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標題: | 接受減壓手術後頸椎脊髓神經病變患者於姿勢控制時之感覺動作整合 Sensorimotor Integration in Postural Control of Patients with Cervical Spondylotic Myelopathy after Decompression Surgery |
作者: | 林昱瑄 Iu-Shiuan Lin |
指導教授: | 徐瑋勵 Wei-Li Hsu |
關鍵字: | 感覺權重,時頻分析,加伯轉換,足底壓力中心, sensory weighting,time–frequency analysis,Gabor transform,center of pressure, |
出版年 : | 2019 |
學位: | 碩士 |
摘要: | 背景: 頸椎脊髓神經病變患者為一壓迫到頸椎脊髓的退化性頸椎疾病。患者可能因本體感覺受損產生平衡障礙,進而增加跌倒風險。其常見的介入方式之一為減壓手術,但過去尚未有研究探討術後頸椎脊髓神經病變患者姿勢控制之恢復,且其於姿勢控制時感覺系統之權重調整仍未被探討。
目的:此研究欲探討頸椎脊髓神經病變患者於手術前後,於姿勢控制時之感覺系統調節與健康人之差異 假說:頸椎脊髓神經病變患者於姿勢控制時之感覺系統調節與健康成人不同,且術後頸椎脊髓神經病變患者之感覺系統權重會再調整。 實驗設計:術後追蹤6個月之觀察性研究 實驗方法:本實驗招募了24位頸椎脊髓神經病變患者(CSM組)和24位年齡相符之健康成人(健康控制組)。頸椎脊髓神經病變患者會於術前、術後3個月以及術後6個月接受評估測試,評估測試包括功能性問卷和靜態平衡測試。功能性問卷包括了改良式日本骨科學會量表之下肢功能(mJOA-LEF)、Nurick分數以及日本骨科學會頸椎脊髓神經病變評估問卷之下肢功能(JOACMEQ-LEF);而靜態平衡測試會讓受試者於睜眼及閉眼情況下站在力板上30秒,足底壓力中心之變化會進行時域分析及時頻分析。控制組會接受一次靜態平衡測試。組內差異會以Friedman檢定(Friedman test)進行無母數統計分析,並使用Wilcoxon符號等級檢定(Wilcoxon signed-rank test)進行事後分析,經Bonferroni校正(Bonferroni correction)後之顯著水準會被設為0.016。組間差異則會以Mann-Whitney U檢定(Mann-Whitney U test)進行分析,顯著水準為0.05。 實驗結果:在CSM組,其mJOA-LEF及Nurick分數於術後3個月及6個月皆有顯著地進步。手術前,頸椎脊髓神經病變患者在睜眼及閉眼情況下,其足底壓力中心之搖晃速度及總能量皆比健康控制組高;且於睜眼情況下,其中度頻帶(本體感覺)比例比控制組低,低度頻帶(小腦、前庭及視覺系統)比例則比控制組高。手術後,於睜眼情況下,CSM組之足底壓力中心搖晃速度於術後3個月顯著地下降;其低度頻帶比例(視覺、前庭覺系統)於手術後六個月後,與控制組無差異。 結論:手術前,頸椎脊髓神經病變患者於姿勢控制時之感覺系統權重與健康成人不同,其本體感覺系統比例下降,而其他三個感覺系統則會上升進行代償。手術後,頸椎脊髓神經病變患者於姿勢控制時,可能因本體感覺系統比例下降,而使視覺及前庭覺系統代償增加的比例減少,此現象間接地顯示了患者的進步。然而患者本體感覺之比例仍比控制組還低,顯示了進步量仍不足,因此,頸椎脊髓神經病變患者於術後可能仍需要平衡訓練及姿勢教育。 Background: Cervical spondylotic myelopathy (CSM) is a degenerative cervical disease with in which the spinal cord is compressed. Patients with CSM experience balance disturbance because of impaired proprioception. Decompression surgery is a recommended treatment aimed to relieve the compression of the spinal cord. However, no study investigated the postural control in patients with CSM after surgery. The weighting of the sensory inputs for postural control in patients with CSM is also unclear. Purpose: To investigate the difference of sensory weighting in postural control between patients with CSM and the healthy adults Hypotheses: The weighting of the sensory systems in postural control of patients with CSM may be different from the one in the healthy adults. Moreover, the sensory systems in postural control would be reweighted after surgery. Design: Observational study with 6-month follow-up. Method: Twenty-four individuals with CSM (CSM group) and 24 age-matched healthy adults (healthy control group) were analyzed in this observational study. The functional outcomes including lower extremity function of modified Japanese Orthopaedic Association Scale (mJOA-LEF), lower extremity of Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ-LEF), Nurick scale and the static balance assessment under eyes-open (EO) and eyes-closed (EC) condition were assessed on the individuals with CSM before surgery, 3 and 6 months after surgery. Time domain and time–frequency-domain variables of the center of pressure (COP) were analyzed. Friedman test was performed for the within-group comparison, and the pairwise comparison was tested by Wilcoxon signed-rank test with Bonferroni correction. Significant level was set at 0.016. Mann-Whitney U test was performed for the group comparison at a significant level of 0.05. Results: In the CSM group, mJOA-LEF and Nurick scale significantly improved 3 and 6 months after surgery. Before surgery, the COP mean velocity and the total energy were significantly higher in the CSM group than in the control group for both vision conditions. Compared with the control group, the CSM group exhibited lower energy content in the moderate-frequency band (i.e., proprioception) and higher energy content in the low-frequency band (i.e., cerebellar, vestibular, and visual systems) under the eyes-open condition. The COP mean velocity of the CSM group significantly decreased 3 months after surgery. The energy content in the low-frequency band (i.e., visual and vestibular systems) of the CSM group was closed to that of the control group 6 months after surgery under the eyes-open condition. Conclusion: Before surgery, the patients with CSM may have had compensatory sensory weighting for postural control, with decreased weighting on proprioception and increased weighting on the other three sensory inputs. After surgery, the postural control of the patients with CSM improved, with decreased compensation for the proprioceptive system from the visual and vestibular inputs. However, the improvement remained insufficient because the patients with CSM still had lower weighting on proprioception than the healthy adults did. Therefore, patients with CSM may require balance training and posture education after surgery. |
URI: | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/78824 |
DOI: | 10.6342/NTU201900445 |
全文授權: | 未授權 |
電子全文公開日期: | 2024-03-11 |
顯示於系所單位: | 物理治療學系所 |
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