臺灣博碩士論文加值系統

背景及目的：本研究目的在於針對有扭傷經驗之踝關節，於肌肉活動產生疲勞現象時對其踝關節之本體感覺的影響。方法：本研究徵召30位平均年齡為22.8±1.05歲的男女受測者，並以踝關節受傷經驗的有無，及踝關節本體感覺缺損的有無作為分組，共計有60隻踝關節進行測試。所有受測者踝關節受測時必須沒有任何的疼痛現象，且經由前拉測試(anterior drawer test)、距骨傾斜測試正常(talar tilt test negative)及平衡感測試(Romberg test)確認不具結構性和神經性的病變的問題。研究設備以等速肌力測試儀(Biodexsystem3 Isokinetic System)進行本體感覺測試，以及肌肉疲勞測試。實驗的進行為：所有受測者均接受兩階段本體感覺的測試，一為肌肉疲勞產生前，以及肌肉疲勞發生後。本體感覺測試以被動重複關節角度測試(RPP)進行，目標角度為內翻10度、內翻20度以及外翻10度，隨機安排測試角度之次序。每個目標角度重複三次測試。肌肉疲勞的產生將以每秒90度的角速度下進行等速踝關節內翻和外翻的交替動作，當收縮的力矩值連續三次低於50％的最大力矩值時，便定義為肌肉疲勞。統計方法：數據分析將以統計軟體SPSS進行，其中針對踝關節受傷經驗分組進行比較外，並根據文獻訂定內翻10度的誤差值3.1度訂為分組之臨界值，比較本體感覺缺損有無的分組，在肌肉疲勞狀況下的改變。結果：以受傷經驗分組進行獨立樣本檢定時，發現前後測中，只有前測的內翻10度有明顯差異，且受傷組優於健康組，當以相關樣本檢定來分析組內的前後測數據，健康組在前後測的比較中，所有的角度均沒有明顯差異，而受傷經驗組則是在小角度上均有明顯差異，而以本體感覺缺損分組進行獨立樣本檢定時，在前後測比較中，也僅有前測的外翻10度有明顯差異，當以相關樣本檢定來分析組內前後測，正常組在前後測的比較中，小角度均有明顯差異，而缺損組在外翻10度有差異。結論：在有受傷經驗的受測者身上，可以很明顯的看到肌肉疲勞產生的影響，所以將來的治療方式裡，不該只強調本體感覺的訓練，更應該強調肌肉的耐力訓練。

Background and purpose： Ankle sprain is the top one in the sports injuries occurring in sports participations. Deficits in joint proprioception are major problems for clinical rehabilitation. There is little evidence to investigate the influence of muscle fatigue on the joint proprioception after injuries. The purpose of this study is to investigate the effect of muscle fatigue on the proprioception of ankle joint after inversion injury. METHOD：Thirty subjects (mean age: 22.8 ± 1.05 years) recruited into this study, totally sixty ankle for the experiment. There are two kinds of the grouping method; one is according to the injury history, another is according to the proprioception deficit. All ankles are pain free and need to pass the few examinations include anterior drawer test, talar tilt test and Romberg’s test to rule out deficits in anatomical structures and neuralgic disorders. The Biodexsystem3 Isokinetic System will be used for the proprioception test demonstrated by passive repositioning error of ankle inversion and eversion. The proprioceptive test will be done before and after muscle fatigue of ankle muscles. There are three target angles (Inversion 10, inversion 20°, and eversion 10°) randomized assigned for the test sequences, and each target taken 3 trials. Muscle fatigue is defined as the maximal torque of ankle muscles declines below 50% peak torque by successive 3 repetitions during isokinetic contraction with 90°/second. ANALYSIS： Data analysis will be processed by SPSS 11.0 to compare the difference in repositioning errors of those subjects with the experience of ankle sprain or not and in that of subjects with proprioceptive deficit grouped by 3.1° the threshold limit value of 10° of ankle inversion under the condition of muscle fatigue. And compare different groups after muscle fatigue. RESULT： The data reveal the only significant difference exist at the 10° of ankle eversion in pre-fatigue test between the healthy and injury history groups. There were no significant differences in the healthy group after muscle fatigue. In injury history group, there were significant differences in the small angle after muscle fatigue. There was only significant difference exist at the 10° of ankle inversion in the pre-fatigue test between the normal and deficit groups. In normal groups, there were significant differences in the small angles. But there was significant difference at the 10° of ankle eversion in the deficit group. CONCLUSION： There were significant effects from muscle fatigue to the subjects, especially in the injury history group. The therapy design should not only emphasis proprioception. The muscle endurance training should be put more considerable.

第一章 緒論

第一節 前言-------------------------------------------------- 1
第二節 研究動機--------------------------------------------- 1
第三節 研究目的--------------------------------------------- 2
第四節 研究假設-------------------------------------------- 2

第二章 文獻探討

第一節 解剖構造--------------------------------------------- 3
第二節 受傷機制--------------------------------------------- 5
第三節 本體感覺--------------------------------------------- 5
第四節 受傷病史對本體感覺的影響----------------------- 12
第五節 肌肉疲勞與本體感覺------------------------------- 15

第三章 實驗方法

第一節 實驗設計--------------------------------------------- 18
第二節 受測者條件------------------------------------------ 18
第三節 儀器設備--------------------------------------------- 19
第四節 主要測量結果---------------------------------------- 22
第五節 實驗流程--------------------------------------------- 22
第六節 統計分析--------------------------------------------- 25

第四章 結果

第一節 偏態與峰度------------------------------------------ 26
第二節 全部受測者的實驗結果----------------------------- 26
第三節 以受傷經驗分組的實驗結果--------------------------- 26
第四節 以本體感覺缺損分組的實驗結果--------------------- 27

第五章 討論

第一節 傷害經驗與本體感覺------------------------------- 34
第二節 肌肉疲勞與本體感覺------------------------------- 38

第六章 結論

第一節 實驗限制--------------------------------------------- 45
第二節 臨床貢獻--------------------------------------------- 46

參考文獻------------------------------------------------------- 52

附錄
一 受試者同意書---------------------------------------- 57

表 目 錄

表 1 肌肉與關節中之本體感覺受器------------------------- 8
表 2 中樞神經的三個層級----------------------------------- 12
表 3 偏態與峰度的分析-------------------------------------- 28
表 4 全部受測者前後測的比較------------------------------ 29
表 5 依受傷經驗分組之比較--------------------------------- 30
表 6 健康組與受傷組在肌肉疲勞產生前、後本體感覺的
差異----------------------------------------------------- 31
表 7 依本體感覺缺損分組之比較---------------------------- 32
表 8 正常組與缺損組在肌肉疲勞產生前、後本體感覺的
差異----------------------------------------------------- 33
表 9 依受傷經驗分組的全比較------------------------------ 47
表 10 依本體感覺缺損的全比較------------------------------ 48

圖 目 錄

圖 1 Biodex Isokinetic System3 等速測力器--------------- 49
圖 2 本體感覺測試狀態正面-------------------------------- 50
圖 3 本體感覺測試狀態側面-------------------------------- 51

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