臺灣博碩士論文加值系統

中文摘要 近年來發生日常生活中意外滑
倒或運動中跌倒造成肩,肘及腕關節的創傷和外傷性關節炎逐漸增加,在臨
床上更有許多人工關節置換,然而因上肢關節的活動度大,且常處於動態負
荷情形下,導致人工關節的鬆弛和移位而失去正常功能.因此,上肢關節在
日常生活活動中,其動態受力情形及創傷時的受力情形,我們透過實驗模
擬,希望能進一步了解上肢各關節受傷的機轉. 本實驗的設計是以手部在
六種不同著地位置(Normal, Apart, Together, Superior, Inferior,
2nd Normal),對10位健康且慣用右手的男性作伏體挺身運動(push-up),然
後擷取腕關節,肘關節及肩關節在伏體挺身運動中的受力情形,並建立一個
資料庫(database),以比較手部著地位置對上肢關節受力的影響.在本研究
中是結合了動態分析系統(MotionAnalysis System)和測力板系統(AMTI
Force Plate)透過生物力學的數學模式由逆向動力學原理並利用電腦程式
來計算各關節在不同著地位置作伏體挺身所受的合力及合力矩. 實驗結
果顯示,當手部位置Normal時肘,腕關節的最大軸向受力約為46.9%的個人
體重,假如手部著地位置是Apart或Superior時,則其最大軸向受力有明顯
減小的趨勢;而肩關節部分則在Anterior-posterior方向受較大的作用力,
而這個方向的力影響著肩關節的穩定度,在Normal位置時最大受力約46.3%
的個人體重.在Flexion moment方面在Normal位置肘關節的最大值
約1658.8N-cm約50.6% Maximal isometric extensor torque,而當手部位
置為Apart, Together時其各約為30%,70.2% Maximal isometric
extensortorque,肩關節在Normal位置所受最大Extension moment
約6203.8 N-cm,而在Inferior位置則明顯增加為7397.2N-cm.而沿著前臂
軸方向的最大力矩在Normal位置時產生296.6N-cm(pronation)或約為33%
Maximal isometricsupinator torque,肘關節的Valgus moment約998.6N-
cm,這個外翻的力矩是由肘關節內側韌帶及其幾何形狀來達成平衡,而當手
部位置為Superior時,則Valgus moment明顯增加為1160N-cm. 肩關節方
面在Superior和Inferior的位置下其所量測的力矩值明顯與Normal位置不
同,Superior位置所受力矩值明顯減少;Inferior位置所受的立矩值則明顯
增加.對於這樣的差異情形肩關節在不同位置時則採用不同的策略來動作,
讓受試者以較易施力的方式來完成push-up.當手部位置為Superior時,則
肩關節採外張的方式;當手部位置為Inferior時,則肩關節改採用內收策
略.由這些分析的結果可以讓我們清楚地了解在push-up過程上肢關節的運
動及最大受力的情形,以期這些結果能對上肢創傷機轉的了解而進一步有
助於在臨床上對上肢創傷的治療與復健.

Abstract Recently, as the incidence of trauma and arthritis
increases in the upperextremity, clinical use of the total
prosthesis for rheumatoid and post-traumaticarthritis and the
resulting complications of prosthetic loosening the
dislocationhave instigated the need to further understand the
mechanism of joint disorderin the shoulder, the elbow, and the
wrist joint. Hence, we will investigate thestatic and dynamic
forces within the joints during simulated loading of theupper
extremity. In this research, there are six sets of push-up
exercises with differenthand positions(Normal, Apart, Together,
Superior, Inferior, 2nd Normal). Tenhealthy male subjects,who
were functionally right-handed, were instructed toperform a
''slow'' push-up of approximately 4 sec duration.
Intersegmentalloading pattern across the upper extremity will be
studied and recorded to establish a database; then, it will be
compare the relationship between differenthands position and
joint loading across the upper extremity during push-upexercise.
In this study was combined Motion Analysis System and Force
PlateSystem over the biomechanical model, inverse dynamics and
computer programsto calaulate the joint force and joint moment
by push-up exercises with differenthand positions. Experiment
has shown that peak forces exerted on the elbow and wrist joint
along the forearm axis averaged 46.9% of the the body weight for
the''Normal'' hand position and were significantly decreased if
hands werepositioned either ''apart'' or ''superior'' from ''normal'';
furthermore, the peakforces exerted on the shoulder joint are
the anterior-posterior shear force whichbrought a unstable
foundation averaged 46.3% of the body weight for the''normal''
hand position. The peak torque in the ''normal'' position tends
toproduce elbow flexion and was 1658.8 N-cm(50.6% of the maximal
isometric extensor torque), also if hands were positioned
''Apart'' and ''Together''averaged 30%, 70.2% of the maximal
isometric extensor torque. The maximalextension moment in the
''normal'' position tend to produce shoulder extensionand was
6203.8 N-cm, also if hands were positioned ''inferior'', the
extensionmoment was significantly swelled to 7397.2 N-cm. The
maximal torque aboutthe forearm axis is tended to produce
forearm with a mean value of296.6 N-cm (33% of the maximal
isometric supinator torque). The maximalvalgus torque at the
elbow opposed by the medial ligamentous and geometricstructure
was 998.6 N-cm and was significantly swelled to 1160 N-cm if
thehand was positioned ''superior''. They have shown the
different moments are exerted on the shoulder ifhands were
positioned either ''superior'' or ''inferior'' from ''normal''.
Thepeak torque was significantly decreased if hands were
positioned ''superior'';teh peak torque was significantly
increased if hands were positioned ''inferior''.Toward the
differences between ''superior'' and ''inferior'',the shoulder
adoptsthe different strategy to push-up. Hands positioned
''superior'' are the splay out;''inferior'' retact. The results in
this study let us understand the pattern of thekinematics and
the kinetics during push-up exercises, and will warrant a
greaterunderstanding of the mechanism of injury extremity.
Furthermore,these data will be helpful in clinical treatment and
rehabilitation.