Please use this identifier to cite or link to this item:
http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/72904
Title: | 以超音波量測無肌筋膜疼痛族群咀嚼肌厚度之研究 Research on ultrasonic measurement of masticatory muscles thickness of group without myofacial pain dysfunction |
Authors: | Pei-Hsuan Chang 張珮璇 |
Advisor: | 陳韻之 |
Keyword: | 肌筋膜疼痛,顳顎關節疾患,信賴度,超音波,肌肉厚度, myofascial pain,temporomandibular disorders,reliability,ultrasound,muscle thickness, |
Publication Year : | 2019 |
Degree: | 碩士 |
Abstract: | 研究目的:咀嚼肌肌筋膜疼痛屬顳顎關節疾患臨床症狀之大宗,現今主要使用觸診作其狀態評估依據,但信賴度不佳。由於咀嚼肌厚度等物理性質的改變,會反映出咀嚼肌狀態的變化,進而可能是一個診斷上的輔助。使用超音波作為咀嚼肌厚度影像量測的設備,具有即時、便利、舒適度、檢查費用相對低廉的優勢。因此,本研究目的為建立可信賴之使用超音波量測咀嚼肌厚度(咬肌、顳肌前部、外翼肌)的方法,分析其肌肉厚度資料,歸納與闡釋其中之規則性。
研究方法:本實驗共納入四十八名經無肌筋膜疼痛之受試者,在儀器效度與操作方法信賴度驗證後,利用標準化之超音波量測模式,於B型超音波下量測受試者之咬肌、顳肌、以及外翼肌的厚度並加以分析。 結果:右側咬肌厚度介於12.13±2.35mm至16.26±2.43mm,左側上段咬肌厚度介於12.75±3.19mm至16.49±2.52mm,雙側數據並無統計上顯著差異,而大部分的咬肌測量位置顯示為與性別和身體質量指數顯著相關(P<0.05),去除性別變項的影響時,身體質量指數與咬肌厚度均呈無顯著相關。而咬肌厚度與最大開口度、下顎對稱性的程度,無論是哪個量測位置,均無統計上顯著相關。右側顳肌前部厚度介於5.19±0.77mm至5.30±0.77mm,左側顳肌前部厚度介於5.06±0.71mm至5.26±0.72mm,雙側數據並無統計上顯著差異,而右側顳肌前部在緊咬時與左側顳肌前部在放鬆、緊咬ㄌ、最大張口等三動作下與性別呈現顯著相關(P<0.05)。除右側顳肌前部緊咬時無顯著關係,其餘量測位置與動作狀態下均顯示與身提質量指數顯著相關。雙側顳肌前部無論處於何種動作狀態下皆顯示與年齡為沒有顯著關係。 右側外翼肌中段在最下開口狀態下中段厚度為14.65±1.38 mm,左側外翼肌中段厚度為14.68±1.11 mm。外翼肌中段肌肉厚度,左右兩側無顯著差異(P<0.05),與性別呈現顯著相關(P<0.05),和身體質量指數則無顯著相關。左側外翼肌中段外,在最大開口下與年齡呈顯著相關(P<0.05)。 結論:顏面部咀嚼肌肌筋膜疼痛為顳顎關節症候群臨床表現病症之一,現今臨床檢查方式為觸診,然觸診的施測者間信度並不高。在肌筋膜疼痛族群中,其咀嚼肌尺寸可能因病症而有所變化,而本實驗使用過去已廣泛運用於量測軀幹骨骼肌厚度之超音波作為測量,並建立可信賴之操作模式。於此操作下,針對無肌筋膜疼痛族群取得咬肌、顳肌前部與外翼肌的肌肉厚度數值,顯示雙側無顯著差異,並與過去近似研究對比,本實驗之受試者在咬肌厚度上來得厚。而經分析後得知咬肌厚度受到性別與身體質量指數影響較多,顳肌前部厚度與身體質量指數高度相關,而外翼肌厚度則與性別和年齡相關。 Purpose: Myofascial pain dysfunction (MPDS) is a common symptom of temporomandibular disorders (TMD). Physical muscle palpation is the main method of examination. However, the inter rater reliability of muscle palpation was not well. Considering the thickness of masticatory muscles vary by their condition, using the real-time, convenient, cost effective ultrasound to measure the muscle thickness would be a suitable investigation method. The purpose of this study is to build a reliable and accurate method of measuring masticatory muscle thickness by ultrasound and elucidate the collecting data. Methods: 48 participants diagnosed with no MPDS were included in this study. After the validity and reliability of the ultrasound measuring protocol were confirmed, the masticatory muscle thickness was measured and analyze. Results: The right masseter muscle thickness was from 12.13±2.35mm to 16.26±2.43mm. The left masseter muscle thickness was from 12.75±3.19mm to 16.49±2.52mm. There was no significant difference between the data of right side and left side. Most of the measuring positions showed that gender and BMI were strongly correlated to the masseter muscle thickness (P<0.05) While removing the impact of gender, BMI was not significantly correlated to the masseter muscle thickness . Neither the amount of maximal mouth opening nor the symmetry of the mandible had significant effect on the masseter muscle thickness.The right anterior temporalis muscle thickness was between 5.19±0.77mm and 5.30±0.77mm,the left anterior temporalis muscle thickness was between 5.06±0.71mm and 5.26±0.72mm. The right side data had no significant difference with the left side. Gender had a significant correlation with right anterior temporalis muscle under clenching, left anterior temporalis muscle under relaxing, clenching and maximum mouth opening. (P<0.05) Unless the right anterior temporalis muscle under clenching, all the other measuring positions correlate to the BMI. Age had no impact on the thickness of the anterior temporalis muscle.The right lateral pterygoid muscle thickness was 114.65±1.38 mm in the middle while the left lateral pterygoid muscle thickness was 14.68±1.11 mm in the middle There was no significant difference between the right side and left side of the middle lateral pterygoid muscle thickness. Gender was a significant factor effecting the muscle thickness (P<0.05) while the BMI was not. Age was also correlated to the left lateral pterygoid muscle thickness measured from the middle part. Conclusion: Muscle palpation is the main method of examining myofascial pain Nowadays. However the inter-rater reliability was not well. The muscle size of the patient with MPDS might vary with the muscle condition. In the present study, we built up a protocol of measuring masticatory muscle thickness by ultrasound and the validity and reliability were good. Following this protocol, we gathered the data of masseter muscle, anterior temporalis muscle and lateral pterygoid muscle thickness from participants without MPDS. After statistical analysis, the masseter muscle, anterior temporalis muscle and lateral pterygoid muscle thickness have no significant difference between the right and left side. Comparing to the previous similar study, the masseter muscle thickness in present study was thicker. Gender and BMI had most of the impact on masseter muscle thickness, but BMI was more strongly correlated to the anterior temporalis muscle thickness. However, the lateral pterygoid muscle thickness was correlated to gender and age. |
URI: | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/72904 |
DOI: | 10.6342/NTU201804283 |
Fulltext Rights: | 有償授權 |
Appears in Collections: | 臨床牙醫學研究所 |
Files in This Item:
File | Size | Format | |
---|---|---|---|
ntu-108-1.pdf Restricted Access | 32.33 MB | Adobe PDF |
Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.