以超音波量測咀嚼肌肌肉痛之顳顎關節症患者的咀嚼肌肌肉性質

Abstract

研究目的：顳顎關節障礙症之病患，常見症狀包含顳顎關節與咀嚼肌肌肉之疼痛或功能障礙。對於咀嚼肌肌肉痛的診斷，目前臨床上主要以觸診後是否產生壓痛作為診斷依據。以觸診方式檢查有咀嚼肌肌肉痛患者的咀嚼肌時，可觀察到咀嚼肌有僵硬的症狀。回顧過往文獻，對於咀嚼肌肌肉痛病患之咀嚼肌肌肉硬度的檢查及量化尚未有客觀且系統性的量測方式，且對咀嚼肌肌肉硬度與疼痛相關性的研究尚不足。目前對於咀嚼肌狀態之研究，已有使用各類影像工具如電腦斷層掃描、磁振掃描造影及超音波影像來測量咀嚼肌的長度、厚度、體積等物理性質。彈性超音波，是目前盛行用於測量軟組織硬度的一種非侵入性技術。本研究分為兩部分，第一部分將透過超音波及剪力波彈性超音波來量測無咀嚼肌肌肉痛之健康受測者的咀嚼肌(咬肌、顳肌、外翼肌)厚度及剛性(硬度)，進行信賴度驗證。第二部分是以剪力波彈性超音波來量測有咀嚼肌肌肉痛之顳顎關節障礙症患者之咀嚼肌肌肉剛性，希望能藉此了解咀嚼肌肌肉痛病患之咀嚼肌肌肉剛性與疼痛度的相關性，作為將來診斷及治療的輔助工具。 研究方法：本研究第一部分納入10名健康受測者，透過超音波及剪力波彈性超音波來量測無咀嚼肌肌肉痛之健康受測者的咀嚼肌(咬肌、顳肌、外翼肌)厚度及剛性，進行信賴度驗證。第二部分是以超音波及剪力波彈性超音波來量測健康受測者48人及有咀嚼肌肌肉痛之顳顎關節障礙症患者22人之咀嚼肌肌肉厚度及剛性，比較兩組的咀嚼肌肌肉性質，希望能藉此了解咀嚼肌肌肉痛病患之咀嚼肌肌肉剛性與疼痛度的相關性，作為將來診斷及治療的輔助工具。 結果：在咀嚼肌肌肉厚度部分，雙側咬肌、顳肌的厚度在健康受測組與患病受測組之間無顯著差異，雙側外翼肌厚度在健康受測組與患病受測組間達顯著差異，且健康受測組厚度平均顯著高於患病受測組。在肌肉剛性部分，雙側咬肌彈性模數在健康受測組與患病受測組間達顯著差異，且患病受測組平均顯著高於健康受測組。顳肌、外翼肌的彈性模數在健康受測組與患病受測之間則無顯著差異。 結論：本研究結果指出咬肌之剛性與性別、年齡、身體質量指數沒有顯著相關。而咬肌之剛性與疼痛程度呈顯著正相關，與最大張口度呈顯著負相關。有咀嚼肌肌肉痛之顳顎關節障礙症患者與健康受測者相比有較大的咬肌彈性模數，然而，咬肌之厚度在兩組間無顯著差異。剪力波彈性超音波的應用可以準確量取咀嚼肌之彈性模數，作為臨床診斷與研究發展之用，且測量咬肌之肌肉剛性有潛力成為咀嚼肌肌肉疼痛臨床診斷的輔助指標。

Purpose: The aim of this study was to measure the thickness and stiffness of masticatory muscle in temporaomandibular disorders (TMD) patients with and without myalgia. Methods: Muscle thickness was measured using ultrasound and muscle stifness was measured using shear wave elastography. First, ten healthy participants were included for reliability test of ultrasound measuring protocol. Seventy participants were included in main study, 48 healthy controls consisted of 24 male volunteers and 24 female volunteers and 22 participants who were temporomandibular disorders patients with masticatory muscle myalgia. Both muscle thickness and muscle stifness were measured and analyzed. Results: There was no significant difference in bilateral masseter and temporalis muscle thickness between myalgia group and healthy group. Bilateral lateral pterygoid muscle thickness in healthy group was significantly greater than myalgia group. Bilateral masseter muscle stifness in myalgia group was significantly greater than healthy controls. Masseter muscle stiffness was positively correlated with pain score and negatively correlated with maximum mouth opening. Conclusion: Shear wave elastography is a useful and reliable measuring device to quantify masticatory muscle stiffness. The results of this study showed that the masseter muscle stifness of TMD patients with myalgia is greater than healthy participants.