JP2001292982A - Evaluation system of stiffness in shoulders - Google Patents

Abstract

PROBLEM TO BE SOLVED: To evaluate a stiffness in the shoulders objectively and reliably by measuring the circulatory kinetics in the deep inside the muscular tissue around the shoulders. SOLUTION: This evaluation system of a stiffness in the shoulders comprises a deep part circulatory kinetics measuring means 10. The deep part circulatory kinetics measuring means 10 receives the near infrared rays irradiated from the skin surface S around the shoulders to the muscular tissue and scattered in the muscular tissue, and finds the absorbance of the muscular tissue and the tissue oxygen saturation or the total hemoglobin quantity based on the absorbance. It is preferable that the tissue oxygen saturation or the total hemoglobin quantity should be corrected according to the thickness of the subcutaneous fat of a subject.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a shoulder stiffness evaluation system capable of objectively evaluating the degree of shoulder stiffness based on measured values.

[0002]

2. Description of the Related Art Conventionally, the degree of shoulder stiffness has been evaluated based on self-report and palpation of a subject. However, such an evaluation method has low objectivity and low reproducibility.

[0003] As a method of evaluating stiff shoulders instead of palpation,
A method based on the measured value of the hardness around the shoulder is known (Journal of the Japanese Society of Acupuncture and Moxibustion, 41 (2), 1991, Japanese Patent Application Laid-Open No. 60-40)
No. 034). However, since the hardness of a living body greatly changes due to the influence of fat, muscle, and the like, it is difficult to obtain a high correlation between the measured value of the hardness of the shoulder peripheral portion and the self-reported evaluation of shoulder stiffness.

[0004]

On the other hand, it is said that one factor of shoulder stiffness is poor circulation in deep muscle tissue around the shoulder. Therefore, deep circulation dynamics in muscle tissue around the shoulder (ie, tissue oxygen saturation, total hemoglobin amount, blood flow)
It is conceivable to measure

[0005] In the deep circulatory dynamics, the blood flow can be measured from the change in the amount of blood per unit time when a blood vessel is closed once. However, it is difficult to close such a blood vessel around the shoulder. It is also difficult to measure blood flow.

[0006] As a method of measuring the deep circulation dynamics,
There is a method in which a needle is pierced directly into a muscle and measured by a hydrogen clearance method. According to the hydrogen clearance method, the circulatory dynamics of a site to be measured can be directly measured. However, the hydrogen clearance method is painful, and there is also a limitation that the act of sticking a needle into a human body can only be performed by a doctor.

[0007] As a method of measuring deep circulation dynamics, a near-infrared light is irradiated into a muscle tissue at a certain distance from the skin surface, and scattered light from the muscle tissue is received, whereby the muscle at a certain distance from the skin surface is received. There is near-infrared spectroscopy to measure deep circulation dynamics in tissues. Because this method is non-invasive,
It can be measured easily without pain. However, in near-infrared spectroscopy, the measurement distance from the skin surface is fixed at a constant value, while the thickness of the subcutaneous fat directly under the skin varies from subject to subject, so the measured value obtained is Affected significantly. Therefore, it is difficult to obtain a high correlation between measurements of deep hemodynamics and self-reported or palpation-based assessment of shoulder stiffness, and therefore this shoulder infrared stiffness can be reliably evaluated. It is difficult to do.

As described above, there has been no method for objectively and simply evaluating shoulder stiffness, and a method for evaluating shoulder stiffness has not been established. For this reason, it is difficult to find the cause of stiff shoulders, and treatment methods are also varied.

Accordingly, the present invention provides a method for measuring deep circulatory dynamics in muscle tissue around the shoulder to evaluate stiff shoulders.
It is an object of the present invention to be able to objectively obtain a highly reliable evaluation value by a simple measurement operation.

[0010]

In order to achieve the above object, the present invention irradiates near infrared light to the muscle tissue from the skin surface around the shoulder and receives light scattered in the muscle tissue. The present invention provides a shoulder stiffness evaluation system including deep circulatory dynamics measuring means for determining the absorbance of the muscle tissue and obtaining the tissue oxygen saturation or the total hemoglobin amount in the muscle around the shoulder based on the absorbance.

In particular, as this shoulder stiffness evaluation system, the tissue oxygen saturation or the total hemoglobin amount calculated based on the absorbance is corrected according to the Body Mass Index (BMI),
A mode in which a correction value of the tissue oxygen saturation or the total hemoglobin amount that does not depend on the BMI is output, or the tissue oxygen saturation or the total hemoglobin amount calculated based on the absorbance is corrected according to the subcutaneous fat thickness, and depends on the subcutaneous fat thickness. The present invention provides a mode for outputting a correction value of the tissue oxygen saturation or the total hemoglobin amount that is not used. Since the correction value of the tissue oxygen saturation or the total hemoglobin amount has a high correlation with the self-reported or palpation-based evaluation of shoulder stiffness, the use of this correction value can increase the reliability of the evaluation of shoulder stiffness. it can.

[0012]

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS Hereinafter, the present invention will be described in detail with reference to the drawings. In each of the drawings, the same reference numerals represent the same or equivalent components.

[0013] The shoulder stiffness evaluation system of the present invention is provided with a deep circulatory dynamics measuring means for measuring tissue oxygen saturation and total hemoglobin amount in the muscular tissue as the deep circulatory dynamics in the muscle tissue around the shoulder.

The deep circulatory dynamics measuring means 10 is, for example, shown in FIG.
As shown in the block diagram of FIG. 1, a light emitting unit 1 for irradiating near infrared light of a predetermined wavelength from a skin surface S around a shoulder to muscle tissue.
And a light receiving unit 2 for receiving light scattered in the muscle tissue;
It can be formed from the arithmetic processing unit 3 which calculates the absorbance of muscle tissue based on the received light and calculates the tissue oxygen saturation or the total hemoglobin amount based on the absorbance.

Here, the light-emitting unit 1 and the light-receiving unit 2 can be configured similarly to the light-emitting unit and the light-receiving unit of the blood flow data measuring device disclosed in Japanese Patent Application Laid-Open No. Hei 10-94527, respectively. in the invention shall be variably set the distance d ₀ at a distance d _1, d ₂ of at least two ways in a range of 0.5~4.0cm between the light emitting portion 1 and the light receiving portion 2.

The distance d ₀ between the light-emitting unit 1 and the light-receiving unit 2 is preferably determined according to the degree of obesity or leanness of the subject, the thickness of the subcutaneous fat, and the like. Index (BMI) (where BM
I = weight (kg) / height (m) ² ), when the subject has a BMI of 18.5 or more and less than 25, d ₁ = 0.5 to
It is preferable to set 1.5 cm and d ₂ = 2.0 to 3.0 cm.

The light emitting section 1 has a wavelength of 700 to 850 n.
It is preferable that near-infrared light of any three wavelengths can be irradiated in the range of m.

A personal computer or the like can be used for the arithmetic processing unit 3.

FIG. 2 shows the deep circulatory dynamics measuring means 10 of FIG.
FIG. 4 is an explanatory diagram of the principle of calculating the tissue oxygen saturation and the total hemoglobin amount in muscle around the shoulder.

That is, in the vicinity of the shoulder, the light (light amount I) of a predetermined wavelength λ is introduced into the muscle tissue from the skin surface S by the light emitting section 1.
_{0 (λ))} is incident, receiving scattered light from the muscle tissue in the light receiving section 2 from the light-emitting portion 1 at a distance d ₁ (light intensity I _{1 (λ)).} Similarly, receiving scattered light from the muscle tissue in the light receiving section 2 from the light-emitting portion 1 at a distance d ₂ (light intensity I _{2 (λ)).} At this time, the following equation is obtained.

[0021]

_{A1-2 ( λ )} = log (I1 _{( λ )} / I2 _{( λ )} ) = εa _{( λ )} · _Ca · d + εb _{( λ )} · _Cb · d + At _{( λ )} (wherein, a _{1-2 (λ):} the absorbance at a wavelength lambda of tissue between the skin surface and the distance d ₂ and a distance d ₁ (tissue portions denoted a dot in FIG. ₂₎ ε _{a (λ):} Molecular extinction coefficient of oxyhemoglobin at wavelength λ ε _{b ( λ )} : Molecular extinction coefficient of reduced hemoglobin at wavelength λ C _a : Concentration of oxyhemoglobin C _b : Concentration of reduced hemoglobin d: Distance from light emitting part 1 in tissue Average optical path length between d ₂ and distance d _{1 At ( λ )} : Absorbance at wavelength λ obtained by removing the absorbance of blood from the absorbance of tissue between distance d ₂ and distance d ₁ from the skin surface ( Absorbance derived from tissues other than blood))

A in this equation_{t ( λ )}Is the near red of three wavelengths
When measured with external light, it becomes very small and can be ignored.
Wear. Therefore, measuring the absorbance at three wavelengths
C _a・ D and C_bD can be calculated, and the sum of
The amount of hemoglobin can be calculated. Also, tissue acid
Elementary saturation is C_a・ D / (C_a+ C_b) D × 100 (%)
It can be calculated from:

When measuring the subject using the deep circulatory dynamics measuring means 10, it is preferable that the subject be in a sitting resting state. The measurement time is preferably set to 0.5 to 5 minutes. If the measurement time is too short, the measured value will not be stable, and if it is too long, the burden will be placed on the subject, and accurate measurement will not be possible.

In the present invention, the effect of subcutaneous fat on the tissue oxygen saturation or the total hemoglobin amount calculated as described above is corrected, and the tissue oxygen saturation or the total hemoglobin amount is determined based on the thickness of the subcutaneous fat of the subject. Regardless of the magnitude, it is preferable to provide a good index of the degree of shoulder stiffness, and it is preferable that such correction processing can be performed by the arithmetic processing unit 3.

For example, the thickness of the subcutaneous fat of the subject is separately measured by an ultrasonic diagnostic apparatus, CT, or the like, and the values of d ₁ and d ₂ are changed according to the measured thickness of the subcutaneous fat.

Further, the correction may be made based on the height and weight without depending on the direct measurement value of the thickness of the subcutaneous fat. For example, d ₁
= 1.0 cm, d ₂ = 2.5 cm, it is preferable to obtain the BMI from the height and weight of the subject and correct it by the following formula. It should be noted that this equation is given by the following equation:
In the case where nm and 830 nm are used, N = 300 and the present inventors have statistically calculated. Also,
In the formula, [totalHb] ₀ and [totalHb] ₁ are the total hemoglobin amounts before and after correction, respectively, and [StO ₂ ] ₀ and [StO ₂ ] ₁ are
The tissue oxygen saturation before and after correction, respectively.

[0027]

[Equation 2] When BMI <18.5 [totalHb] ₁ = [totalHb] ₀ * (BMI / (21.7 ± 0.5)) [StO ₂ ] ₁ = [StO ₂ ] ₀ * (1.02 ± 0.02) 18.5 ≦ BMI <25 For [totalHb] ₁ = [totalHb] ₀ * (BMI / (21.7 ± 0.5)) [StO ₂ ] ₁ = [StO ₂ ] ₀ * 1.0 For 25 ≦ BMI [totalHb] ₁ = [totalHb] ₀ * ( BMI / (21.7 ± 0.5)) [StO ₂ ] ₁ = [StO ₂ ] ₀ * (0.98 ± 0.02)

By making the relationship between the tissue oxygen saturation obtained as described above and the total hemoglobin amount as that of an actual case of stiff shoulder, the tissue oxygen saturation measured by the deep circulatory dynamics measuring means 10 or the subject The correction value of the tissue oxygen saturation calculated as necessary depending on the degree of obesity of the subject is 75%
In the following cases, it can be determined that the subject has stiff shoulders due to poor deep circulation. In addition, even when the correction value of the total hemoglobin amount measured by the deep circulatory dynamics measuring means 10 or the total hemoglobin amount calculated as necessary depending on the obesity degree of the subject is 300 g · cm / L or less, It can be determined that there is stiff shoulder due to poor deep circulation.

[0029]

DESCRIPTION OF THE PREFERRED EMBODIMENTS The present invention will be specifically described below based on embodiments.

Example 1 (1) Measurement Tissue oxygen saturation and total hemoglobin content of 139 adults were measured at the periphery of both shoulders (corresponding to a hole in the ceiling: sample number n = 278).

The measurement was performed using a tissue oxygen saturation / hemoglobin monitor (manufactured by PSA-IIIN Biomedical Science) using near-infrared spectroscopy. Value. In this case, when the ones digit of the measured value did not move for 5 seconds or more, it was determined that the measured value was stabilized.

The distance between the light emitting part and the light receiving part is 1.0 cm,
Two types of 2.5 cm were used. Further, the irradiation wavelength from the light emitting portion was set to three types of 700 nm, 750 nm, and 830 nm.

On the other hand, the height and weight of each subject were measured, and
MI was calculated.

The evaluation of the stiff shoulder by the subject himself is as follows.
-E self-report in five stages. A: very elaborate B: elaborate C: somewhat elaborate D: not very elaborate E: not elaborate

The evaluation of shoulder stiffness by palpation was performed by one physician in the following four grades a to d. a: very strong stiffness b: strong stiffness c: stiffness d: no stiffness

(2) Relationship between the measured value of tissue oxygen saturation or the measured value of total hemoglobin amount and BMI If the subject's own stiff shoulder is evaluated as not stiff, and if the physician does not have stiffness in the palpation evaluation, the stiffness is evaluated. For the evaluated healthy individuals, the measured values of tissue oxygen saturation and B
FIGS. 3A and 3B show the relationship with MI and the relationship between the measured value of the total hemoglobin amount and BMI, respectively. From this figure, it was confirmed that the measured value of the tissue oxygen saturation and the measured value of the total hemoglobin amount were each correlated with the BMI and were affected by the subcutaneous fat thickness.

Measured value of tissue oxygen saturation [StO_Two]₀And total hemo
Measured value of globin amount [totalHb]₀According to the value of BMI
The correction values for tissue oxygen saturation are corrected as shown below.
[StO _Two]₁And total hemoglobin correction value [totalHb]₁Get
Was.

[0038]

[Equation 3] When BMI <18.5 [totalHb] ₁ = [totalHb] ₀ * (BMI / 21.75) [StO ₂ ] ₁ = [StO ₂ ] ₀ * 1.02 When 18.5 ≦ BMI <25 [totalHb] ₁ = [ totalHb] ₀ * (BMI / 21.75) [StO ₂ ] ₁ = [StO ₂ ] ₀ * 1.0 When 25 ≦ BMI [totalHb] ₁ = [totalHb] ₀ * (BMI / 21.75) [StO ₂ ] ₁ = [StO ₂ ] ₂ ] ₀ * 0.98

FIGS. 4A and 4B show the relationship between the correction value of the tissue oxygen saturation and the BMI, and the relationship between the correction value of the total hemoglobin amount and the BMI, respectively. From this figure, it was confirmed that neither the correction value of the tissue oxygen saturation nor the correction value of the total hemoglobin amount had a correlation with BMI.

(3) Relationship between Subject's Consciousness and Corrected Deep Circulation Dynamics Subject's own stiff shoulder evaluation and tissue oxygen saturation correction value [S
FIG. 5 shows the relationship between tO ₂ ] ₁ and the relationship between the evaluation of the subject's own stiff shoulder and the correction value [totalHb] ₁ of the total hemoglobin amount.
(A) and FIG. 5 (b).

Those who self-reported that they were "extremely stiff" compared to those who self-evaluated "not stiff" had significantly lower correction values for tissue oxygen saturation and total hemoglobin. Was.

(4) Relationship between evaluation by physician palpation and corrected deep circulatory dynamics Evaluation of shoulder stiffness by palpation by physician and correction value of weaving oxygen saturation
6 (a) and 6 (b) show the relationship with [StO ₂ ] ₁ and the relationship between the evaluation of shoulder stiffness by palpation of a doctor and the correction value [totalHb] ₁ of the total hemoglobin amount, respectively.

Those who were evaluated as "no stiffness" by palpation of a physician and evaluated as "very strong stiffness" had significantly lower correction values for tissue oxygen saturation and total hemoglobin amount. Was.

The above (2), (3), (4), by using the correction value [totalHb] ₁ of the correction value [StO _{2] 1} to the total amount of hemoglobin tissue oxygen saturation, self-reported subject It can be understood that the degree of shoulder stiffness can be objectively evaluated, with good consistency with the evaluation by palpation and the evaluation by palpation of a doctor.

(5) Influence of Heat on Deep Circulation Dynamics In the evaluation of the subject's own stiff shoulders, for the five persons who evaluated that they were extremely stiff or stiff, the area around their shoulders was heated to dry heat (42 ° C. for 60 minutes). ) Or moist heat (42 ° C 6
0 minutes), the corrected value of the tissue oxygen saturation before and after each thermal treatment [StO ₂ ] ₁ , the corrected value of the total hemoglobin amount [to
talHb] ₁ , required self-reported evaluation of stiff shoulders. Here, the self-reported shoulder stiffness evaluation value was obtained by scoring the subject's own shoulder stiffness evaluation in the five stages A to E described above and taking the average.

A: Very elaborate ... 5 points B: Elaborate ... 4 points C: Slightly elaborate ... 3 points D: Not very elaborate ... 2 points E: Not elaborate ... 1 point

Table 1 shows the results.

[0048]

[Table 1] Before thermal heat 60 minutes after _{[StO 2] 1 [totalHb]} 1 self _{[StO 2] 1 [totalHb]} 1 Self (%) (g · cm / L) declaration (%) (g · cm / L) reported dry heat Heat 72.6 ± 1.8 292.5 ± 94.2 4.5 74.8 ± 2.02 313.6 ± 95.9 2.9 Wet heat 74.3 ± 1.5 295.3 ± 39.3 4.6 77.0 ± 1.7 317.4 ± 42.6 2.1

It can be seen from Table 1 that the heating of the dry heat or the wet heat eases the stiffness of the subject and improves the evaluation results of the deep circulation. Therefore, from these results, it is possible to satisfactorily evaluate shoulder stiffness by measuring deep circulatory dynamics, and to evaluate the effect of stiff shoulder treatment by measuring deep circulatory dynamics. It can be seen that it can be used as.

[0050]

According to the present invention, the tissue oxygen saturation or the total hemoglobin amount is measured as the deep circulation dynamics of the muscle tissue around the shoulder, so that the degree of stiffness can be objectively and reliably measured by a simple measurement operation. Can be evaluated.

Therefore, by using the shoulder stiffness evaluation system of the present invention, it is possible to examine the effect of various physical treatments or chemical treatments on shoulder stiffness. Further, the stiff shoulder evaluation system of the present invention can be used as a screening means for stiff shoulder treatment.

[Brief description of the drawings]

FIG. 1 is a block diagram of a deep circulatory dynamics measuring means.

FIG. 2 is an explanatory diagram of a calculation principle of a tissue oxygen saturation and a total hemoglobin amount.

FIG. 3 is a graph showing a relationship between a measured value of tissue oxygen saturation or a total hemoglobin amount (before correction) and BMI.

FIG. 4 is a graph showing the relationship between the corrected tissue oxygen saturation or total hemoglobin amount and BMI.

FIG. 5 is a diagram showing the relationship between the degree of shoulder stiffness due to self-report of a subject and the corrected tissue oxygen saturation or total hemoglobin amount.

FIG. 6 is a diagram showing the relationship between the degree of shoulder stiffness by palpation of a doctor and the corrected tissue oxygen saturation or total hemoglobin amount.

[Explanation of symbols]

 DESCRIPTION OF SYMBOLS 1 Light-emitting part 2 Light-receiving part 3 Operation processing part 10 Deep circulation dynamics measuring means

 ──────────────────────────────────────────────────続 き Continuing on the front page (72) Inventor Ichiro Tokiko 2606 Kabane-cho, Akaga-cho, Haga-gun, Tochigi Pref. In Kao Corporation Research Institute (72) Inventor Isamu Watanabe 2606, Kaiga-cho, Akabane-cho, Haga-gun, Tochigi Pref. Term (reference) 4C038 KK00 KK01 KL07 KM01

Claims (3)

[Claims] 1. A muscle tissue is irradiated with near-infrared light from the skin surface around the shoulder, the light scattered in the muscle tissue is received, the absorbance of the muscle tissue is determined, and the shoulder area is determined based on the absorbance. A shoulder stiffness evaluation system including a deep circulatory dynamics measuring means for obtaining tissue oxygen saturation or total hemoglobin amount in muscles of the head. 2. Tissue oxygen saturation or total hemoglobin amount calculated based on absorbance is measured using a Body Mass Index (BMI).
2. The shoulder stiffness evaluation system according to claim 1, wherein the correction is performed in accordance with the following formula, and a correction value of the tissue oxygen saturation or the total hemoglobin amount that is independent of the BMI is output. 3. Tissue oxygen saturation or total hemoglobin amount calculated based on absorbance is corrected according to subcutaneous fat thickness,
The shoulder stiffness evaluation system according to claim 1, wherein a correction value of the tissue oxygen saturation or the total hemoglobin amount independent of the subcutaneous fat thickness is output.