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http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/47197完整後設資料紀錄
| DC 欄位 | 值 | 語言 |
|---|---|---|
| dc.contributor.advisor | 林啟萬(Chii-Wann Lin),王兆麟(Jaw-Lin Wang) | |
| dc.contributor.author | Mu-Lien Lin | en |
| dc.contributor.author | 林木鍊 | zh_TW |
| dc.date.accessioned | 2021-06-15T05:50:31Z | - |
| dc.date.available | 2016-08-22 | |
| dc.date.copyright | 2011-08-22 | |
| dc.date.issued | 2011 | |
| dc.date.submitted | 2011-08-19 | |
| dc.identifier.citation | [1] B. R. Briggs AM, 'Back pain: A National Health Priority Area?,' Medical Journal of Australia 2009.
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| dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/47197 | - |
| dc.description.abstract | 中文摘要
人的一生中發生下背痛的機率在成人部分有79.2%而在青少年部份更高達84%；於2001-2002年統計每年下背痛也有15~45%的發生機會，其發生頻率僅次於感冒；目前常見之治療下背痛疼痛方法包含有射頻熱凝療法、神經刺激與脊椎內注射等方法。1965年Dr.Shealy便已開始使用射頻熱凝療法治療下背痛，其作用機轉主要是利用射頻產生高熱將神經破壞達成止痛的目的，這種方式會造成嚴重的副作用如：神經敏感疼痛及神經再生造成的神經瘤；因此1998年Slujter發展出脈衝射頻電刺激治療，溫度保持在42℃以下，不會造成神經的熱破壞也沒有產生其他的副作用，其原理便是利用電場的作用來達到止痛的目的。 由於臨床止痛效果僅能維持有限的時間，所以病人約三到六個月需回診再接受脈衝射頻電刺激治療，而且每次病人都須添購昂貴的治療電極針…等都是一種醫療資源的浪費，還有在治療中病人及醫師都要暴露在螢光照影的輻射線下，尤其是醫師長時間累積的輻射量更是相當危險。 基於上述之原因，發展微型定位導航系統以及植入式脈衝射頻電刺激系統，將此定位系統應用於脈衝式射頻電刺激脊椎背根神經節來治療下背痛，結果可改善針刺的精確度及減少X光曝射量，而且醫生使用及手術可以大大減少花費及學習時間；利用植入式CMOS晶片用雙極式低強度電壓射頻取代傳統式脈衝射頻電刺激之缺點，也就是因為單極電刺激由身體進行迴路需要大電壓的缺點，所以藉此植入方式可以減少病人反覆回診及醫療設備衛材使用等的浪費。 本研究藉由動物實驗及神經結紮疼痛模型針對脊椎背根神經節L5結紮，進行小電壓雙極電刺激參數、波形實驗、生物分子標記(cfos、pp38)、植入電極刺激、重複刺激驗證、電生理實驗，觀察雙極式射頻電刺激效果以及植入式設備可行性；藉由電生理實驗觀察電訊號變化；並且我們在定位導航系統以人體實驗進行功能效能確認已得到證實，精確度位置誤差4.6mm(範圍：1.7-9.4mm)，在於角度誤差為3.6度，由VAS疼痛量表中手術前5.8(2.3)至手術後4.1(2.1)，於統計上有意義(P=0.067)，X-ray曝射量為0.95mSv)，遠少於一般螢光照影劑量。 由實驗結果中驗證雙極式脈衝射頻電刺激利用±3.3V、±1.25V能夠讓老鼠腳底耐受能力提升，由脈衝射頻電刺激波形中發現弦波比方波具有提昇更高的耐受力；利用cfos和pp38進行生物分子機轉分析，本研究中PRF減少了cfos、的表現，不論是在第三小時還是第一天，同時證實了PRF作用在腰椎L5 背根神經節抑制L4中pp38表現，強烈顯示PRF間接作用在神經元和膠細胞互動之中，雖然機轉尚未明白；將電極利用生物性封裝植入動物體內進行低頻定位及脈衝射頻電刺激治療可重複提高老鼠疼痛的耐受力，藉由電生理紀錄脊髓訊號經由脈衝射頻電刺激治療後兩個半小時，傳導疼痛的C神經纖維訊號下降同時Aδ神經纖維也隨之增加，在此可發現脈衝射頻電刺激明顯地抑制C神經纖維的反應，並改變不同傳入感覺神經的路徑；综合上述結果我們結論PRF在週邊神經作用是經由功能性的抑制而非較小的神經元變性。 | zh_TW |
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| dc.description.tableofcontents | 口試委員審定書 I
誌謝 II 中文摘要 III 英文摘要 IV 表目錄 XI Chapter 1 前言 1 1.1 下背痛 1 1.2 下背痛於臨床治療之方法 2 1.3 神經病變性疼痛 4 1.4 電刺激療法 6 1.5 射頻電刺激 8 1.6 脈衝射頻電刺激 10 1.7 射頻電刺激/脈衝式射頻電刺激於臨床之應用 12 1.7.1 臨床射頻電刺激治療方式 12 1.7.2 臨床射頻電刺激治療流程 13 1.7.3 臨床疼痛量表(Visual Analogue Scale, VAS) 15 1.8 植入式電刺激器 17 Chapter 2 發展可植入式電刺激晶片 19 2.1 研究動機 19 2.2 脈衝射頻電刺激可行性實驗設計 19 2.2.1 脈衝射頻電刺激單次刺激於小動物疼痛抑制研究 19 2.2.2 脈衝射頻波形於神經性疼痛抑制之效應研究 22 2.2.3 植入電極於長期多次脈衝射頻電刺激 23 2.2.4 動物神經電生理實驗 24 2.2.5 神經訊號紀錄與分析 24 2.3 脈衝射頻電刺激器 27 2.4 刺激電極與封裝 29 2.5 植入用刺激電極 30 2.6 動物實驗準備 33 2.6.1 行為實驗 33 2.6.2 電生理實驗手術 35 Chapter 3 單次脈衝射頻電刺激有效性研究 41 3.1 動物實驗研究 41 3.2 無線充電晶片脈衝射頻電刺激波形有效性研究 42 3.3 脈衝射頻電刺激波形有效性研究 50 3.4 電極植入多次刺激於疼痛抑制之有效性分析 50 3.5 電生理於脈衝射頻電刺激分析 54 Chapter 4 應用電腦微定位導航系統於脈衝射頻電刺激在背根神經節之臨床試驗 63 4.1 簡介 63 4.2 材料與方法 63 4.1.1 系統介紹 63 4.1.2 小型化的追蹤裝置 64 4.1.3 定位架 64 4.1.4 影像處理單元 65 4.1.5 工作流程 65 4.1.6 系統測試 65 4.3 結果 66 4.4 討論 67 Chapter 5 討論與展望 69 5.1 結果與討論 69 5.2 未來展望 73 參考文獻 74 | |
| dc.language.iso | zh-TW | |
| dc.subject | 脈衝射頻電刺激 | zh_TW |
| dc.subject | 無線射頻 | zh_TW |
| dc.subject | 植入式設備 | zh_TW |
| dc.subject | Implantable Device | en |
| dc.subject | Pulsed Radiofrequency | en |
| dc.subject | Wireless Radiofrequency | en |
| dc.title | 植入式脈衝射頻電刺激與微型導航系統於下背痛之臨床應用 | zh_TW |
| dc.title | An Implantable Pulsed-Radiofrequency on Dorsal Root Ganglion and Study of Navigation System for Low Back Pain | en |
| dc.type | Thesis | |
| dc.date.schoolyear | 99-2 | |
| dc.description.degree | 博士 | |
| dc.contributor.advisor-orcid | ,王兆麟(jlwang@ntu.edu.tw) | |
| dc.contributor.oralexamcommittee | 呂學士,邱弘瑋,楊燿州,高明見,施文彬 | |
| dc.subject.keyword | 脈衝射頻電刺激,植入式設備,無線射頻, | zh_TW |
| dc.subject.keyword | Pulsed Radiofrequency,Implantable Device,Wireless Radiofrequency, | en |
| dc.relation.page | 78 | |
| dc.rights.note | 有償授權 | |
| dc.date.accepted | 2011-08-19 | |
| dc.contributor.author-college | 工學院 | zh_TW |
| dc.contributor.author-dept | 醫學工程學研究所 | zh_TW |
| 顯示於系所單位： | 醫學工程學研究所 | |
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