臺灣博碩士論文加值系統

膝關節韌帶斷裂損傷在國內外皆為一種常見的運動傷害，未必侷限於運動員，其影響層面相當廣泛。因前十字韌帶構造影響，撕裂傷並不適合進行修補，因此前十字韌帶重建術便是最常見的手術之一。現時，大部份的重建術都能以內窺鏡手術去進行。以往單束固定綑綁雖然在恢復膝關節功能上有改進，但對於膝關節結構的穩定度並不足夠，部分案例也會出現不穩定或者位移，甚至可能發展成退化性關節。透過幾個體外運動測試、翻轉及旋轉測試，結果顯示靠單束重建並不足以控制膝關節旋轉負載和外翻力矩。
本文開發一可量測膝關節旋轉及內外翻並且將膝關節鬆弛度透過旋轉測試後的數據量化的儀器，得以更清楚地瞭解前十字韌帶損傷和正常膝蓋比較結果，且能驗證手術是否成功地重建膝關節。主要功能包括：對前/後十字韌帶與內/外副側韌帶進行內外翻、內外旋轉量測。高靈敏度與數據重現性。操作容易，降低使用者經驗之影響。具良好的數據顯示與考量人因工程之介面設計。

The Knee ligament broken of the fission damage is the common sports damage in domestic and overseas. It’s not confined to sportsman, that is affect of the wide range in aspects. Because the Structure effect of anterior cruciate ligament (ACL), the laceration is not suitable to carry out remedial. Therefore, anterior cruciate ligament reconstruction is one of the most common surgical. At present, the majority of reconstruction can be made use of endoscopic surgery. Although previous single-beam fixed bundled in the recovery knee function of improved, but for the stability of the knee structure is not enough, in some cases will be unstable or displacement, and may even develop into the degenerative joint. Through several vitro exercise testing、flip and rotate the test, the results showed that rely on single-bundle reconstruction is not sufficient to control the rotation and valgus torque on the knee load.
In this study, develop of a can be measured knee rotation and turned inside and outside, in addition to through the instrument to quantify the knee laxity rotation test data, can be more clearly understand the and compare with results for anterior cruciate ligament injury and normal knee, and can verify whether the operation succeeded in reconstructing the knee. The main function include：The ACL, PCL, MCL, LCL of Knee ligament conducted varus and valgus angulation , internal and external rotation measurements. High sensitivity and data reproducibility. Operation easier and reduce the impact of the user experience. With good evidence that the consideration due to the interface of the project design.

目錄
致謝.............................................................................................................I
中文摘要...................................................................................................II
英文摘要..................................................................................................III
章節目錄..................................................................................................IV
圖目錄......................................................................................................VI
表目錄......................................................................................................XI
第一章 緒論..............................................................................................1
1.1 前言..............................................................................................1
1.2 研究背景......................................................................................2
1.2.1 膝關節構造........................................................................2
1.2.2 膝關節韌帶鬆弛度檢測..................................................9
1.3 文獻回顧....................................................................................12
1.4 新式量測方法研究動機............................................................19
1.5 論文架構....................................................................................21
第二章 新型膝關節韌帶測試系統之設計程序....................................22
2.1 市場需求....................................................................................23
2.2 問題敘述....................................................................................24
2.3 概念設計....................................................................................25
2.4 主體結構....................................................................................26
第三章 實驗設備與架構........................................................................30
3.1 研發之量測系統........................................................................30
3.1.1 硬體設備..........................................................................30
3.2 實驗流程架構............................................................................41
3.3 實驗對象....................................................................................44
3.4 實驗概述....................................................................................45
第四章 研究結果與分析........................................................................50
4.1 一般族群受同一受測者左右腳比較分析................................52
4.2 一般族群同一受測者與不同施測者之重現性評估................65
4.3 特殊族群同一受測者左右腳比較分析....................................78
4.4 特殊族群同一受測者與不同施測者之重現性評估................91
4.5 分析整理..................................................................................104
第五章 結論與未來展望......................................................................106
5.1 結論.........................................................................................106
5.2 未來展望.................................................................................107
參考文獻................................................................................................108
附錄A-1.................................................................................................111
附錄A-2.................................................................................................114
附錄B.....................................................................................................116

參考文獻
[1]. Bupa, Lateral collateral ligament injury, http://www.bupa.co.uk/individuals/health-information/directory/k/knee-ligament-injuries
[2]. Sagittal Plane, From Wikipedia, The Free Encyclopedia, http://en.wikipedia.org/wiki/Sagittal_plane
[3]. Muscular System, Functions and its Muscular Tissue and Cell, http://ptstudent.blogspot.tw/2011/09/muscular-system-fuctions-and-its.html
[4]. 陳志華，骨科運動醫學，二版，台北，力大圖書公司，民國九十九年。
[5]. S. Boisgarda, G. Versier, S. Descamps, S. Lustig , C. Trojani, P. Rosset, D. Saragaglia, P. Neyret, “Bicruciate ligament lesions and dislocation of the knee: Mechanisms and classification,” Orthopaedics &; Traumatology: Surgery &; Research, Vol. 95, pp. 627-631, September 2009.
[6]. 許文銘，「新型膝關節韌帶量測裝置之開發」，國立中央大學光機電工程研究所，碩士論文，民國九十六年。
[7]. PFPS - PATELLOFEMORAL PAIN SYNDROME , http://www.coachroblowe.com/injuries-lower-knee-pfps-overview.htm
[8]. Wrist Fixation Device for Elbow Stress Examination, US Patent No. 5462068, Oct. 31, 1995.
[9]. Wrist Fixation Device for Elbow Stress Examination, US Patent No. 5724991, Mar. 10, 1998.
[10]. Device and Method for Evaluating Injuries to Ligments, US Patent No. 6419645, Jul. 12, 2002.
[11]. Carrie L. Docherty and Katherine Rybak-Webb., “Reliability of the Anterior Drawer and Talar Tilt Tests Using the LigMaster Joint Arthrometer,” Journal of Sport Rehabilitation, Vol. 18, pp. 389-397, 2009.
[12]. LigMasterTM User’s Manual, 2003, Sport Tech Inc., downloadable from http://www.ligmaster.com
[13]. Jong Keun Seon, Sang Jin Park, Keun Bae Lee, Taek Rim Yoon, Hyoung Yeon Seo, Eun Kyoo Song “Stability comparison of anterior cruciate ligament between double- bundle and single-bundle reconstructions”, International Orthopaedics, vol.33, pp.425-429, 2009.
[14]. Andrew G Tsai, Volker Musahl, Hanno Steckel, Kevin M Bell, Thore Zantop, James J Irrgang, Freddie H Fu, ”Rotational knee laxity: Reliability of a simple measurement device in vivo”, BMC Musculoskeletal Disorders, vol. 9, No. 35, 2008
[15]. R. Dana Carpenter, Sandra J. Shefelbine, Jesus Lozano, Julio Carballido-Gamio, Sharmila Majumdar “A New Device for Measuring Knee Rotational Kinematics Using Magnetic Resonance Imaging”, Journal of Medical Devices, vol. 2 , 044501-1-044501-5, 2008
[16]. Daisuke Araki, Ryosuke Kuroda, Seiji Kubo, Norifumi Fujita, Katsumasa Tei, Koji Nishimoto, Yuichi Hoshino, Takehiko Matsushita, Tomoyuki Matsumoto, Koki Nagamune, Masahiro Kurosaka” A prospective randomised study of anatomical single-bundle versus double-bundle anterior cruciate ligament reconstruction: quantitative evaluation using an electromagnetic measurement system”, International Orthopaedics, vol.35, pp.439-446, 2011.
[17]. Guo Lin,Yang Liu, Yang Chang-qi, Zhao Shi-zhi, Tang Liang, Han Xue-song, “Dynam icmechanicalstudyofanteriorcruciate ligamentbyafour quadrantzoning method”, Journal of Medical Biomechanics, vo1.22, No.4, December 2007.

[18]. Yasutaka Tashiro, Ken Okazaki, Hiromasa Miura, Shuichi Matsuda, Takefumi Yasunaga, Makoto Hashizume, Yoshitaka Nakanishi, Yukihide Iwamoto, “Quantitative Assessment of Rotatory Instability After Anterior Cruciate Ligament Reconstruction”, The American Journal of Sports Medicine, Vol. 37, No. 5 ,pp. 909-916 , 2009 .
[19]. Mak-Ham Lam, Daniel TP Fong, Patrick SH Yung, Eric PY Ho, Wood-Yee Chan, Kai-Ming Chan, ” Knee stability assessment on anterior cruciate ligament injury:Clinical and biomechanical approaches”, Sports Medicine, Arthroscopy, Rehabilitation, Therapy &; Technology, vol.1 , No. 20 , 2009
[20]. Toshiaki Izawa, Ken Okazaki, Yasutaka Tashiro, Hirokazu Matsubara, Hiromasa Miura, Shuichi Matsuda, Makoto Hashizume, Yukihide Iwamoto, “ Comparison of Rotatory Stability After Anterior Cruciate Ligament Reconstruction Between Single-Bundle and Double-Bundle Techniques”, The American Journal of Sports Medicine, Vol. 39, No. 7 ,pp. 1470-1477 , 2011 .
[21]. Knee Ligament Testing System, US Patent No. 4583555, Apr. 22, 1986.
[22]. Knee Ligament Testing Device and Method of Use, US Patent No. 4969471, Nov. 13. 1990.
[23]. Liden, M., Ejerhed, L., Sernert, N., Laxdal, G., Kartus, J., “Patellar tendon or semitendinosus tendon autografts for ACL reconstruction reconstruction, randomized study with a 7-year follow-up,” AmJ Sports Med .Vol. 35, pp. 740-748, 2007.
[24]. Gregory C. Keene, Parminder Jeer, Rehan Gul, “Intraoperative arthrometry in anterior cruciate ligament reconstruction,” Acta Orthopædica Belgica, Vol. 71, pp. 565-570, 2005.
[25]. Carrie L. Docherty and Katherine Rybak-Webb., “Reliability of the Anterior Drawer and Talar Tilt Tests Using the LigMaster Joint Arthrometer,” Journal of Sport Rehabilitation, Vol. 18, pp. 389-397, 2009.
[26]. Roberta, H., Nouveau, S., Gageot, S., and Gagnière, B., , “ A New Knee Arthrometer, the GNRB:Experience in ACL Complete and Partial Tears, ” Orthopaedics &; Traumatology: Surgery &; Research, Vol. 95, pp. 171-176, 2009.
[27]. B. SÖderberg. ,“Roentgen Stereophotogrammetric Analysis of Motion between the Bone and the Socket in a Transtibial Amputation Prosthesis:A Case Study, ”JPO, Vol. 15, pp. 95-99, 2003.
[28]. Michael Harris, Gordon Taylor., Medical Statistics Made Easy, Martin Dunitz, a member of the Taylor &; Francis Group, 2006.
[29]. 勞工安全衛生研究所人體計側資料庫 http://www.iosh.gov.tw/
[30]. 彭定國，吳鴻錚，鄭大興，MINITAB統計分析與應用，初版，新文京開發出版股份有限公司，台北，民國九十五年。
[31]. Braden C. Fleming Bjarne Brattbakk, Glenn D. Peura, Gary J. Badger, Bruce D. Beynnon.,” Measurement of anterior-posterior knee laxity: a comparison of three techniques,” Journal of Orthopaedic Research, Vol. 20, pp. 421-426, 2002.