臺灣博碩士論文加值系統

研究背景與目的：肩關節夾擠症候群（shoulder impingement syndrome）是肩部常見的問題之一，易影響患者生活功能。肩胛關節本體感覺對於肩部動作品質扮演著重要的角色，有學者認為肌內效貼紮（kinesiology taping）能夠促進本體感覺，使動作正常化，避免再次受傷，但尚未有證據支持此理論。因此本篇研究的目的是要探討肌內效貼紮對肩夾擠症候群患者肩部本體感覺、肩胛運動學及肌肉活性的影響，並進一步討論本體感覺、肩胛運動學及肌肉活性三者之間的相關性。研究方法：本實驗收取30位肩關節夾擠症候群患者，分配至肌內效貼紮組及偽貼紮組（placebo taping group）兩組。以測量關節復位誤差來評估關節位置覺（joint position sense），肱盂關節於肩胛平面下手臂抬舉至60度及120度時測量；肩胛胸廓關節則於肩胛上提（elevation）、下移（depression）、前突（protraction）及後縮（retraction）四個動作下做測量。本實驗使用Liberty電磁式追蹤系統（Liberty electromagnetic tracking system, Polhemus, Colchester, VT, USA）收集三度空間中關節位置及動作，以及使用表面肌電圖儀（surface electromyograhy）收集上斜方肌（upper trapezius）、下斜方肌（lower trapezius）及前鋸肌（serratus anterior）的肌肉活性。統計分析：本體感覺之復位誤差資料使用二因子重複測量之變異數分析（Two-way repeated measures analysis of variance, ANOVA），各肌肉訊號分析及肩胛運動學則使用三因子重複測量之變異數分析，若基本資料或前測數值組間有所差異，則使用共變數分析（analyses of covariance, ANCOVA），檢定組別與貼紮之交互作用（interaction）。並用事後比較（post hoc）檢定組內前後測之差異，顯著水平α值定於0.05，組內與組間差異比較之α值以Bonferroni法調整後，設在小於0.017視為達到統計上之顯著差異。本體感覺及肩胛運動學與肌肉活性三者之相關性，則使用皮爾森相關係數（Pearson’s correlation coefficients）分析。結果：分析兩組貼紮前後肩部本體感覺、肩胛運動學及肌肉活性的改變，結果發現肩關節復位誤差兩組間無顯著交互作用（p>0.05）；肩胛關節於前突動作時之肩胛上/下轉角度（p=0.040）及前/後傾角度（p=0.044）復位誤差，兩組間有顯著交互作用，肌內效貼紮組貼紮後有顯著復位誤差的減少；探討肩胛運動學發現兩組間於肩胛前/後傾角度變項有組別與貼紮之交互作用（F=6.364, p=0.027），肌內效貼紮組貼紮後有顯著肩胛後傾的增加；探討肩胛肌肉活性則發現，肌內效貼紮並未顯著改變肩胛肌群的肌電活性，唯於肩胛平面放下120至90度時肌內效組內比較之下斜方肌肌電訊號有接近統計意義之趨勢（p=0.09）。此外，肩胛本體感覺與下斜方肌活性（R=－0.265，p=0.04）、肩胛後傾（R=－0.269，p=0.04）及肩胛上轉（R=－0.326，p=0.01）有低度相關性存在，有統計上之顯著意義。結論：本研究發現肌內效貼紮能夠改善肩夾擠患者肩胛本體感覺，並影響肩胛運動學。且肩胛本體感覺與下斜方肌活性、肩胛後傾及上轉有相關性存在。建議臨床可將肌內效貼紮作為介入方式之一，改善肩夾擠患者本體感覺缺損及肩胛控制不良問題。且評估肩關節問題時，需同時考量本體感覺、肌肉表現及關節運動學三者間之關聯。

Background and Objectives: Impingement syndrome is one of the most common disorders of the shoulder, which often results in functional limitation and disability. Proprioception plays an important role in improving movement quality of the shoulder complex and some believe that scapular proprioception can be enhanced by kinesiology taping. But, evidence to support this hypothesis is limited. Therefore, the purposes of this study are to investigate the effect of kinesiology taping on proprioception of scapulothoracic and glenohumeral joint, scapular kinematics and muscle activity, and the relationship among the three. Methods: Thirty patients with shoulder impingement syndrome were recruited and randomly assigned into kinesiology taping or placebo taping group in this study. The joint position sense (JPS) was measured as the reposition errors at 60° and 120° arm elevation in the scapular plane (scaption) for the glenohumeral joint, and in the direction of scapular elevation, depression, protraction and retraction for the scapulothoracic joint. Liberty electromagnetic tracking system (Polhemus, Colchester, VT, USA)was used to collect the joint orientation and position. Surface electromyography (TeleMyo 2400T G2, Noraxon USA Inc, Scottsdale, AZ)was used to collect the muscle activity of upper trapezius (UT), lower trapezius (LT) and serratus anterior (SA). Statistical Analysis: Two-way repeated measures analysis of variance (ANOVA) was used to compare the joint reposition error of the glenohumeral and the scapulothoracic joint and three-way repeated measures analysis of variance was used to analyze scapular kinematics and muscle activity before and after taping. Pearson’s correlation coefficient was used to describe the relationship among the reposition errors, scapular kinematics and muscles activity. The level of significance was set at α=0.05. Results: Compared with placebo taping, kinesiology taping significantly decreased the reposition errors of the upward/downward rotation (p=0.040) and anterior/posterior tilt (p=0.044) when performing scapular protraction, increased posterior tilt (F=6.364, p=0.027) during scaption. Scapular proprioception was related to the muscle activity of lower trapezius (－0.265，p=0.04), scapular posterior tilt (R=－0.269，p=0.04) and upward rotation (R=－0.326，p=0.01). Conclusions: Our study verified the effects of kinesiology taping on scapular proprioception, kinematics, muscle activity and the relationship among the three. We recommended that kinesiology taping could be used as an intervention tool to improve the proprioception and neuromuscular control of the shoulder complex in the individuals with shoulder impingement syndrome.

目錄
謝誌 i
目錄 ii
表目錄 v
圖目錄 viii
附錄目錄 x
中文摘要 xiii
Abstract xv
第一章 簡介 1
第一節 研究背景與動機 1
第二節 研究目的 2
第三節 研究假設（問題） 2
第四節 重要性 2
第二章 文獻回顧 3
第一節 肩關節夾擠症候群 3
第二節 本體感覺 6
第三節 肌內效貼布（Kinesiology Tape） 8
第四節 肩部本體感覺、肩胛運動學及肩胛肌群肌電訊號相關性研究 13
第五節 綜合文獻討論 14
第三章 研究方法 15
第一節 研究設計與研究架構 15
第二節 研究材料與研究方法 15
一、 研究對象 15
二、 研究工具 16
三、 研究測試項目與步驟 20
四、 介入方式 26
五、 研究流程 26
第三節 資料處理與分析方法 27
一、 資料處理 27
二、 統計分析 28
第四章 結果 30
第一節 受測者基本資料及前測資料 30
第二節 肩關節本體感覺 31
第三節 肩胛關節本體感覺 31
第四節 肩胛運動學 32
第五節 肩胛肌群肌電訊號 33
第六節 本體感覺、肩胛運動學及肩胛肌群肌電訊號之相關性 34
第五章 討論 37
第一節 受測者基本資料 37
第二節 肩胛運動學 38
第三節 肩胛肌群肌電訊號 39
第四節 肩關節本體感覺 40
第五節 肩胛關節本體感覺 42
第六節 本體感覺、肩胛運動學及肩胛肌群肌電訊號相關性討論 43
第七節 臨床應用 44
第八節 研究限制及未來研究方向 45
第六章 結論 47
參考文獻 48


表目錄
表1、各肢段解剖座標軸定義-採國際生物力學學會（International Society of Biomechanics, ISB）之建議 56
表2、受測者基本資料 57
表3、肌內效貼紮組及偽貼紮組理學檢查資料之組間差異比較 58
表4、肩關節本體感覺測試-前測資料之組間差異比較 59
表5、肩胛關節本體感覺測試-前測資料之組間差異比較 60
表6、肩胛關節本體感覺測試-前測資料之組間差異比較 61
表7、肩胛運動學測試（肩胛前/後傾角度）-前測資料之組間差異比較 62
表8、肩胛運動學測試（肩胛內/外轉角度）-前測資料之組間差異比較 63
表9、肩胛運動學測試（肩胛上/下轉角度）-前測資料之組間差異比較 64
表10、肩胛肌群肌電活性（上斜方肌）-前測資料之組間差異比較 65
表11、肩胛肌群肌電活性（下斜方肌）-前測資料之組間差異比較 66
表12、肩胛肌群肌電活性（前鋸肌）-前測資料之組間差異比較 67
表13、貼紮前後肩關節於肩胛平面抬舉至60°目標位置復位誤差之組間差異比較 68
表14、貼紮前後肩關節於肩胛平面抬舉至120°目標位置復位誤差之組間差異比較 69
表15、貼紮前後肩胛上提動作復位誤差之組間差異比較 70
表16、貼紮前後肩胛下移動作復位誤差之組間差異比較 71
表17、貼紮前後肩胛前突動作復位誤差之組內及組間差異比較 72
表18、貼紮前後肩胛後縮動作復位誤差之組間差異比較 73
表19、貼紮對於肩夾擠症候群患者在肩關節屈曲動作時肩胛前/後傾角度差異 74
表20、貼紮前後肩胛運動學（肩胛前/後傾角度）之組內及組間差異比較 75
表21、貼紮對於肩夾擠症候群患者在肩關節屈曲動作時肩胛內/外轉角度差異 76
表22、貼紮前後肩胛運動學（肩胛內/外轉角度）之組內及組間差異比較 77
表23、貼紮對於肩夾擠症候群患者在肩關節屈曲動作時肩胛上/下轉角度差異 78
表24、貼紮前後肩胛運動學（肩胛上/下轉角度）之組內及組間差異比較 79
表25、貼紮對於肩夾擠症候群患者在肩關節屈曲動作時上斜方肌肌電訊號差異 80
表26、貼紮前後肩胛肌群（上斜方肌）肌電訊號之組間差異比較 81
表27、貼紮對於肩夾擠症候群患者在肩關節屈曲動作時下斜方肌肌電訊號差異 82
表28、貼紮前後肩胛肌群（下斜方肌）肌電訊號之組內及組間差異比較 83
表29、貼紮對於肩夾擠症候群患者在肩關節屈曲動作時前鋸肌肌電訊號差異 84
表30、貼紮前後肩胛肌群（前鋸肌）肌電訊號之組間差異比較 85
表31、肩胛關節復位誤差與肩胛肌群活性之相關性分析 86
表32、肩胛關節復位誤差與肩胛肌群活性之相關性分析 87
表33、肩胛關節復位誤差與肩胛運動學之相關性分析 88
表34、肩胛關節復位誤差與肩胛運動學之相關性分析 89
表35、肩胛運動學與肩胛肌群活性之相關性分析 90

圖目錄
圖1、實驗流程圖 91
圖2、各感測接受器及電極片之放置 92
圖3、被動肩關節屈曲活動度之量測 93
圖4、被動肩關節伸直活動度之量測 94
圖5、被動肩關節外展活動度之量測 95
圖6、被動肩關節外旋活動度之量測 96
圖7、被動肩關節內旋活動度之量測 97
圖8、上斜方肌最大等長肌力測試姿勢 98
圖9、下斜方肌最大等長肌力測試姿勢 99
圖10、前鋸肌最大等長肌力測試姿勢 100
圖11、測試肩胛前突與後縮本體感覺之移動木架 101
圖12、肩關節本體感覺測試位置 102
圖13、肩胛上提與下移本體感覺之測試位置 103
圖14、肩胛前突與後縮本體感覺之測試位置 104
圖15、肩胛運動學及肩胛肌群肌電活性之測試位置 105
圖16、肌內效貼紮方式 106

附錄目錄
附錄一 台北榮民總醫院 人體試驗暨倫理委員會 同意臨床試驗證明書 107
附錄二 前驅實驗一： 同日內施測 者信度檢 109
附錄三 前驅實驗二： 肌內效貼紮對健康受試者肩胛關節本體感覺的影響 120
附表 1、肩關節復位誤差之同日內施測者再信度 127
附表 2、肩胛關節本體感覺同日內施測者再信度：下移之復位誤差 128
附表 3、肩胛關節本體感覺同日內施測者再信度：上提之復位誤差 129
附表 4、肩胛關節本體感覺同日內施測者再信度：前突之復位誤差 130
附表 5、肩胛關節本體感覺同日內施測者再信度：後縮之復 位誤差 131
附表 6、肩胛運動學同日內施測者再信度：上 /下轉 132
附表 7、肩胛運動學同日內施測者再信度：前 /後傾 133
附表 8、肩胛運動學同日內 施測者再信度：/外轉 134
附表 9、以最大等長自主收縮來正規化肩胛肌群的電訊號之同日內施測者信度檢測：上斜方肌 135
附表 10 、以最大等長自主收縮來正規化肩胛肌群的電訊號之同日內 施測者、以最大等長自主收縮來正規化肩胛肌群的電訊號之同日內 施測者信度 檢測：下斜方肌 xi
附表 11 、以最大等長自主收縮來正規化肩胛肌群的電訊號之同日內施測者信度 、以最大等長自主收縮來正規化肩胛肌群的電訊號之同日內施測者信度 檢測：前鋸肌 137
附表 12 、各肌肉之最大等長力測 試同日內施者信度檢 138
附表 13 、肩關節活動度量測 之同日內施者信檢 139
附表 14 、受測者基本資料 140
附表 15 、理學檢查資料之組間差異比較 141
附表 16 、介入前後肩胛突動作復位誤差之組間異比較 142
附表 17 、介入前後肩胛縮動作復位誤差之組間異比較 143
附表 18 、介入前後肩胛上提動作復位誤差之 組間差異比較 144
附表 19 、介入前後肩胛下移動作復位誤差之組間異比較 145
附表 20 、貼紮對於健康受試者在肩關節屈曲動作時胛前 /後傾角度差異 146
附表 21 、介入前 後肩胛運動學（/後傾角度）之組間差異比較 147
附表 22 、貼紮對於健康受試者在肩關節屈曲動作時胛內 /外轉角度差異 148
附表 23 、介入前後肩胛運動學（內 /外轉角度）之組間差異比較 149
附表 24 、貼紮對於健康受試者在肩關節屈曲動作時胛上 /下轉角度差異 150
附表 25 、介入前後肩胛運動學（上 /下轉角度）之組間差異比較 151
附表 26 、貼紮對於健康受試者在肩關節屈曲動作時上斜方肌電訊號差異 152
xii
附表 27 、介入前後肩胛肌群（上斜方）電訊號之組間差異比較 153
附表 28 、貼紮對於健康受試者在肩關節屈曲動作時下斜方肌電訊號差異 154
附表 29 、介入前後肩胛肌群（下斜方）電訊號之組間差異比較 155
附表 30 、貼紮對於健康受試者在肩關節屈曲動作時前鋸肌電訊號差異 156
附表 31 、介入前後肩胛肌群（鋸）電訊號之組間差異比較 157
附表 32 、肩胛活動度（最大位移量之 90% ） 158

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