頸部疼痛患者之頸胸椎關節活動度與呼吸功能的關聯性

Association of Neck Range of Motion and Cervical/Thoracic Segmental Mobility with Respiratory Function in Patients with Neck Pain

目的：（1）探討頸部疼痛患者與一般健康人之呼吸功能的異同。（2）頸部疼痛患者疼痛特性與頸胸椎椎間關節活動度是否影響呼吸功能。方法：25位頸部疼痛患者與26位年齡配對之健康人，記錄疼痛特性，頸胸椎椎間關節活動度，呼吸模式、最大靜態呼吸壓與肺功能測試。統計方式以獨立樣本t檢定比較兩組呼吸功能之差異。頸部疼痛組，以皮爾森相關係數檢定之頸部疼痛嚴重程度與呼吸功能之相關，以及單因子變異數分析疼痛時間與呼吸功能是否相關；頸部疼痛組頸胸椎椎間關節活動度與呼吸功能之相關性以獨立樣本t檢定分析。結果：兩組在呼吸模式、最大靜態呼吸壓有顯著差異（p＜0.05）。疼痛程度與最大靜態呼吸壓有輕度至中度負相關性，疼痛時間大於一年者最大靜態呼吸壓有顯著降低（p＜0.01）。下胸椎椎間關節活動度受限者之最大靜態呼吸壓顯著低於無受限者（p＜0.05）。結論：頸部疼痛患者與健康人相比顯示有異常的呼吸功能，比健康人多使用上胸呼吸模式，最大靜態呼吸壓減少。疼痛嚴重程度與時間會降低最大靜態呼吸壓。下胸椎椎關節活動度與最大靜態呼吸壓相關。

Purposes: Neck pain is a common problem in the general population. The symptoms often accompany a restriction in spinal segment mobility. Also, chest pain or difficulty expanding the chest during breathing has been noted in the clinic; however, the connection between neck pain and respiratory needs further study. Therefore, the purpose of the current study was to determine the difference in respiratory function between patients with neck pain and healthy controls, and to determine the effect of pain characteristics and cervical/thoracic segmental mobility on respiratory function. Methods: Twenty-five patients with neck pain and 26 age- and gender-matched healthy controls were recruited. The demographic data were recorded. The outcome measures included the characteristics of pain, cervical/ thoracic segmental mobility, breathing pattern, chest mobility, maximum inspiratory/expiratory pressure (Pimax / Pemax), and pulmonary function test results. The differences in all of the variables between groups were assessed using independent-t tests. One-way ANOVA was used to analyze respiratory function among the groups with pain of different duration. Independent t-tests were used to determine whether or not cervical/thoracic segmental mobility is associated with respiratory function. Results: Patients with neck pain presented with increased upper chest mobility during deep breathing, and decreased respiratory muscle strength (Pimax and Pemax; p<0.05). Significant associations were noted between pain severity and respiratory muscle strength. Increased pain duration decreased respiratory muscle strength. The respiratory muscle strength was decreased when the lower thoracic spine restricted (p<0.05). Conclusions: Most neck pain patients exhibited an upper chest breathing pattern. Pain severity and duration, and restricted segmental mobility of the lower cervical and lower thoracic spine were associated with a change in chest mobility and decreased respiratory muscle strength of patients with neck pain.