臺灣博碩士論文加值系統

遠端橈骨骨折為所有骨折中最常見之種類，遠端橈骨骨折易合併軟組織之受損，其中以三角纖維軟骨複合體最為常見，發生率為59%至64%，遠端橈骨骨折患者合併三角纖維軟骨複合體受損有關節活動度減少、抓握力量減弱及手腕尺側疼痛等之問題。回顧文獻多針對此類患者使用傳統量角器、手部握力器以及主觀自我填答問卷等量測其功能性表現，但上述量測工具未根據三角纖維軟骨複合體的構造及功能量測到其損傷後功能的限制，且先前文獻較少利用客觀之運動或力學量測法進行量測此類患者之功能，故在本論文中使用客觀之運動或力學量測法探究患者三角纖維軟骨複合體受損對於遠端橈骨骨折患者功能表現之影響。
因此本論文有兩個研究目的，第一為從客觀之運動學、力學及手功能的角度探討遠端橈骨骨折合併與未合併三角纖維軟骨複合體受損患者及健康組功能表現之差異，第二為在不同的時間點探討遠端橈骨骨折合併與未合併三角纖維軟骨複合體受損患者功能表現恢復趨勢之差異。根據目的提出的研究假設有兩個，第一為遠端橈骨骨折合併與未合併三角纖維軟骨複合體受損之患者及健康組在手功能、運動學、力學表現及自我填答問卷之表現有差異，第二為不同時間點遠端橈骨骨折合併與未合併三角纖維軟骨複合體受損兩組功能性表現恢復的趨勢有差異。
本論文納入遠端橈骨骨折合併三角纖維軟骨複合體受損組(Distal radius fracture with triangular fibrocartilage complex injury, DRF- TFCC)、遠端橈骨骨折未合併三角纖維軟骨複合體受損組(Distal radius fracture without triangular fibrocartilage complex injury, DRF)及健康組三組受試者。每組受試者皆會接受手功能、運動學及力學等客觀之評估，針對第一個研究目的使用K-W檢定及曼－惠特妮U檢定根據組別做分析，針對第二個目的使用曼－惠特妮U檢定分析前後時間點資料之差值比較恢復的趨勢。
本論文第一個研究目的結果為手腕橈側及尺側繞轉工作空間DRF-TFCC組與DRF組皆與健康組有顯著差異，DRF-TFCC組橈側繞轉於術後半年而尺側繞轉術後一年才能恢復與正常人相同的功能，DRF組恢復的時間點早於DRF-TFCC組。旋後動作轉動門把的運動單元在半年時DRF-TFCC組較DRF組多。前臂旋轉力矩值則是在12週所有的角度執行旋後的力矩值時DRF-TFCC組較DRF組差。傑伯森手功能測驗中紙翻面測驗、移動輕罐及重罐測驗以及明尼蘇達手部操作測驗中放置測驗DRF-TFCC與DRF組在兩個月與健康組有顯著差異，傑伯森手功能測驗中的餵食測驗DRF-TFCC與DRF組在三個月時與健康組有顯著差異。DRF-TFCC組與DRF組在關節活動度、問卷、手部握力在全部的週數皆無顯著差異。
第二個研究目的結果為8至12週時DRF-TFCC組在0、30sup、60pro、60sup度執行旋後力矩值以及30pro、30sup角度執行旋前力矩值恢復的趨勢較DRF組慢，手部握力在26至52週時DRF-TFCC組恢復速率較DRF組慢。
此研究結果為遠端橈骨骨折合併三角纖維軟骨複合體受損患者可能有前臂旋轉力量受限、手腕繞轉工作空間的限制以及牽涉前臂動作的動作品質較差的問題，在研究上提供較能準確量測到三角纖維軟骨複合體受損的量測工具讓未來的研究能更深入探討此類患者，在臨床上提供前臂旋轉力量量測工具了解此類患者功能受損情形及治療後患者功能進步的情形，以及此類患者在臨床上能使用訓練前臂旋轉肌力的工具增進此類患者功能表現。

Triangular fibrocartilage complex (TFCC) is a structure located between distal radius, distal ulnar and ulnar carpus. There are three functions of the TFCC which are keeping the stability of distal radioulnar joint in order to do forearm rotation, delivering 20% of the axial load and maintaining the stability of the ulnar carpus. Previous studies indicated DRF patients combined with TFCC injury have poor performance in range of wrist motion, decreased grasp power and hard to do activities involving forearm rotation. However, functional performances of these patients were not measured based on the structure and function of TFCC by traditional measurements in previous studies. In this study, kinematic, kinetic and performance-based assessments were thus used to comprehend the functional limitations for those DRF patients with TFCC injury. The purpose of the study is to investigate the hand functional performances, kinematics and kinetics among DRF group, the DRF-TFCC group and healthy group. The results of this study revealed DRF-TFCC group have decreased rotational torque of supination in all degree of dynamometer compared to the DRF patients at the three-month follow-up. The wrist circumduction of the DRF-TFCC group and DRF group was limited compared to the health group in the four-week and two-month follow-ups, but only the DRF-TFCC group showed limitation in the three- and six-month follow-ups. This study has its merits on providing more precise measurements for detecting the impairments of TFCC injury accompanied with DRF for further research works. The findings of assessments also showed that the patients with DRF combined with TFCC injury had decreased forearm rotational torque, limited wrist workspace and poor forearm movement quality that might need more attentions for further clinical interventions or cares

表目錄 XII
圖目錄 XVI
第一章、緒論 1
第一節、研究動機及重要性 2
第二節、研究目的與假設 4
第二章、文獻回顧 5
第一節、遠端橈骨骨折 5
壹、遠端橈骨骨折發生率 5
貳、遠端橈骨骨折分類 5
參、遠端橈骨骨折治療及復健治療 7
第二節、三角纖維軟骨複合體 10
壹、三角纖維軟骨複合體構造及功能 10
貳、三角纖維軟骨複合體受損功能之影響 14
參、三角纖維軟骨複合體傷害之分類 14
肆、三角纖維軟骨複合體傷害之診斷 17
伍、三角纖維軟骨複合體受損之復健計畫 18
第三節、遠端橈骨骨折合併三角纖維軟骨複合體受損 20
壹、遠端橈骨骨折合併三角纖維軟骨複合體受損發生率 20
貳、遠端橈骨骨折合併三角纖維軟骨複合體受損手術後功能比較 20
第四節、文獻回顧總結 22
第三章、研究方法 23
第一節、研究流程 23
第二節、研究對象 25
第三節、研究工具及參數 26
壹、傳統量角器(Goniometer) 26
貳、動作分析設備及運動學參數 26
參、力學量測及參數 30
一、雙平面等速肌力測試計(Bi-planar isokinetic dynamometer (BID)) 30
二、手部握力器(Jamar hydraulic hand dynamometer) 32
肆、手功能Hand function 33
一、傑伯森手功能測驗(Jebsen-Taylor Hand Function Test) 33
二、明尼蘇達手部操作測驗(Minnesota rate of manipulation test) 34
伍、手功能自我填答問卷Self-reported questionnaire 35
一、徒手功能評量表Manual ability measure 35
二、短版上肢功能評估問卷(DASH) 35
三、疼痛視覺類比量表(visual analogue scale for pain) 36
第四節、資料統計及分析方法 37
第四章、研究結果 39
第一節、人口學資料 39
第二節、 組別差異、組間與組內恢復趨勢差異 40
壹、關節活動度 40
貳、運動學資料 51
參、力學功能表現 63
肆、手功能 83
伍、自覺疼痛程度及自我量測問卷 98
第五章、討論 102
第一節、組別差異 102
壹、關節活動度 102
貳、運動學 103
參、旋轉力矩值與常規化手部握力值 105
肆、常規化握力值 107
伍、手功能 108
陸、自覺疼痛程度及自我量測問卷 109
第二節、DRF與DRF-TFCC組間與組內恢復趨勢 110
第六章、結論 116
第一節、總結 116
第二節、臨床應用與學術發展 117
第三節、研究限制及未來研究建議 118
參考文獻 119
附錄一、視覺類比量表(VAS) 127
附錄二、視覺類比量表自覺徒手功能調查表 128

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