臺灣博碩士論文加值系統

背景與目的：足底潰瘍一直以來是危害糖尿病人生活品質的一大元兇，它容易讓人疏忽但是卻又難以確實治療的特性往往讓人感到遺憾，故足底潰瘍的發現與預防一直是相關研究者的焦點。目前相信，足底潰瘍的發生與足底壓力有著密不可分的關係，但影響足底壓力之因素繁多，難以定論。故透過足底分區壓力來個別觀察不同區域之壓力變化，有助於釐清在研究足底壓力與糖尿病足之間的關係。本論文之研究目的在於透過分區的方式探討糖尿病患步行時之足底壓力，將足底分為10個區域，分別與兩項血糖控制指標─糖化血色素以及飯前血糖對照，檢驗足底壓力與血糖控制之效果是否具有關聯性。
方法：本實驗共有432名受測者，皆為糖尿病患。本實驗排除無法獨立行走、具有足部神經病變或關節變形者，以及有其他影響運動功能之神經肌肉骨骼系統疾患。所有受測者皆進行臨床檢查、足底壓力測量以及病史收集三個階段之流程。收集受測者之基本身體資料、足底壓力相關參數、糖化血色素和飯前血糖。最後分別觀察各區壓力的特徵，以及各項壓力相關參數與血糖指標間的關聯性。
結果：本實驗發現，以最大平均壓力而言，糖尿病患第二掌骨與第三掌骨下的壓力最大，其次為腳跟。而在負載率，腳跟的負載率最高，其餘部位之負載率明顯較低。在衝量上，最大值也出現在第二腳掌與第三腳掌骨區域，顯示本區承受最多能量。而單點最大壓力同樣為第二第三腳掌骨有最大值，但明顯大拇趾的單點最大壓力比同區域之平均壓力大許多。在壓力參數與臨床檢查之相關性，本實驗發現平均壓力與糖化血色素在大腳趾與第一腳掌骨區域有中度正相關，其餘則無關聯性。單點最大壓力與糖化血色素主要在大腳趾與第一腳掌骨有低度正相關，其餘相關性則不明顯。
II
結論：糖尿病患的足底壓力模式與血糖控制有關。之後的研究可以分區觀察為基礎，深入探討足底壓力與週邊血管病變等相關併發症之間之關聯性。

Purpose and background: The prevalence of diabetes mellitus is increasing every year in Taiwan. Many complications of DM have a great impact on the individuals with DM for life time. Neuropathy, sensory loss and muscle deficit make DM patients change there gaits and postures. These changes of walking mechanism maybe affect their plantar pressure abnormally. Alternant plantar pressure applies on different areas of plantar side of feet repeat and repeat. Finally, patients may suffer form foot ulceration without definite trauma. Individuals with DM have a higher rate of foot ulceration and lower extremity amputation than those without diabetes.
Result form previous research, foot ulceration of DM patient is associated with 1)neuropathy 2)avescular disease. Physical examinations for neuropathy and avescular disease combine with plantar pressure can predict the possibility of foot ulceration of DM patients. Furthermore, plantar pressure can also provide clinicians and health professionals a direct evidence to make up a proper decision.
The purpose of this study was to determine the pattern of DM patient’s plantar pressure during level walking. By separating plantar pressure to 10 regions, and discus pressure associated parameters of these region with other clinical data, the relationships between plantar pressure and result of clinical examinations could be found.
Methods: 432 subjects with DM patients participated in this study. DM patients with neuropathy, foot deformity and unable to walk independently
IV
were excluded. HbAlc and the fasting blood glucose level(A.C.) were measured. And all of the subjects completed the pressure data collection and history taking.
Result: We found that subjects with DM have increased mean pressure on 2nd metatarsal bone and 3rd metatarsal bone. Mean load rate on heel was higher than other areas. Impulse on 2nd metatarsal bone was the highest of foot. Maximum peak pressure was located on 2nd metatarsal and 3rd metatarsal done.
Discussion: The highest plantar pressure was located on forefoot 2nd metatarsal bone area. As HbA1c increased, mean pressure and max peak pressure increased.

目錄
中文摘要 I
英文摘要 III
誌謝 V
目錄 VI
圖目錄 IX
表目錄 XI
第壹章 緒論 - 1 -
第一節 研究背景與動機 - 1 -
第二節 研究目的 - 5 -
第貳章 文獻探討 - 6 -
第一節 糖尿病與其併發症 - 6 -
第二節 糖尿病與足部潰瘍 - 6 -
第三節 足部潰瘍的檢測 - 7 -
第四節 足底潰瘍產生之可能機轉 - 9 -
第五節 足底壓力與足部潰瘍 - 10 -
第六節 足底潰瘍之預防 - 13 -
第七節 足底壓力之應用 - 14 -
第八節 分區足底壓力之探討 - 15 -
第參章 研究方法與步驟 - 18 -
第一節 研究架構 - 18 -
第二節 研究對象 - 19 -
第三節 研究設備 - 21 -
第四節 資料收集 - 22 -
3-4-1臨床檢查 - 23 -
3-4-2足底壓力測量 - 23 -
3-4-3病史調查 - 28 -
第五節 重要名詞釋義與操作型定義 - 29 -
第六節 資料分析及處理 - 30 -
第肆章 研究結果 - 32 -
第一節 受測者 - 32 -
第二節 足底壓力參數 - 32 -
第三節 臨床檢查資料 - 38 -
第四節 臨床檢查資料與足底壓力之相關性 - 39 -
4-4-1 臨床檢查資料與各區區域平均壓力之相關性 - 39 -
4-4-2 臨床檢查資料與單點最大壓力之相關性 - 45 -
第伍章 討論 - 50 -
第一節 區域平均壓力 - 50 -
第二節 平均負載率 - 52 -
第三節 衝量 - 52 -
第四節 單點最大壓力 - 53 -
第陸章 結論與建議 - 56 -
第一節 結論 - 56 -
第二節 今後研究方向與建議 - 57 -
參考文獻 - 58 -
附錄 - 68 -

圖目錄
圖 3 1: 研究架構圖 - 18 -
圖 3 2: 足底壓力系統及0.5m壓力板 - 22 -
圖 3 3: 光學影像 - 25 -
圖 3 4: 靜態足底壓力分布圖 - 26 -
圖 3 5: 動態足底壓力分布圖 - 26 -
圖 3 6: 足底壓力分區圖 - 28 -
圖 4 1: 慣用與非慣用腳平均壓力分布比較圖 - 35 -
圖 4 2: 慣用與非慣用腳平均負載率分布比較圖 - 36 -
圖 4 3: 慣用與非慣用腳衝量分布比較圖 - 36 -
圖 4 4: 慣用與非慣用腳單點最大壓力分布比較圖 - 36 -
圖 4 5: 非慣用腳T1區糖化血色素與最大壓力值散佈圖 - 40 -
圖 4 6: 非慣用腳MT1區糖化血色素與最大壓力值散佈圖 - 40 -
圖 4 7: 非慣用腳MH區糖化血色素與最大壓力值散佈圖 - 41 -
圖 4 8: 慣用腳T1區糖化血色素與最大壓力值散佈圖 - 41 -
圖 4 9: 慣用腳MT1區糖化血色素與最大壓力值散佈圖 - 42 -
圖 4 10: 慣用腳MT2區糖化血色素與最大壓力值散佈圖 - 42 -
圖 4 11: 慣用腳MT2區飯前血糖與最大壓力值散佈圖 - 43 -
圖 4 12: 慣用腳MT3區飯前血糖與最大壓力值散佈圖 - 44 -
圖 4 13: 非慣用腳T1區糖化血色素與最大單點壓力散佈圖 - 46 -
圖 4 14: 慣用腳MT1區糖化血色素與最大單點壓力散佈圖 - 46 -
圖 4 15: 慣用腳T1區糖化血色素與最大單點壓力散佈圖 - 47 -
圖 4 16: 慣用腳MT1區糖化血色素與最大單點壓力散佈圖 - 47 -
圖 4 17: 慣用腳MT2區糖化血色素與最大單點壓力散佈圖 - 48 -

表目錄
表 3 1:足底壓力系統規格細項 - 21 -
表 4 1: 受測者基本資料之平均值與標準差(Mean±S.D) - 32 -
表 4 2: 非慣用腳各區域壓力參數平均值與標準差(Mean±S.D.) - 34 -
表 4 3:慣用腳各區域壓力參數平均值與標準差(Mean±S.D.) - 35 -
表 4 4: 臨床檢查資料平均值與標準差(Mean± S.D.) - 38 -
表 4 5: 糖化血色素與各區平均壓力相關係數表 - 39 -
表 4 6: 飯前血糖與各區平均壓力相關係數表 - 43 -
表 4 7: 糖化血色素與各區單點最大壓力相關係數表 - 45 -
表 4 8: 飯前血糖與各區單點最大壓力相關係數表 - 48 -

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