臺灣博碩士論文加值系統

網球肘（肱骨外側上髁炎）是一種常見的手肘疼痛疾病，會影響病人在工作場所的生產力及日常生活品質。網球肘常見的發生原因是手指及手腕伸直肌（特
別是在橈側伸腕短肌）重覆用力使肌腱骨頭交接處過度負荷。類固醇注射是少數被證明有短期療效的網球肘治療方法，但其潛在的副作用使病人的接受度不高。
肉毒桿菌毒素注射造成暫時性的局部肌肉無力應可以降低橈側伸腕短肌持續的負荷及促進肱骨外側上髁炎的正常修復機轉，先前的初步研究顯示A型肉毒桿菌毒素注射對治療網球肘似乎有不錯的效果。本研究的目的在比較肉毒桿菌素與類固醇注射對治療網球肘的效果。
本研究收集網球肘病人，隨機分派接受A型肉毒桿菌毒素或類固醇注射治療。療效評估包括視覺類比疼痛量表、世界衛生組織生活品質問卷台灣簡明版、及手部握力，分別在注射前及注射後第4 週、8 週、12週時由非注射者的另一位研究人員負責評估。共有16位病人（19側網球肘）參加此項雙盲臨床試驗，其中一位兩側網球肘的病人注射後未接受療效評估故進行統計時被排除，最後接受A型肉毒桿菌毒素注射的有8側網球肘，接受類固醇注射的有9側網球肘，二組病人的基本資料比較上並無差別。統計結果發現在注射後4週類固醇組有顯著疼痛改善，肉毒桿菌毒素組則在注射後4週及8 週時有顯著握力下降但無疼痛改善的情形。由本次實驗的結果顯示，A型肉毒桿菌毒素注射於橈側伸腕短肌無法像類固醇注射可以改善網球肘病人的疼痛，且肉毒桿菌毒素注射會造成如手指及手腕伸直無力。

Tennis elbow (humeral lateral epicondylitis) is a common painful elbow disorder that has a direct impact on the affected worker’s productivity and quality of life.
Steroid injection is one of the few methods proven to have short-term efficacy in treating tennis elbow, but its potential adverse effects lead to a low acceptance rate. Botulinum toxin injection into the extensor carpi radialis brevis can cause temporary muscle weakness and might facilitate the auto-repair mechanism in tennis elbow. Some preliminary studies suggested that type A botulinum toxin injection is effective in treating tennis elbow. The objective of this study is to compare botulinum toxin injection with corticosteroid injection in treating tennis elbow.
We recruited patients of tennis elbow and assigned them randomly to receive type A botulinum toxin or corticosteroid injection. The treatment outcomes, including visual analogue scale (VAS), WHO Quality of Life-BREF (WHOQOL-BREF) Taiwan Version questionnaire, and grip strength, were assessed at the baseline and 4
weeks, 8 weeks, and 12 weeks after the treatment by an investigator blind to the drug assignment. Sixteen patients with 19 elbows affected by humeral lateral epicondylitis were enrolled into the trial, but one patient lost to follow-up, leading to 8 elbows receiving botulinum toxin injection and 9 elbows receiving corticosteroid injection in the final comparison. The demographic data between the two groups did not differ. We found steroid was superior to type A botulinum toxin in treating tennis elbow at
week 4, while the grip strength decreased significantly in the botulinum toxin group at
4 and 8 weeks after injection without improvement in pain. In conclusion, type A
botulinum toxin injection into extensor carpi radialis brevis is not as effective as
steroid injection in relieving the pain caused by tennis elbow, and it is associated with
weakness in finger and wrist extension.

第1 章 緒論...............................................1
1.1 研究背景..............................................1
1.2 研究目的..............................................1
1.3 研究的重要性..........................................2
第2章 文獻回顧............................................3
2.1 網球肘................................................3
2.1.1 網球肘的診斷........................................3
2.1.2 網球肘的流行病學資料................................3
2.1.3 網球肘的發生原因與病程階段..........................4
2.1.4 網球肘的治療方法....................................4
2.2 肉毒桿菌毒素..........................................5
2.2.1 肉毒桿菌毒素的基本介紹..............................5
2.2.2 肉毒桿菌毒素的止痛效果與可能機轉....................7
2.2.3 肉毒桿菌毒素注射治療網球肘的相關研究................9
第3章 研究材料與方法.....................................12
3.1 研究個案的收集.......................................12
3.1.1 研究設計類型.......................................12
3.1.2 受試者納入條件.....................................12
3.1.3 受試者排除條件.....................................13
3.1.4 試驗前及試驗期間禁止或避免使用的治療及藥品.........13
3.2 執行步驟.............................................13
3.3 主要療效指標的評估方法...............................14
3.3.1 手部握力測量 (grip strength) ......................14
3.3.2 視覺類比疼痛量表（visual analogue pain scale）.....14
3.3.3 世界衛生組織生活品質問卷台灣簡明版
(WHOQOL-BREF Taiwan version ) ...........................14
3.4 主要療效指標的評估者及時間點.........................15
3.5 統計分析方法.........................................15
第4 章 研究結果..........................................17
4.1 研究族群之基本特性...................................17
4.2 療效評估.............................................17
4.2.1 肉毒桿菌毒素注射組在各個時期的統計結果.............18
4.2.2 類固醇注射組在各個時期的統計結果...................19
4.2.3 肉毒桿菌毒素注射組與類固醇注射組在各個時期兩組比
較的統計結果.............................................19
4.3 注射後的反應.........................................20
第5 章 討論..............................................21
5.1 本次研究結果的臨床意義...............................21
5.2 與其他相關肉毒桿菌毒素治療網球肘研究的數據比較.......25
5.3 與其他相關研究類固醇治療網球肘的數據比較.............26
5.4 肉毒桿菌毒素組注射後的無力現象對實驗結果的影響.......27
第6 章 結論與建議........................................29
6.1 結論.................................................29
6.2 建議.................................................29
參考文獻.................................................30

表目錄
表 1. 基本人口學變項.....................................36
表 2. 肉毒桿菌毒素注射組與類固醇注射組之注射前比較.......37
表 3. 肉毒桿菌毒素注射組與類固醇注射組在注射
後4 週、8 週與12 週之比較(原始值) ...................... 38
表 4. 肉毒桿菌毒素注射組在注射前與注射後各週之比較.......39
表 5. 類固醇注射組在注射前與注射後各週之比較.............40
表 6. 肉毒桿菌毒素注射組與類固醇注射組在注射
後4 週、8 週與12 週之比較(淨值)......................... 41

圖目錄
圖 1. 研究流程圖.........................................42

附錄目錄
附錄 1. 世界衛生組織生活品質問卷台灣簡明版...............43

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世界衛生組織生活品質問卷台灣版問卷發展小組（2005）。台灣版世界衛生組織生活品質問卷之發展及使用手冊（第二版）。