臺灣博碩士論文加值系統

近二十年來，大部份的下肢骨骨折皆以髓腔內鋼釘（intra-madullary nailing）固定法來做治療。傳統的骨折是以一根鋼釘貫穿骨折部位加以固定（Küntscher nail），但是如果骨折呈現斜面狀（oblique）、粉碎不穩定狀（comminuted）、或是骨折處有缺損（segmental bone loss），則使用單一的內固定鋼釘往往無法使骨折部位達到堅實的固定（rigid fixation），而會造成骨折處變短、位移、扭曲、癒合不良（mal-union），甚至無法癒合（non-union）。因此，近年來便發展出“互鎖式髓腔內固定”（interlocking nail）的鋼釘，以改進上述之缺點。在使用此種鋼釘進行骨折固定手術時，一個很重要且卻頗為繁瑣的工作就是找出鋼釘兩端固定孔(screw holes)的位置，以便分別自骨折處之遠端（distal）及近端（proximal）兩側鑽孔固定之。由於鋼釘在手術時是植入在骨髓腔內，其外有骨骼及肌肉組織包覆，骨科醫師無法由目視法得知固定孔的正確位置。因此一般都得借助於其它輔助器械或X光機協助，以找尋孔洞之正確位置。
目前常採取下列兩種方法協助固定孔之尋找：其一，徒手操作（free—hand method）方式；其二，則是使用各種不同的“瞄準器”( Target Aiming Device, TAD )為之。
所謂徒手操作是指執行手術的醫師憑著本身的經驗，於體外骨折部位模擬判斷固定孔大概位置，利用嚐試錯誤的方式（trial-and-error），於推測部位試行鑽孔，以期順利找出固定孔的位置，並進行固定。由於固定孔的直徑僅約四公釐，些許的偏差便會使固定螺釘無法鎖入固定孔。因此，利用此法找尋定位孔通常需花費較長的時間，而且鑽孔部位的骨骼也因而會遭到多次的鑽孔與破損。而應用所謂的“瞄準器”( Target Aiming Device, TAD )，事實上是利用另也無法保證其準確度。但無論使用何種方法，都得需要借助於X—光機協助孔洞之定位。使用x—光機除了成本昂貴之外，最主要的缺點為會造成病患及醫師額外的輻射劑量吸收。對一個常需進行該項手術的醫師言，即使採取相關的防護措施，長時間累積下來的輻射劑量亦頗可觀。根據統計，既使對一位具有相當經驗的醫師而言，平均也得花費十五至卅分鐘以上的時間方可完成遠端固定孔之定位。因此，如果能設計一種方法，讓醫師能目視或經由電視螢幕在手術現場即時看到隱藏於骨骼內的固定孔，就沒有上述的問題了。
本研究的目的在於提供醫師一個在手術現場操作簡單、無傷害性、直接透視組織的方法。此方法主要是應用動物組織對較長波長的可見光及近紅外光吸收很少。也就是說這個頻段的光線可以穿透較厚的人體組織，具有用於體內照明的原理。我們應用此原理設計了體內照明系統，並進行下肢骨折使用互鎖式鋼釘內固定的臨床驗證，臨床應用結果證實本實驗所設計的“體內照明技術進行髓腔內鋼釘固定手術”定位脛骨遠端孔是非常可靠( reliable )、方便( convenience )及有效的( efficiency )。

Lower extremities fractures are treated by intra-medullary nailing that is a golden standard method for the recent twenty years. In the past time, we use Küntscher nail to fix all types of fractures, but twisting, shortening, malunion or even nonunion occurred while the fracture patterns met to oblique, comminuted or segmental bone loss. Interlocking nail is introduced to prevent such problems as previous complications.
During operation, we must localize the distal and proximal screw holes and then use screws to fix the nail ( locking the nail ). Because the nail is embedded in the medullary cavity, so we must use the roentgenography to “ see “ the screw holes and completed this procedure. In additional of the high cost of X-ray machines, radiation exposure hazards are also dangerous to doctors and patients.
As we know, the biological tissues are translucent in the wavelength range 700-1000 nm. By utilizing this unique property, we developed an endo-transilluminator to aid medical diagnoses and surgeries. The system guides (generates) light of selected wavelength to (in) the internal human or animal bodies. Light that carry the information about tissue structure near the light source can penetrate out the surface of the body. It can then be detected, in situ and in real-time, by external observers or cameras. Illuminating from within the body eliminates the problem of interference due to light reflection from tissue surface, thus makes imaging of internal tissue structure possible. The technique has been demonstrated to provide great help to clinical diagnoses and surgeries.

誌謝 2
目錄 3
Abstract 4
中文摘要 5
表索引 7
圖索引 8
第一章 緒論 10
1-1 引言 10
1-2 骨折之固定 10
1-3 前人之研究 13
1-4 研究動機 14
1-5 本論文各章節內容 16
第二章 系統與方法 17
2-1系統設計 17
2-2 臨床試驗 19
第三章 研究結果 22
3-1 光源強度實驗 22
3-2 動物實驗 22
3-3 人體實驗 23
第四章 討論 24
4-1 結果分析 24
4-2 系統缺點及預期改進方法 25
第五章 結語 27
參考文獻 29
影像資料 57

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