of cervical multifidus during head retraction manoeuvre with progressive resistance. The validity and reliability of measuring cervical multifidus using ultrasonography hasn’t been proven. Methods. In the pilot study, thickness, width and area of multifidus were measured at C4, C5 and C6 were measured using MRI and ultrasonography. The limit of agreement and the regression analysis were used to compare the results of two modalities. Besides, muscle thickness was repeatedly measured during the static and head retraction manoeuvre using ultrasonography by the same rater on the same day; the CVw and CVb were used to investigate reliability. In the main study, multifidus architecture measured in twenty asymptomatic subjects (24.3±4.7 yo, 5 women and 15 men) during head retraction manoeuvre with progressive resistance and during relaxation using ultrasonography apparatus with 10MHz linear transducer. ANOVA with repeated measurement and post-hoc analysis were to investigate the difference among different cervical levels and resistance force levels. Results. The pilot study showed that the limit of agreement was ±0.20 cm and the moderate level of correlation (R2 ranged in 0.42~0.64) for muscle thickness measured between MRI and ultrasonography. For muscle thickness, the CVw values under static and under head retraction against maximum resistance were lower than 10%. In the main study, there was a curvilinear relationship between muscle thickness change and resistance, and the quadratic equations were the proper curves for estimation. There was significant difference of muscle thickness change within 50% of maximum retraction against resistance; and there was no significant difference among three cervical levels. It was suggested that muscle at C6 relaxed more slowly during the period from the beginning of relaxation. Conclusion. The present study built a valid and reliable method for measuring continuous and dynamic changes of muscle thickness using ultrasonography. The results supported muscle function of cervical multifidus for segmental stability but not for force production. Key words: ultrasonography, cervical multifidus, muscle architecture, head retraction against resistanceTable of Contents Table of Contents…………………………………………………………………….iii List of Tables…………………………………………………………………..……..v List of Figures………………………………………………………………..……....vi List of Appendix………………………………………………………………….....vii Abstract………………………………………………………………………………1 中文摘要…………………………………………………………………….....1 Abstract…………………………………………………….…………………...3 Background…………………………………………………………………………..5 Purpose of Study……………………………………………………………………..8 Terminology………………………………………………………………………….9 Hypothesis…………………………………………………………………………...10 Literature Review……………………………………………………………………11 The importance of cervical dorsal deep muscles…………………………....….11 1.1 Anatomic structure………………………………………….…………11 1.2 Physiology…………………………………………………………….12 1.3 Sensory function……………………………………………………....13 1.4 Motion function…………………………………………………….…14 1.5 Clinical changes…………………………………………………….…20 1.5.1 Muscle fiber……………………………………………………21 1.5.2 Muscle architecture….…………………………………………21 1.5.3 Muscle strength………………………………………………...21 1.5.4 Configuration and segmental motion……………………….….22 1.5.5 Sensory function-propioception…………………………….….23 1.5.6 The effect of training and exercise…………….…………….…23 The methods of measuring muscle architecture.………………..………………25 2.1 The relationship of muscle architecture and muscle function……..…..25 2.2 Magnetic resonance image (MRI)……….………..…………..……….26 2.3 Ultrasonography…………………………………………………..…...27 2.4 The validity and reliability of measuring muscle using the imaging systems………………………………………...………………………28 2.5 The methods to measure muscle activity……………..……………….29 Contents of Study The Pilot Study……..………………………………………………………….…..32 Ultrasonography of Cervical Multifidus-Comparison with Magnetic Resonance Image and Test-retest Reliability Introduction…………………………………………………………………..32 Methods and Materials……………………………………………………….35 Results………………………………………………………………………..43 Discussion…………………………………………………………………….46 Conclusion……………………………………………………………………52 The Main Study……………………………………….……………………..……..53 Cervical Multifidus Contraction Pattern During Head Retraction Manoeuvre in Asymptomatic Young Adults Using Ultrasonography Introduction……………………………………………………………….…..53 Methods and Materials………………………………………………………..58 Results…………………………………………………………………….…..65 Discussion……………………………………………………………………,.73 Conclusion………………………………………………………………….…78 Summary………………………………………………………………………….....79 Reference List…………………………………………………………………….....80 List of Tables Table 1-1 The measurement data of cervical multifidus using ultrasonography and MRI…………………………………………………………………..………T-1 Table 1-2 Reliability of intra-rater inter-session under the conditions of rest and maximum retraction against resistance…………………..…..…………………………..T-2 Table 2-1 Muscle thickness and force of cervical multifidus under rest and maximum retraction against resistance……………………………………………...…...T-3 Table 2-2 Kappa analysis for the consistence of muscle contraction pattern…………....T-4 Table 2-3 Kappa analysis for the consistence of muscle relaxation pattern…………......T-5 Table 2-4 Reliability for measurement muscle thickness under different force levels during contraction………………………..………………………………………..…T-6 Table 2-5 Reliability for measurement muscle thickness under different force levels during relaxation…………………………………………………………………..…T-7 Table 2-6 The values of coefficients in the best fitted quadratic equations…...………...T-8 Table 2-7 The change in muscle thickness under different force levels during contraction…..…………………………………………………………….....T-9 Table 2-8 The change in muscle thickness under different force levels during relaxation…………………...……………………………………………......T-10 Table 2-9 The rate of change in muscle thickness under different force levels during contraction……..……………………………………………………..……...T-11 Table 2-10 The rate of change in muscle thickness under different force levels during relaxation………..…….………………………………..………………..…..T-12 List of Figures Fig. I-1 HDI 5000 ultrasound apparatus……………………………………………...F-1 Fig. I-2 Designed head support…………………………………………………….…F-2 Fig. I-3 A balance board with a inclinometer………………………………………...F-3 Fig. I-4 The placement of the transducer and custom-designed device for the transducer during prone position…….………………………………………..………... F-4 Fig. I-5 The muscle image under ultrasonographic image…………………………...F-5 Fig. I-6 The muscle image under the MRI image…………………….………….…...F-6 Fig. I-7 A designed examining chair with force transducer…………………………..F-7 Fig. I-8 Instruments and experimental arrangement….…………………………..…..F-8 Fig. I-9 The placement of the transducer during sitting…………………………...….F-9 Fig. I-10 The definition of measurement for Cervical multifidus using the MRI image………………………………………………………………….……F-10 Fig. I-11 The definition of measurement for Cervical multifidus using ultrasonography………………………………………………………….…F-11 Fig. I-12 Experimental arrangement……….…………………………………………F-12 Fig. 1-1 Regression analysis for cervical multifidus thickness at C4-C6 levels….....F-13 Fig. 1-2 Regression analysis for cervical multifidus width at C4-C6 levels………...F-14 Fig. 1-3 Regression analysis for cervical multifidus area at C4-C6 levels……..…....F-15 Fig. 2-1 Contraction pattern of the change in muscle thickness of cervical multifidus at C4, C5 and C6 levels…………….………………………………..……………...F-16 Fig. 2-2 Relaxation pattern of the change in muscle thickness of cervical multifidus at C4, C5 and C6 levels……………………………………………..……………....F-17 Fig. 2-3 Rate of change in muscle thickness of cervical multifidus at C4, C5 and C6 levels during contraction………………………….……………..……………...…..F-18 Fig. 2-4 Rate of change in muscle thickness of cervical multifidus at C4, C5 and C6 levels during relaxation……………………………………………………….....….F-19 List of Appendix Consent for subjects…………………………………………………………........A-1 Questionnaire for subject’s base data…………………………………………..…A-3521614 bytesapplication/pdfen-US頭部抗後移阻力超音波肌肉形態頸部多裂肌muscle architecturecervical multifidusultrasonographyhead retraction against resistanceotherhttp://ntur.lib.ntu.edu.tw/bitstream/246246/63509/1/ntu-93-R91428006-1.pdf