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研究生:劉雅棻
研究生(外文):Ya-Fen Liu
論文名稱:腕隧道症候群病患的疼痛與神經損傷狀況之探討
論文名稱(外文):Studies of pain and nerve damage condition in Carpal Tunnel Syndrome
指導教授:呂怡靜呂怡靜引用關係
指導教授(外文):Yi-Jing Lue
學位類別:碩士
校院名稱:高雄醫學大學
系所名稱:醫學系神經學科碩士班
學門:醫藥衛生學門
學類:醫學學類
論文種類:學術論文
畢業學年度:97
語文別:中文
論文頁數:145
中文關鍵詞:腕隧道症候群波士頓腕隧道量表溫度感覺量化測試
外文關鍵詞:Carpal tunnel syndromeBCTQQSTpainnerve damage
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研究目的:腕隧道症候群(carpal tunnel syndrome, CTS)為神經受壓迫的神經病變疾病,疼痛是組織受到傷害而發出的警訊,但關於疼痛與神經損傷間的研究仍不足。本研究目的欲了解CTS疼痛情形並探討疼痛與神經損傷的關係。研究方法:先以泛文化改編發展中文版波士頓腕隧道量表(Boston Carpal Tunnel Questionnaire, BCTQ),作為後續研究疼痛評估使用,再進行疼痛與神經損傷的探討。病患以中文版BCTQ及視覺類比分數(Visual Analogue Scale, VAS)來量化其自覺疼痛,以神經電生理學檢查及溫度感覺量化測試分別評估大直徑神經纖維及小直徑神經纖維的損傷情形。研究結果: 中文版BCTQ具良好信效度。疼痛情形方面,123位CTS病患中約60%有疼痛症狀。BCTQ症狀嚴重程度的第一至五題,文字內容可評估疼痛的有無、程度、頻率及發生時間,適合CTS疼痛評估用。疼痛與神經損傷情形方面,以溫度感覺量化測試顯示CTS及健康對照組在冷溫度閾值(p=0.03)與熱溫度閾值(p=0.01)有顯著差異。再將受試者分為病患疼痛組、病患無疼痛組及健康對照組,冷溫度閾值(p=0.003)及熱溫度閾值(p=0.017)三組間具顯著差異,經事後檢定在病患疼痛與病患無疼痛間,冷溫度閾值有顯著差異(p=0.038)。神經電生理學部分,依神經生理綜合分級病患最多為第三級嚴重程度(33.3%),遠端運動潛期(distal motor latency)與BCTQ整體疼痛有中度正相關(rho=0.39)。疼痛組及無疼痛組兩組間的遠端運動潛期有顯著差異(p=0.008)。以邏輯迴歸分析探討大小直徑神經損傷情形是否造成疼痛,只有遠端運動潛期具有顯著意義(p=0.03),代表疼痛可能是由大直徑神經纖維損傷所造成。結論: 中文版BCTQ適合做為CTS疼痛評估用。CTS病患冷、熱溫度閾值比正常人閾值較高、較為遲鈍,可能有小直徑神經纖維的損傷。藉本研究可了解CTS疼痛情形與評估方法以及疼痛的發生與神經損傷的關係,做為臨床CTS疼痛與神經損傷情形評估的參考。
Background and purpose: Carpal tunnel syndrome (CTS) is a
neuropathic condition caused by nerve compression. The pain is an alert as a result of tissue damaged. Research on the relationship between pain and nerve damage however is still insufficient. The aim of this study was to understand pain caused by CTS and to assess the association between pain and the status of nerve damage. Methods: We developed and translated the Chinese version of the Boston Carpal Tunnel Questionnaire (BCTQ) through cross-cultural adaptation process for pain assessment and examined pain and the nerve damage condition. Patients quantified their pain level using the Visual Analogue Scale (VAS) and the Chinese BCTQ. The degree of the large myelinated nerve fiber damage was assessed by using the nerve conduction studies (NCS), and the damage status of the small nerve fiber was quantified by using the thermal quantitative sensory testing (QST). Results: The Chinese version of BCTQ showed good reliability and validity. Pain symptoms were found in approximately 60% of the 123 CTS patients. The first five questions of BCTQ symptom severity scale were suitable for CTS pain assessment, as the contents included assessment of pain intensity, frequency, and pain at day or night. CTS patients and healthy controls were significantly different in the cold detection threshold (CDT) (p=0.03) and the warm detection threshold (WDT) (p=0.01). When comparing painful and painless CTS with the control group, significant differences were found in CDT (p=0.003) and WDT (p=0.017). Post-hot analysis found significant difference between the painful and painless CTS groups in CDT (p=0.038). The third grade of neurophysiological grading scale was most common (33.3%). A moderate positive correlation was found between distal motor latency and the first five questions of BCTQ (rho=0.39). There was significant difference between painful and painless CTS in distal motor latency (p=0.008).When examining the presence of pain and large or small nerve fibers damage conditions using logistic regression, distal motor latency was the only significant independent variable (p=0.03). It implies that pain maybe caused by the damage status of large nerve fibers mainly. Conclusion: Chinese version of BCTQ is suitable for assessing pain symptoms in CTS. CTS patients may have abnormal small nerve fiber function, and with higher CDT and WDT than healthy controls. Our results shed some light on suitable scale for pain assessment and the relationship between pain and nerve damage condition in CTS.
目錄
中文摘要--------------------------------------------------i
英文摘要------------------------------------------------iii
致謝------------------------------------------------------v
目錄-----------------------------------------------------vi
表目錄---------------------------------------------------ix
圖目錄----------------------------------------------------x
附錄目錄-------------------------------------------------xi


第一章 緒論---------------------------------------------1
第一節 研究背景與動機--------------------------------1
第二節 研究假設與目的------------------------------------4
第二章 文獻回顧-----------------------------------------6
第一節 腕隧道症候群與疼痛--------------------------------6
第二節 疼痛相關評估--------------------------------------11
2.2.1視覺類比分數---------------------------------------11
2.2.2波士頓腕隧道量表-----------------------------------13
第三節 神經電生理學檢查----------------------------------16
第四節 溫度感覺量化測試----------------------------------19
2.4.1 溫度感覺量化測試介紹-----------------------------19
2.4.2 溫度感覺量化測試於疼痛症狀的應用-----------------22
2.4.3 溫度感覺量化測試於腕隧道症候群的應用-------------24
第三章 研究設計與方法-----------------------------------27
第一節 研究架構------------------------------------------27
第二節 中文版波士頓腕隧道量表的發展 ---------------------28
3.2.1 前言------------------------------------------28
3.2.2 研究設計與方法--------------------------------29
3.2.3 結果------------------------------------------36
3.2.4 討論------------------------------------------42
3.2.5 結論------------------------------------------44
第三節 溫度感覺量化測試於腕隧道症候群之再測信度----------45
3.3.1 前言------------------------------------------45
3.3.2 研究設計與方法--------------------------------45
3.3.3 結果------------------------------------------47
3.3.4 討論------------------------------------------48
3.3.5 結論------------------------------------------49
第四節 腕隧道症候群病患疼痛評估與神經損傷狀況的探討---50
3.4.1 研究對象-----------------------------------------50
3.4.2 研究步驟與評估方法-------------------------------52
3.4.3資料處理------------------------------------------57
3.4.4統計分析------------------------------------------59
第四章 結果---------------------------------------------61
第一節 腕隧道症候群病患的疼痛症狀--------------------61
第二節 腕隧道症候群病患疼痛與神經損傷狀況------------63
4.2.1 神經損傷情形-------------------------------------64
4.2.2 疼痛症狀與神經損傷情形的關係---------------------67
第五章 討論---------------------------------------------69
第一節 腕隧道症候群病患之自覺疼痛症狀探討------------69
第二節 腕隧道症候群病患疼痛與神經損傷狀況探討--------72
第三節 研究限制與建議--------------------------------79
第六章 結論---------------------------------------------81
參考文獻-------------------------------------------------82
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