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研究生:蔡麗瑛
研究生(外文):Tsai Li-Ying
論文名稱:以超音波檢測短波熱療對退化性膝關節滑膜囊炎之變化
論文名稱(外文):Sonographic Evaluation of Synovitis in Patients with the Osteoarthritic Knee after Shortwave Diathermy
指導教授:詹美華詹美華引用關係
指導教授(外文):Jan Mei-Hwa
學位類別:碩士
校院名稱:國立臺灣大學
系所名稱:物理治療學研究所
學門:醫藥衛生學門
學類:復健醫學學類
論文種類:學術論文
論文出版年:2002
畢業學年度:90
語文別:中文
論文頁數:110
中文關鍵詞:超音波影像學退化性膝關節炎滑膜囊炎短波熱療
外文關鍵詞:SonographyOA kneesSynovitisShortwave diathermy
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退化性膝關節炎是臨床上常見的病變,其病理變化以軟骨的磨損為主,並且產生滑膜囊炎及週邊組織之變化,造成了疼痛、水腫、關節僵硬等症狀,影響走路、上下樓梯等日常生活功能。物理治療中之短波熱療即為治療退化性膝關節炎患者常用之方式,研究証實,短波確實可降低疼痛及提高功能指數,然而過去的文獻中對於短波熱療是否亦能藉由減輕發炎來達到上述之效能則不明確。因此本研究之目的有三:1. 建立使用超音波測量退化性膝關節炎患者滑膜囊炎的客觀評估方法; 2.利用超音波影像當做檢測工具,觀察退化性膝關節炎患者接受短波熱療後滑膜囊之厚度及充血指數是否減少;3. 分析滑膜囊厚度及充血指數變化量與疼痛指數及功能障礙指數變化量之相關性。實驗之前為了確保本研究是一客觀評估膝關節滑膜囊炎之正確方法,透過先驅實驗得知以超音波影像評估退化性膝關節炎之滑膜囊厚度,可獲得高度評估者間及評估者內重測信度。研究方法: 30位(6位男性及24位女性)經台大復健科或骨科門診診斷為退化性膝關節炎之患者;包括實驗組21名及控制組9名。實驗組之受試者又分成兩組: 第一組11人,僅接受每週至少三次每次20分鐘之感應線圈式短波治療,第二組患者10人,除了接受短波治療外並且服用消炎止痛之藥物;而控制組之受試者則只接受評估沒有接受任何治療。以HDI 5000超音波影像儀評量受試者膝關節滑膜囊厚度及充血之情形。所有受試者分別在短波治療前、治療10次後、20次後及30次後各接受一次超音波影像檢查。檢測部位共有四個:1. 髕骨上方滑膜囊;2. 髕骨外側滑膜囊;3. 髕骨內側滑膜囊;4. 髕骨下方滑膜囊。另外,記錄患者之疼痛指數及功能障礙指數之情況。結果:實驗組之受試者接受30次之短波治療後,受試者隨著治療次數之增加,在膝關節滑膜囊厚度及充血指數上有統計意義的變小,滑膜囊厚度及充血指數的變化量,和疼痛指數及功能障礙指數的改變有高度正相關。反之,控制組之受試者,不論為髕骨上方、外側、內側或下方之滑膜囊厚度或充血指數,在實驗結束後皆無統計意義的變化。結論:本研究之受試者接受30次短波治療後,透過超音波檢測其膝關節滑膜囊厚度有明顯變薄之情形,反之控制組的患者則無明顯之變化;証實短波熱療確實可降低滑膜囊炎,且滑膜囊炎和疼痛指數和功能障礙指數有高度相關。建議臨床上可將超音波影像檢查納入例行的評估中,對早期退化性膝關節炎患者可有早期診斷,早期治療的效果。

Osteoarthritis of the knees is a common disease in the elderly. Shortwave diathermy (SWD) is one of the most frequently used modalities for the patients with knee arthritis. Theoretically SWD can reduce chronic synovitis, but no experimental report had been found. Recently, sonography has being developed to evaluate the disorders of musculoskeletal system. The purpose of this study were:1. to assess the reliability of sonography in evaluating the synovitis of OA knee; 2. to observe the change of synovitis in OA knees after SWD by using sonography; 3. to correlate the changes of synovitis with the pain and functional incapacity scale. Methods: Thirty subjects were participated in this study including study and control groups. All subjects in the study group received 30 sessions of shortwave diathermy. They were assessed by sonography before treatment and re-assessed after 10 , 20 , ahd 30 sessions of shortwave therapy to observe the change of synovitis. Subject was supine with the knee in 30 flexion and the measurments of synovium were done around patella at superior, inferior, lateral and medial portion. Control group did not receive any treatment except sonography evaluation. Results: After 30 sessions of SWD, the thickness and vascular index of synovium, pain scale, Bandi’s criteria of functional incapacity score were decreased in study group. The correlation of synovial thickness with pain and functional incapacity score were high. The correlation of vascular index of synovitis with pain and functional incapacity score were high too. Conclusion: Shortwave diathermy can reduce chronic synovitis of the OA knees. Ultrasonic image can be used as a good tool to observe the synovium of the knee joint. In the future, we hope physical therapist can use sonography to assess the synovium of the OA knees, to detect the real pathological location and to select a proper modality for the patients.

目錄………………………………………………………………….V
表目錄…………………………………………………………..VIII
圖目錄……………………………………………………………….X
第一章 、 前言.......................................1
第一節 、研究背景與動機................................1
第二節 、研究問題與實驗假說............................4
第三節 、研究目的......................................5
第四節 、研究的重要性..................................5
第二章 、文獻回顧......................................6
第一節 、退化性膝關節炎結構上的變化....................6
第二節 、短波熱療對於退化性膝關節炎的影響..............8
第三節 、灰階超音波影像檢測膝關節滑膜的相關研究.......10
第四節 、能量都卜勒超音波影像檢測膝關節充血發炎的相關研究 .............................................13
第三章 、先驅實驗.....................................16
第一節 、以超音波影像檢測膝關節滑膜囊厚度之信度測試...16
3-1-1、信度測試之研究方法.............................16
3-1-2、信度測試之結果.................................18
3-1-3、信度測試之討論.................................20
第二節 、探討受試者在短波熱療後膝關節滑膜囊立即之變化.23
3-2-1、探討短波熱療後膝關節滑膜囊立即變化之研究方法...23
3-2-2、在短波熱療後膝關節滑膜囊立即之變化結果.........24
3-2-3、短波熱療對膝關節滑膜囊立即之影響...............25
第四章 、研究方法.....................................27
第一節 、受試者.......................................27
第二節 、實驗儀器與設備...............................28
第三節 、實驗步驟與流程...............................28
第四節 、資料分析與統計...............................31
第五章 、結果.........................................33
第一節 、膝關節滑膜囊厚度在不同次數的短波熱療後之變化.33
第二節 、膝關節滑膜囊充血指數在不同次數的短波熱療後之變化 .............................................36
第三節 、膝關節疼痛及功能障礙指數在不同次數的短波熱療後之變化 .............................................37
第四節 、滑膜囊厚度和疼痛指數及功能障礙指數變化之相關性 .............................................38
第五節 、充血指數和疼痛指數及功能障礙指數變化之相關性.39
第六節 、比較滑膜囊炎厚度及充血指數四處測量部位之敏感度結果 .............................................39
第六章 、討論.........................................40
第一節 、短波熱療對滑膜囊炎之影響.....................40
第二節 、滑膜囊厚度及充血指數對疼痛及功能障礙指數之預測力 .............................................42
第三節 、比較四處滑膜囊炎厚度及充血指數測量部位之敏感度 .............................................44
第四節 、研究限制.....................................46
第五節 、未來研究方向.................................46
第六節 、結論與臨床應用...............................47
參考文獻…………………………………………………………..48
表…………………………………………………………………..59
圖…………………………………………………………………..78
附錄一、受試者同意書…………………….……..………… 103
附錄二、修飾後班第之功能評估量表………….……………..105
附錄三、疼痛指數……………………………………………….106
附錄四、受試者相關基本資料記錄表……………….…………107
附錄五、滑膜組織結構圖……………………………………….110

參考文獻
1. Deyle GD, Henderson NE, Matekel RL, Ryder MG, Garber MB, Allison SC. Effectiveness of manual physical therapy and exercise in osteoarthritis of the knee. A randomized, controlled trial. Ann Intern Med 2000;132:173-81.
2. Fisher NM, Gresham G, Pendergast DR. Effects of a quantitative progressive rehabilitation program applied unilaterally to osteoarthritis knee. Arch Phys Med Rehabil 1993;74:1319-26.
3. Peyron JG, Altman RD. The epidemiology of osteoarthritis. In: Moskowitz RW, Howell DS, Goldberg VM, Mankin HI. Osteoarthritis: Diagnosis and Medical /Surgical Management. 2nd ed. Toronto: WB Saunders Co.; 1992. p. 15-38
4. Monteforte P, Rovetta G. Sonographic assessment of soft tissue alterations in osteoarthritis of the knee. Int J Tissue React 1999;21:19-23.
5. Howell DS, Treadwell BV, Tripple S. Etiopathogenesis of osteoarthritis. In: Moskowitz RW, Howell DS, Goldberg VM, Mankin HI. Osteoarthritis :Diagnosis and Medical /Surgical Mangemant. 2nd ed. Toronto: WB Saunders Co.;1992. p.233-54
6. Felson DT, Naimark A, Anderson J, Kazis L, Castelli W, Mecnan RF. The prevalence of knee osteoarthritis in the elderly. The Framingham osteoarthritis study. Arthritis Rheum 1987;30:914-8.
7. Kellgren JH, Lawrence JS. Radiological assessment of osteoarthrosis. Ann Rheum Dis 1957;16:494-502.
8. Haralson K. Physical modalities. In: Banwell BF, Gall V. Physical Therapy Management of Arthritis. New York: Churchill-Livingstone; 1988. P.77-106
9. Svarcova J, Trnavsky K, Zvarova J. The influence of ultrasound, galvanic currents and shortwave diathermy on pain intensity in patients with osteoarthritis. Scand J Rheumatol Suppl 1988; 67:83-5.
10. Rennie GA, Michlovitz SL. Biophysial principles of heating and superficial heating agents. In: Michlovitz SL. Thermal Agents in Rehabilitaion. 3th ed. Philadelphia: FA Davis Co; 1996.p.107-38
11. Hecox B. Physiological response to local heat gain or loss. In: Hecox B, Mehreteab TA, Weisberg J. Physical Agents. Norwalk: Appleton & Lange; 1994. p.91-114
12. Kitchen S, Partridge C. Review of shortwave diathermy continuous and pulsed patterns. Physiotherapy 1992;78:243-52.
13. Chamberlain MA, Care G, Harfield B. Physiotherapy in osteoarthrosis of the knees. Int Rehab Med 1982;4:101-6.
14. Vanhatanta H. Effect of short-wave diathermy of mobility and radiological stage of the knee in the development of experimental osteoarthritis. Am J Phys Med 1982;61:59-65.
15. Jan Mei-Hwa, Lai Jin-Shin. The effects of physiotherapy on osteoarthritic knees of females. J Formosan Med Assoc 1991;90:1008-13.
16. Lehmann JF, deLateur BJ. Therapeutic heat. In: Lehmann JF. Therapeutic Heat and Cold. 2nd ed. Baltimore: Williams&Wilkins; 1990. p.417-581
17. Goats GC. Continuous short-wave(radio-frequency)diathermy. Br J Sports Med 1989;23:123-7.
18. Saito T, Koshino T. Distribution of neuropeptides in synovium of the knee with osteoarthritis. Clin Orthop 2000;376:172-82.
19. Smith M, Triantafillou S, Parker A, Youssef PP, Coleman M. Synovial membrane inflammation and cytokine production in patients with early osteoarthritis. J Rheumatol 1997;24:365-71.
20. Gronblad M, Konttinen Y T, Jorkala O, Liese P, Hukkanen M, Polak JM. Neuropeptides in synovium of patients with rheumatoid arthritis and osteoarthritis. J Rheumatol 1988;15:1807-10.
21. Myers SL, Brandt KD, Ehlich JW, Braunstein EM, Shelbourne KD, Heck DA el al. Synovial inflammation in patients with early osteoarthritis of the knee. J Rheumatol 1990;17:1662-9.
22. Pirich C, Schwameis E, Bernecker P, Radauer M, Friedl M, Lang S. Influence of radiation synovectomy on articular cartilage, synovial thickness and enhancement as evidenced by MRI in patients with chronic synovitis. J Nucl Med 1999;40:1277-84.
23. Bullough PG. The pathology of osteoarthritis. In: Moskowitz RW, Howell DS, Goldberg VM, Mankin HI. Osteoarthritis: Diagnosis and Medical /Surgical Management. 2nd ed. Toronto: WB Saunders Co.;1992. p. 39-70
24. Lanyon P, O'Reilly S, Jones A, Doherty M. Radiographic assessment of symptomatic knee osteoarthritis in the community: definitions and normal joint space. Ann Rheum Dis 1998;57:595-601.
25. Derek T, Cooke V, Kelly BP, Harrison L, Mohamed G, Khan B. Radiographic grading for knee osteoarthritis. A revised scheme that relates to alignment and deformity. J Rheumatol 1999;26:641-4.
26. Manger B, Kalden JR. Joint and connective tissue ultrasonography-a rheumatologic bedside procedure? Arthritis Rheum 1995;38:73642.
27. Balint PV, Sturrock RD. Musculoskeletal ultrasound imaging: a new diagnostic tool for the rheumatologist? Br J Rheumatol 1997;36:1141-2.
28. 王崇禮。肌肉骨骼系統的超音波檢查。台灣醫學 1998; 2:181-6。
29. Fornage BD. Muskuloskeletal Ultrasound. Philadelphia: Churchill Livingstone; 1995.
30. Martinoli C, Pretolesi F, Crespi G, Bianchi S, Gandolfo N, Valle M, et al. Power Doppler sonography: clinical application. Eur J Radiol 1998;28:133-40.
31. Rubaltelli L, Fiocco U, Cozzi L, Baldovin M, Rigon C, Bortoletto P, et al. Prospective sonographic and arthroscopic evaluation of proliferative knee joint synovitis. J Ultrasound Med 1994;13:855-62.
32. Aisen AM, McCune WJ, MacGuire A, Carson PL, Silver TM, Jafri SZ, et al. Sonographic evaluation of the cartilage of the knee. Radiology 1984;153:781-4.
33. Iagnocco A, Coari G, Zoppini A. Sonographic evaluation of femoral condylar cartilage in osteoarthritis and rheumatoid arthritis. Scand J Rheumatol 1992;21:201-3.
34. van Holsbeeck M, van Holsbeeck K, Gevers G, Marchal G, van Steen A, Favril A, et al. Staging and follow-up of rheumatoid arthritis of the knee. Comparison of sonography, thermography, and clinical assessment. J Ultrasound Med 1988;7:561-6.
35. Fiocco U, Coxxi L, Rubaltelli L, Rigon C, Candia ADE, Tregnaghi A, et al. Longterm sonographic follow up of rheumatoid and psoriatic proliferative knee joint synovitis. Br J Rheumatol 1996;35:155-63.
36. Sureda D, Quiroga S, Arnal C, Boronat M, Andreu J, Casas L. Juvenile rheumatoid arthritis of the knee: evaluation with US. Radiology 1994;190:403-6.
37. Cooperberg PL, Tsang I, Truelove L, Knickerbocker WJ. Gray scale ultrasound in the evaluation of rheumatoid arthritis of the knee. Radiology 1978;126:759-63.
38. Woo S, Kwan MK, Coutts RD, Akeson WH. Biomechanical considerations. In: Moskowitz RW, Howell DS, Goldberg VM, Mankin HI. Osteoarthritis: Diagnosis and Medical /Surgical Management. 2nd ed. Toronto:WB Saunders Co.; 1992. p. 191-212
39. Altman RD. Laboratory findings in osteoarthritis. In: Moskowitz RW, Howell DS, Goldberg VM, Mankin HI. Osteoarthritis: Diagnosis and Medical /Surgical Management. Toronto:WB Saunders Co.;1992. p. 313-28
40. Utsinger PD. Diffuse idiopathic skeletal hyperostosis(dish, ankylosing hyperostosis). In: Moskowitz RW, Howell DS, Goldberg VM, Mankin HI. Osteoarthritis: Diagnosis and Medical /Surgical Management. 2nd ed. Toronto:WB Saunders Co.; 1992. p. 355-66
41. Hicks J, Gerber LH. Rehabilitation in the management of patients with osteoarthritis. In: Moskowitz RW, Howell DS, Goldberg VM, Mankin HI. Osteoarthritis: Diagnosis and Medical /Surgical Management. 2nd ed. Toronto:WB Saunders Co.;1992. p. 427-64
42. Day MJ. Diathermy. In: Hecox B, Mehreteab TA, Weisberg J. Physical Agents. Norwalk: Appleton & Lange; 1994. p.143-62
43. Kloth LC, Ziskin MC. Diathermy and pulsed radio frequency radiation. In: Michlovitz SL. Thermal Agents in Rehabilitaion. 3rd ed. Philadelphia: FA Davis Co; 1996. p.213-54
44. 詹美華、林永福。臨床膝部短波熱效應之研究。中華物療誌 1990;15:7-12。
45. Currier DP, Kramer JF. Sensory nerve conduction : heating effects of ultrasound and infrared. Physiother Can 1982;34:341.
46. Chastain PB. The effects of deep heat on isometric strength. Phys Ther 1978;58:543.
47. Lehamann JF. Diathermy. In : Krusen FH, Kottke FJ, Elwood J. Handbook of Physical Medicine and Rehabilitation. Toronto:WB Saunders Co.;1971.
48. Abramson DI, Bell Y, Rejal H, Tuck SJ, Burnett C, Fleischer CJ. Change in blood flow, oxygen uptake and tissue temperatures produced by therapeutic physical agents. II. Effect of short-wave diathermy. Am J Phys Med 1960;39:87-95.
49. Hansen TI, Kristensen JH. Effect of massage, shortwave diathermy and ultrasound upon 133Xe disappearance rate from muscle and subcutaneous tissue in the human calf. Scand J Rehab Med 1973;5:179-82.
50. 詹美華、葉柄強、林光華。直接與間接膝部短波熱療對下肢血流及體表溫度的影響。中華物療誌 1993;18:64-71。
51. Lehmann JF, Brunner GD, Stow RW. Pain threshold measurements after therapeutic application of ultrasound, microwaves and infrared. Arch Phys Med Rehabil 1958;39:560-5.
52. Balogun JA, Okonofua FE. Management of chronic pelvic inflammatory disease with shortwave diathermy. Phy Ther 1988; 68:1541-5.
53. Vanharanta H, Eronen I, Videman T. Shortwave diatherny effect of S-Sulfate uptake and glucosaminiglycan concentration in rabbit knee. Arch Phys Med Rehabil 1982;63:25-8
54. 曹建和。二維超音波成像。林文澧:醫用超音波原理及技術。台北:教育部醫學工程科技教育改進計劃教材;2000. p.24-41。
55. Bude RO, Rubin JM, Adler RS. Power versus conventional color doppler sonography: comparison in the depiction of normal intrarenal vasculature. Radiology 1994; 192:777-80.
56. Babcock DS, Patriquin H, Lafortune M, Dauzat M. Power doppler sonography: basic principles and clinical applications in children. Pediatr Radiol 1996; 26:109-15.
57. Rubin JM, Bude RO, Carson PL, bree RL, Adler R. Power doppler US: a potentially useful alternative to mean frequency-based color doppler US. Radiology 1994:190:853-6.
58. Shung KK, Cloutier G, Lim CC. The effects of hemotrcrit, shear rate, and turbulence on ultrasonic doppler spectrum from blood. IEEE Trans Biomed Eng 1992;39:462-9.
59. Macsweeney JE, Cosgrove DO, Arenson J. Color doppler energy (power)mode ultrasound. Clin Radiol 1996; 51:387-90.
60. Bude RO, Bubin JM. Power doppler sonography. Radiology 1996;200:21-3.
61. Winsberg F. Power doppler US. Radiology 1995; 873.
62. Newman JS, Adler RS, Bude RO, Rubin JM. Detection of soft-tissue hyperemia: value of power Doppler sonography. Am J Roentgenol 1994; 163:385-9.
63. Newman JS, Laing TJ, McCarthy CJ, Adler RS. Power Doppler sonography of synovitis: assessment of therapeutic response--preliminary observations. Radiology 1996; 198:582-4.
64. Breidahl WH, Newman JS, Taljanovic MS, Adler RS. Power doppler sonography in the assessment of musculoskeletal fluid collections. Am J Roentgenol 1996;166:1443-6.
65. Fleiss JL. The design and analysis of clinical experiments. New York, Jone Wiley & Sons; 1986.
66. Tsai LY, Chai HM, Wang CL, Jan MH. Sonographic evaluation of synovial and cartilaginous changes in patients with osteoarthritis knees after shortwave diathermy — a preliminary study. FJPT 2001;26(3):129-35.
67. Altman RD, Gray R. Inflammation in osteoarthritis. Clinic in Rheumatic Disease 1985;11:353-65.
68. Balint PV, Sturrock RD. Intraobserver repeatability and interobserver reproducibility in musculoskeletal ultrasound imaging measurements. Clin Exp Rheumatol 2001;19:89-92.
69. Giovagnorio F, Martinoli C, Coari G. Power doppler sonography in knee arthritis —a pilot study. Rheumatology 2001;20:101-4.
70. Ogilvie-Harris DJ, Ornaiser VL. Synovial iron deposition in osteoarthritis and rheumatoid arthritis. J Rheumatol 1980;7:30-6.
71. Soren A, Cooper NS, Waugh TR. The nature and designation of osteoarthritis determined by its histopathology. Clin Exp Rheumatol 1988;6:41-6.
72. Wakefield RJ, Gibbon WW, Emery P. The current status of ultrasonography in rheumatology. Rheumatology 1999;38:195-201.
73. Weisberg J. Pain. In: Hecox B, Mehreteab TA, Weisberg J. Physical Agents. Norwalk: Appleton & Lange; 1994. p.37-48.
74. Magee DJ. Principles and concepts. In:Orthopedic Physical Assessment. 2nd ed. Toronto, WB Saunders Co.; 1992. p. 1-32
75. Draper DO, Knight K, Fujiwara T, Castel JC. Temperature change in human muscle during and after pulsed short-wave diathermy. J Orthop Sports Phys Ther 1999;29:13-22.
76. Palmer DG. The anatomy of the rheumatoid lesion. Br Med Bull 1995;51:286-95.
77. Revell PA, Mayston V, Lalor P, Mafp P. The synovial membrane in osteoarthritis : a histologicak study including the characterisation of the cellular infiltrate present in inflammatory osteoarthritis using monoclonal antibodies. Ann Rheum Dis 1988;47:300-7.
78. Geborek P, Forslind K, Wollheim FA. Direct assessment of synoviall blood flow and its relation to induced hydroststic pressure changes. Ann Rheum Dis 1989;48:281-6.
79. Wojtys EM, Beaman DN, Glover RA, Janda D. Innervation of the human knee joint by substande-p fibers. Arthroscopy 1990;6:254-63.
80. Levine JD, Moskowitz MA, Basbaum AI. The contribution of neurogenic inflammation in experimental arthritis. J Immunol 1985;135:843-7.
81. Walther M, Harms H, Krenn V, Radke S, Faehndrich TP, Gohlke F. Correlation of power doppler sonography with vascularity of the synovial tissue of the knee joint in patients with osteoarthritis and rheumatoid arthritis. Arthritis Rheum 2001;44:331-8.
82. Lindblad S, Hedfors E. Arthroscopic and immunohistologic characterization of knee joint synovitis in osteoarthritis. Arthritis Rheum 1987;30:1081-8.

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