臺灣博碩士論文加值系統

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

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