退化性頸椎炎患者之頸部靜力感覺研究

Sensation of Static Force in Patients with Cervical Spondylosis

研究目的︰比較無症狀年輕人、無症狀中年人、與退化性頸椎炎中年患者之間頸部靜力感覺是否有顯著差異。背景︰45歲到64歲的人口中有顯著頸椎退化現象的盛行率大約60%，而65歲以上的人口則高達70～85%。過去的研究顯示年齡老化與關節損傷都會造成本體感覺功能下降。但是，這些研究大部分都是測量位置感覺或是動作感覺。到目前，還沒有研究探討退化性頸椎炎對頸部靜力感覺的影響。方法︰受試者分成三組，分別是年輕組19名（22.9（3.6歲）、中年組19名（55.4（5.0歲）、病人組18名（51.4（6.1歲）。利用「力量換能器」測量受試者頸部出力大小，並使用「維持恆定力量」的技術測試受試者在四種出力狀況下：25%屈曲方向最大主動收縮（maximal voluntary contraction toward flexion, FMVC）、50%FMVC 、25%伸展方向最大主動收縮 （maximal voluntary contraction toward extension, EMVC）、和50%EMCV時頸部出力大小與目標力量之間的誤差。本研究使用百分比絕對誤差（percentile absolute error, pAE）和百分比固定誤差（percentile constant error, pCE）來評估力覺的好壞。結果︰pCE在25%FMVC和50%FMVC時三組之平均值均為負值，且病人組比年輕組和中年組為高（p<0.05）。pAE在50%FMVC時病人組比年輕組高（p<0.05）。結論︰年齡老化對中年人的頸部靜力感覺沒有顯著的影響，但是退化性頸椎炎會造成中年病人頸部屈曲方向的靜力感覺低估。另外，年齡老化與退化性頸椎炎同時存在時會造成中年病人的頸部靜力感覺在屈曲方向中等出力時有顯著的誤差。對退化性頸椎炎患者建議加強頸部屈肌對靜力感覺功能的訓練。

Purpose: This study is aimed to compare the force sense during neck flexion and extension in normal young (NY), middle-aged (MA) subjects, and patients with cervical spondylosis (CS). Background: The prevalence of cervical degeneration (grade 2-4) was over 60% in populations aged between 45-64 years. The prevalence increased to over 70-85% in the populations aged above 65. In the aged population, the proprioception of the joints declines, and is further impaired by joint damage. In most of the previous studies, the proprioception was evaluated in the aspect of joint position sense. The force sense associated with muscle contractions in patients has not been investigated. Methods: Nineteen NY adults (age, 22.9±3.6), 19 MA adults (age, 55.4±5.0), and 18 CS patients (age, 51.4±6.1) were recruited in this study. The subjects performed isometric maximal voluntary contraction toward flexion (FMVC) and extension (EMVC) in head neutral position recorded by a force transducer. The subjects then performed four force levels: 25% FMVC, 50% FMVC, 25% EMVC, and 50% EMVＣ. The force error between the force generated by the subject and the target force was calculated in term of percentage absolute error (pAE) and percentage constant error (pCE). One-way analysis of variance (ANOVA) was used to compare the difference among three groups by SPSS 10.0 software. Results: The pCE during 25% and 50% FMVC was significantly higher in CS group than in MA and NY groups (p<0.05). The pAE during 50%FMVC were significantly higher in CS group than in NY group (p<0.05). Conclusions. Natural aging does not show significant effect on force sense. Cervical spondylosis is associated with the decreases of force sense. Furthermore, the combination of pathological process and natural aging show significant decline of force sense. Proper training to improve the force sense in patients with cervical spondylosis is advised.