臺灣博碩士論文加值系統

在齒列矯正治療時經常使用橫腭弧線（Transpalatal arch），而患者於裝置後通常都會有不太舒服的感覺。因此，為了瞭解舌頭的吞嚥功能在裝置橫腭弧線後的功能適應性變化，本研究是在同一位受測者放置兩次不同高度（2mm和4mm）之橫腭弧線，每次放置7天。選取15名健康的成年志願者為受測對象，使用防震掃描技術之B模式結合M模式口腔超音波做舌頭之吞嚥運動的紀錄與客觀測量數據，和使用視覺類比尺度做受測者的主觀自我評分紀錄（吞嚥困難度、牙齒疼痛度和舌頭疼痛度）。了解舌頭吞嚥運動之客觀的超音波測量數據變化和受測者的主觀自我評分紀錄之間的關係，並以無母數分析法之Spearman’s correlation analysis求得其間的相關性；觀察吞嚥模式受影響的程度，並以無母數分析法之Wilcoxon sign ranked test求得其間的差異。
結果顯示客觀的超音波吞嚥運動測量數值和受測者的主觀自我評分紀錄之間是有相關性存在的，尤其以休息位置與早期終止期運動幅度之正相關、吞嚥困難度與晚期終止期和全部吞嚥運動時間之正相關、舌頭疼痛度與牙齒疼痛度之正相關為有意義。裝置橫腭弧線會使舌頭的休息位置向下移動、使吞嚥運動之晚期運送期時間延長並於第七天回復、使吞嚥運動之早期終止期幅度增加、使吞嚥運動之晚期終止期時間延長且高度越大之橫腭弧線所造成之時間延長量越長、和使全部吞嚥時間延長。拆除橫腭弧線後，吞嚥運動之超音波測量數值會立即回復，但是舌頭的休息位置則會在拆除2mm橫腭弧線後之第7天會回復；以及拆除4mm橫腭弧線後之第1天會回復。因此由本實驗可知，吞嚥運動會受橫腭弧線影響，且於7天內會有初期的適應。於橫腭弧線拆除後，吞嚥運動會立即回復。

The application of transpalatal arch (TPA) is quite common in orthodontic treatment. However, patients often feel discomfort after application of TPA. Therefore, the purpose of this study was to investigate the influence of TPA on tongue movement during swallowing as well as the adaptation ability of tongue on TPA. 15 healthy adults without any known swallowing disorder were selected in this study. There are two different TPAs (2mm and 4mm) to wear and the wearing time is 7 days for each one. The volunteers were examined by the B+M mode ultrasonography for the subjective tongue movement during swallowing and by the visual analogue scales (VAS) for the objective self-evaluation (dysphagia, toothache, pain of tongue). The relationships between the objective VAS value and the subjective ultrasonographic measurement of swallowing movement were examined by Spearman’s correlation analysis. The differences between the original condition and ongoing conditions after TPA application were examined by Wilcoxon sign ranked test.
There are correlations between the objective VAS value and the subjective ultrasonographic measurement of swallowing movement. The changes of rest position are positively correlated to the changes of magnitude of early final phase. The degrees of dysphagia are positively correlated to the changes of duration of late final phase and total swallowing. The degrees of pain of tongue are positively correlated to the degrees of toothache. The application of TPA resulted in an downward movement of the rest position, a prolonged duration in late transport phase (p<0.05) and recovered in 7th day, an increased magnitude of early final phase, a prolonged duration of late final phase and the longer prolongation induced by the higher TPA, a prolonged duration of total swallowing. Besides the rest position of tongue, all swallowing ultrasonographic measurements were recovered immediately after removal of TPA. The rest position was recovered in 7 days after removal of 2mm TPA and recovered in 1 day after removal of 4mm TPA. Indeed, the swallowing movement of tongue was interfered after application of TPA, but the tongue owned the ability of adaptation to TPA in 7 days. The swallowing movement will recover immediately after removal of TPA.

目 錄
致謝I
中文摘要II
英文摘要IV
目錄VII
附圖目錄IX
附表目錄X
第壹章　緒論1
第貳章 文獻回顧3
第壹節 舌頭的吞嚥功能4
第貳節 研究舌頭位置及運動的方法6
第參節 口腔超音波的簡介與發展7
第肆節 橫腭弧線的功能13
第伍節 矯正疼痛與視覺類比尺度17
第陸節 研究目的20
第參章 材料與方法21
第壹節 研究對象22
第貳節 實驗流程與測量項目23
第參節 吞嚥運動的測量與動態和靜態影像的取得與分析30
第肆節 實驗誤差估計與再現性的評估36
第伍節 統計方法38
第肆章 結果40
第壹節　誤差41
第貳節　休息位置、視覺類比尺度與其相關性評估42
第叁節　吞嚥超音波測量及橫腭弧線的影響45
第肆節　拆除橫腭弧線後的吞嚥運動49
第伍章 討論51
第壹節　誤差52
第貳節　橫腭弧線的位置54
第参節　休息位置、視覺類比尺度與其相關性評估56
第肆節　吞嚥超音波測量及橫腭弧線的影響59
第伍節　拆除橫腭弧線後的吞嚥運動69
第陸節　臨床意義的探討71
第陸章 結論73
第柒章 參考文獻76
圖表附錄82
附圖目錄
圖1 超音波實驗說明83
圖2 超音波B＋M模式圖84
圖3 橫腭弧線84
圖4 實驗室製做流程圖85
圖5 視覺類比尺度評分圖86
圖6 受測者之實驗測量項目與時機之流程示意圖87
圖7 M-mode吞嚥超音波影像與吞嚥分期88
圖8 超音波測量儀88
圖9 防震掃描裝置與技術89
圖10 操作方法與收錄舌頭吞嚥動態和靜態影像處理流程圖90
圖11 超音波分析法91
圖12 裝置2mm橫腭弧線期間吞嚥運動變化92
圖13 裝置4mm橫腭弧線期間吞嚥運動變化92
圖14 拆除2mm橫腭弧線期間吞嚥運動變化93
圖15 拆除4mm橫腭弧線期間吞嚥運動變化93
附表目錄
表1 吞嚥超音波影像計算項目94
表2 實驗時機代號說明表94
表3 吞嚥超音波計算項目代號說明表95
表4 視覺類比尺度代號說明表95
表5 超音波影像之測量者的誤差95
表6 視覺類比尺度評估表之測量者的誤差96
表7 防震掃描技術之再現性96
表8 個體再現性之評估96
表9 吞嚥運動休息位置之描述性統計97
表10 吞嚥困難度之描述性統計98
表11 牙齒疼痛度之描述性統計99
表12 舌頭疼痛度之描述性統計100
表13 相關性評估101
表14 剷起期（第I期）吞嚥運動之描述性統計102
表15 早期運送期（第IIa期）吞嚥運動之描述性統計103
表16 晚期運送期（第IIb期）吞嚥運動時間之描述性統計104
表17 早期終止期（第IIIa期）吞嚥運動之描述性統計105
表18 晚期終止期（第IIIb期）吞嚥運動之描述性統計106
表19 全部（Total）吞嚥運動之描述性統計107
表20 裝置橫腭弧線後之吞嚥運動的變化108
表21 裝置不同高度橫腭弧線後之吞嚥運動的淨效應變化109
表22 拆除橫腭弧線後之吞嚥運動的變化110

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