先天肌肉性斜頸( Congenital Muscular Torticollis, CMT )主要是因為胸鎖乳突肌中纖維組織不正常增生，文獻中CMT發生率從0.3% ~ 2%，在新生兒骨骼肌肉疾病發生率排名第三。本實驗嘗試結合超音波儀器的即時檢查、低花費及切片檢查的準確度，為臨床檢查提供一個客觀的指標供醫師參考，先從小老鼠(wistar rat)的動物模型開始，利用人為的方式製造固定大小的傷口，分別有三組不同恢復時間產生不同程度的纖維組織堆疊，從超音波影像上擷取平均回音強度當作特徵建立指標K值，發現K值與切片纖維化百分比之間的相關係數r=0.75(p<0.01)，屬於高度正相關，本實驗降低了切片的取樣誤差，且用來描述纖維化程度的K值具有病理意義。在5個有追蹤的案例中(年齡3.1 1.8個月)，成功看到K值隨著時間下降，表示纖維細胞因為復健而逐漸消散，但是下降幅度的大小不在本實驗的討論當中。

Congenital muscular torticollis ( CMT ) caused by the fibrotic change of the sternocleidomastoid muscle ( SCM ) can be detected by ultrasonography. The incidence of CMT varies from 0.3% to 2% in literature and is the third skeletal muscular diseases in infants. This study aimed to combine the advantages of ultrasound and the accuracy of histopathology to construct objective diagnostic reference by animal model. We proposed a K value based on the ultrasound image’s difference of mean echo intensity in injured and normal side, and K value has positive correlation with the fibrosis ratio of histopathology, Pearson correlation r=0.75 (p<0.01). In five follow-up cases of infants ( 3.1 1.8 months ), K value decrease by time because the degeneration of the fibrotic tissue.

致謝 I
中文摘要 II
Abstract III
目錄 IV
圖目錄索引 VI
表目錄索引 VIII
第一章 序論 1
1-1 前言 1
1-2 文獻回顧 3
1-3 研究動機及目的 7
1-4 論文架構 9
第二章 研究方法 11
2-1 超音波成像原理 11
2-2 先天肌肉性斜頸 13
2-2-1 骨骼肌的組成 13
2-2-2 先天肌肉性斜頸的超音波檢查 15
2-3 實驗架構 20
2-3-1 動物實驗 22
2-3-2 超音波影像處理 27
2-3-3 計算纖維化百分比 31
2-3-4 臨床檢查的標準流程( Standard Operating Procedure, SOP ) 36
2-4 統計分析 40
第三章 實驗結果及討論 44
3-1 ROI框選的限制 44
3-2平均回音強度與纖維化百分比 53
3-3 探頭角度限制 59
3-4 應用於先天肌肉性斜頸案例 62
第四章 總結 65
4-1 結論 65
4-2 未來研究方向 66
參考文獻 69

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