臺灣博碩士論文加值系統

背景:體重過重是重要的健康問題，亦是疾病的危險因子，如因不 當的下肢關節承重，出現下肢關節排列異常。過去鮮少探討體重過 重者髕股骨疼痛症候群的膝關節排列與相關肌肉的表現特徵。因 此，本研究目的是探討體重過重成人其膝關節排列與相關膝關節肌 力、柔軟度及肌耐力，與髕股骨疼痛症候群的關係。
方法:本研究招募對象為體重過重成人，年齡於 20 至 65 歲間，及 身體質量指數(BMI) ≧24 公斤/公尺 2。量測項目為以視覺類比量尺 表示前膝疼痛強度，KUJALA 分數問卷評估前膝疼痛症狀及功能。 以量角器測量股四頭肌角度 (Q-angle)、以攝影機記錄下蹲時的膝關 節排列，經軟體 2D MaxTRAQ (Innovision Systems, Columbiaville, MI, USA)輔助分析計算外翻角度。以傾角器 (ISOMED, PO Box 22248, USA)量測膝關節肌肉柔軟度，包括股四頭肌，腿後肌群、股 四頭肌、髂脛束、腓腸肌及比目魚肌。而肌力測試則以手持測力器 (Micro FET3. Hoggan Health Industries Inc, West Jordan, UT, USA) 量 測。以一分鐘反覆坐站次數表示下肢肌耐力。依分組之條件分為髕 股骨疼痛組或無痛組進行資料分析。統計分析以平均值、標準差等 進行描述性統計，兩組間以獨立 t 檢定進行推論性統計，由皮爾森 相關性分析探討量測值間的相關性。
結果:本研究共計 55 位受試者完成，其中髕股骨疼痛組有 21 位， 平均年齡為 38.4±10.9 歲。BMI 平均為 30.7±6.3 公斤/公尺 2，前膝疼痛強度平均為 3.4±1.2 分，KUJALA 分數平均為 88±5.4 分。有 34 位為無痛組，平均 BMI 為 28.3±3.9 公斤/公尺 2，前膝疼痛強度平 均為 0.2±0.6 分，KUJALA 分數平均為 99.5±1.2 分。相較於無痛組， 髕股骨疼痛組的 BMI (p= 0.02)、前膝疼痛 (p< 0.05)及 KUJALA 分數 問卷 (p< 0.05)顯著嚴重。體重過重的成人下肢動態膝關節排列呈現 膝關節外翻，BMI 及體脂肪越高、較趨近於膝關節內翻，但而膝關 節站蹲排列及肌肉表現未顯示兩組間統計的差異。相關性分析顯 示，BMI 及體脂肪與膝關節動態排列，髖關節及膝關節肌力呈現顯 著負相關。體脂肪與非患側或非慣用側之 Q 角度呈現顯著正相關， 而肌肉量與 Q 角度呈現顯著負相關，與患側或慣用側的單腳下蹲呈 現顯著正相關。BMI 與柔軟度之股四頭肌、非患側腳或非慣用腳的 髂脛束呈現顯著的正相關，而體脂肪與腿後肌群、股四頭肌柔軟度 呈現顯著正相關，肌肉量與髂脛束、腓腸肌柔軟度呈現顯著的正相 關，則與患側或慣用側的腿後肌群柔軟度呈現顯著的負相關。肌肉 量與髖關節內轉肌力呈現顯著的負相關。下肢肌耐力僅與體脂肪呈 現顯著的負相關 (r=-0.39, p<0.05)。
結論:本研究的結果顯示，體重過重的成人下肢動態膝關節排列受 BMI 及體脂肪而改變，且 BMI 可為下肢動態膝外翻角度的預測參 數。體脂肪量對於非患側或非慣用側，及肌肉量對於患側或慣用側 之單腳下蹲與 Q 角度有關。BMI 與體脂肪對於下肢雙關節肌群的柔 軟度有相關。BMI 及體脂肪越高與下肢肌力表現越差有相關。而過 多的體脂肪與下肢肌耐力表現有相關性。體重過重的成人其 BMI 與體脂肪量或肌肉量確實與膝關節排列與肌力及柔軟度有關，因此應 積極控制體重以避免對下肢骨骼肌肉系統不當影響與惡化。

Background: Overweight has been recognized as a major public health problem and a risk factor for musculoskeletal system disorders developing from malalignment of the knee. In addition, malalignment of the lower extremities is a predisposing factor for patellofemoral pain syndrome (PFPS). The symptoms of PFPS consist of anterior knee pain, larger Q-angle, knee valgus, and muscle imbalance (strength and flexibility). Issues related to knee joint alignment and muscle performance in overweight individuals have rarely been explored. Thus, the purpose of this study was to investigate the relationships between knee joint alignment during single leg squatting and relative muscle flexibility, strength, and endurance in overweight adults with PFPS.
Methods: We recruited subjects aged 20 to 65 years with body mass indexes (BMI) ≥ 24 kg/m2. The measures tested consisted of Q-angle, dynamic knee valgus during single leg squatting, and muscle flexibility, strength, and endurance. Q-angle was measured by goniometer, and the dynamic knee valgus for the knee joint angle was photographed during single leg squatting and calculated using 2D MaxTRAQ software (Innovision Systems, Columbiaville, MI, USA). Muscle strength was measured by handheld dynamometer (Micro FET3; Hoggan Health Industries, West Jordan, UT, USA). In addition, flexibility of the hamstring, quadriceps, iliotibial band, gastrocnemius, and soleus were tested by inclinometer (ISOMED, PO Box 22248, USA). A one-minute sit to stand test was used to assess the muscle endurance of the lower extremities. Participants were assigned to a PFPS group or the non-PFP group based on inclusion and exclusion criteria. Descriptive statistics were used to determine mean and frequency, and independent sample t-tests were used to test for differences between two groups. Pearson correlation coefficients were calculated for correlation analysis among measures.
Results: A total of 55 subjects (mean age 38.4 ± 10.9 years) were recruited. Of these, the 21 subjects comprising the PFPS group showed a mean BMI value of 30.7 ± 6.3 kg/m2, pain intensity by Visual Analog Scale (VAS) of 3.4 ± 1.2, and KUJALA score of 88 ± 5.4. The remaining 34 subjects were in the non-PFPS group (mean BMI of 28.3 ± 3.9 kg/m2, VAS of 0.2 ± 0.6, and KUJALA score of 99.5 ± 1.2). BMI, VAS, and KUJALA scores in the PFPS group were significantly greater than in the non-PFPS group. However, there were no differences in knee alignment and muscle performance of the lower extremities between the two groups. Correlation analyses showed that BMI and body fat were negatively associated with dynamic knee valgus and muscle strength. Body fat was positively correlated and muscle mass was negatively correlated with Q-angle. BMI was correlated with flexibility of the quadriceps and iliotibial band. In addition, body fat was correlated with flexibility of the hamstring and quadriceps. Muscle mass was associated with flexibility of the iliotibial band and gastrocnemius; however, it was negatively correlated with hamstring flexibility and hip internal rotation. Body fat was associated with muscle endurance (r = -0.39, p < 0.05).
Conclusions: The overweight adults revealed dynamic knee valgus alignment during single leg squatting tests. BMI was associated with dynamic knee valgus, flexibility of the quadriceps and iliotibial band, and muscle strength. Body fat was associated with Q-angle, dynamic knee valgus, flexibility of the hamstring and quadriceps, muscle strength, and endurance. In contrast, muscle mass was associated with Q-angle, single leg squatting, flexibility of the iliotibial band, gastrocnemius, and hamstring, and muscle strength of hip internal rotation. Our findings thus suggest implementing a muscle strengthening and stretching program, as well as correction of the dynamic knee valgus alignment, in overweight adults with PFPS. This could delay knee pain and degenerative deterioration.

目錄
指導教授推薦書 …………………………………………………………
口試委員會審定書 ………………………………………………………
致謝 ……………………………………………………………………iii
中文摘要 ………………………………………………………………iv
英文摘要 ………………………………………………………………vii
目錄 ……………………………………………………………………x
圖目錄 …………………………………………………………………xii
表目錄 ………………………………………………………………xiii
第一章 緒論 ……………………………………………………………1
1.1 研究背景與動機 ………………………………………………1
1.2 研究目的 ………………………………………………………2
第二章 文獻回顧 ………………………………………………………3
2.1 髕股骨關節 ……………………………………………………3
2.2 髕股骨症候群 …………………………………………………3
2.3 體重過重與髕股骨疼痛症候群之關係 ………………………4
2.4 髕股骨疼痛症候群與下肢膝關節排列之關係 ………………5
2.5 髕股骨疼痛症候群之下肢肌肉表現 …………………………7
2.6 研究假設 ………………………………………………………9
第三章 研究方法 ……………………………………………………11
3.1 研究設計 ……………………………………………………11
3.2 研究對象 ……………………………………………………11
3.3 研究流程 ……………………………………………………12
3.4 測量項目與工具 ……………………………………………13
3.5 統計分析 ……………………………………………………22
第四章 結果 …………………………………………………………34
第五章 討論 …………………………………………………………50
5.1 受試者特徵 …………………………………………………50
5.2 下肢膝關節排列 ……………………………………………51
5.3 下肢柔軟度表現 ……………………………………………54
5.4 下肢肌力表現 ………………………………………………56
5.5 下肢肌耐力表現 ……………………………………………58
5.6 研究限制 ……………………………………………………59
第六章 結論 …………………………………………………………60
參考文獻 ………………………………………………………………61
附錄一 受試者基本資料 ……………………………………………66
附錄二 KUJALA Anterior Knee Pain Scale …………………………67


圖目錄
圖3.1 研究流程圖 ……………………………………………………24
圖3.2 視覺類比量尺 …………………………………………………25
圖3.3 身體組成分析 …………………………………………………26
圖3.4 靜態膝關節Q角度測量工具及方式 …………………………27
圖3.5 動態膝關節排列測量 …………………………………………28
圖3.6 柔軟度測試工具與肌群測量 …………………………………29
圖3.7 柔軟度之肌群測量 ……………………………………………30
圖3.8 肌力測試工具及肌群測量 ……………………………………31
圖3.9 肌力之肌群測量 ………………………………………………32
圖3.10 肌耐力測試方式 ……………………………………………33

表目錄
表4.1 受試者基本特徵 ………………………………………………37
表4.2 下肢膝關節排列及肌肉表現 …………………………………38
表4.3 依肥胖等級分組下肢膝關節排列及肌肉表現的比較 ………39
表4.4 身體質量指數與膝關節排列的相關性 ………………………40
表4.5 身體質量指數與下肢柔軟度的相關性 ………………………41
表4.6 身體質量指數與下肢肌力、肌耐力的相關性 ………………42
表4.7 體脂肪與下肢膝關節排列的相關性 …………………………43
表4.8 體脂肪與下肢柔軟度的相關性 ………………………………44
表4.9 體脂肪與下肢肌力、肌耐力的相關性 ………………………45
表4.10 肌肉量與下肢關節排列的相關性 …………………………46
表4.11 肌肉量與下肢柔軟度的相關性 ……………………………47
表4.12 肌肉量與下肢肌力、肌耐力的相關性 ……………………48
表4.13 身體質量指數與下肢膝關節排列的線性迴歸 ……………49

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