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研究生:邱玉萍
研究生(外文):csiu yu ping
論文名稱:職業性肌肉骨骼傷害對本體感覺影響之研究
論文名稱(外文):A study on infected proprioception due to work-related musculoskeletal disorders
指導教授:賴永昌 蘇純瑩蘇純瑩引用關係
指導教授(外文):Lai Yu ChSu chwen yng
學位類別:碩士
校院名稱:高雄醫學大學
系所名稱:職業安全衛生研究所
學門:醫藥衛生學門
學類:公共衛生學類
論文種類:學術論文
論文出版年:2001
畢業學年度:89
語文別:中文
論文頁數:58
中文關鍵詞:職業性肌肉骨骼傷害本體感覺
外文關鍵詞:work-related musculoskeletal disordersproprioception
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有關職業性肌肉骨骼傷害的研究,常以問卷調查法取得相關職業病資料,至於職業性肌肉骨骼傷害是否影響本體感覺其相關性的研究相當少。當肌肉骨骼產生酸痛而影響工作人員的工作表現時,也可能會使本體感覺受器的精準性下降,降低神經肌肉系統的動作控制及關節的穩定性,導致職業傷害的發生。因此本研究的目的在於探討膝部職業性肌肉骨骼傷害是否影響膝部關節本體感覺之精準性。
  本研究為橫斷式研究,針對工作需長期站立及走動之職業族群為主,故研究對象為高雄市某家公部門身心障礙福利機構教保人員,該機構之行政人員為對照組。研究方法先以問卷調查挑選出過去三個月中,曾經有膝部肌肉骨骼方面酸痛或不舒服的症狀持續一周以上的教保人員,結果共有13位教保人員與13位無任何膝部症狀之行政人員比較,二組均使用照相機記錄方式,進行膝關節體位感覺測試,並以開放鏈運動及閉鎖鏈運動進行35。、70。和100。三種膝關節屈曲角度的重複性試驗,比較二組受測者的膝關節體位感覺之差異性。本研究中以多變量變異數分析比較教保人員和行政人員之平均絕對誤差角度之差異情形;以相依樣本t考驗分析開放鏈與閉鎖鏈運動之平均絕對誤差角度之差異情形;以重複量數單因子變異數分析(repeated measures ANOVA)考驗三個關節角度位置對平均絕對誤差角度之差異情形。
本研究結果發現:整體而言,教保人員和行政人員之間,其平均絕對誤差角度值有顯著差異,組別差異在開放鏈運動膝屈曲35。、70。及閉鎖鏈運動膝屈曲35。、100。呈現顯著差異,其中教保人員平均絕對誤差角度值皆明顯大於行政人員。在教保人員中,關節角度35。、100。在開放/閉鎖鏈運動有顯著差異;並且三個關節角度之間,其平均絕對誤差角度值有顯著差異,組別差異在開放鏈運動膝屈曲35。、70。及閉鎖鏈運動膝屈曲35。、100。呈現顯著差異。
  由研究結果顯示,因需長期站立及走動之教保人員,容易造成膝部肌肉骨骼傷害,而膝部職業性肌肉骨骼傷害確實對本體感覺受器之精準度產生影響,間接導致動作控制的協調性變差,因此,建議應了解累積性傷害造成之原因,加強穩定膝關節肌群之肌力及訓練,減低肌肉骨骼傷害之程度,以維持本體感覺功能及動作的協調性。
Work-related musculoskeletal disorders (WRMDs) symptons were conducted mostly by questionnaire surveys or clinical diagnoses in the past.There are hardly any reports to study the proprioception deficit that may directly related to the infected WRMD. In this thesis, we have chosen government employees of a handicap institution where heavy physical demands are needed as our research groups to investigate the accuracy of knee joint position sense that maybe influenced by the WRMD illness. For a healthy person, the proprioception can regulate the body posture and the associated muscular coordination accordingly. The musculoskeletal pain perceived by a worker can affect one’s job performance and especially in his proprioceptor accuracy that could cause reduction in motor control, joint instability and may lead to occupational injury.
We use cross-sectional profiling method to study two separate groups that are working within the Handicap Institution of the Kaohsiung Municipal Social Workers Department. The professional staffs or direct health-caretakers who require long standing or walking hours during typical workdays are served as the control group and other supporting administrative staffs are to be our reference group. Based on questionnaire screening, for three consecutive months, 13 health-caretakers that had claimed of knee joint pain and another 13 office-workers without any knee pain complaining were selected for comparison. These two group persons were then conducted for the knee joint position sense tests in open-chain and closed-chain exercises in which photographed analyses were used to determine the proprioception errors. By repeated testing and analyses of knee flexion angles at 35。, 75。and 100。, we found distinct variations in the knee joint position sense among our study groups. Multivariate ANOVA analysis is performed to compare health-caretakers with office-workers for the differences in average absolute errors based on open/close chain exercises while paired samples t-test are used in analyzing the difference of average absolute error open/close chain exercises. The difference of average absolute errors of three angles is carried out by the repeated measures ANOVA.
  Based on this study in general, we have found there are major differences between caretakers and office workers in average absolute errors which have been shown in the group of open-chain exercises at 35。and 75。and also in the group of close-chain exercises at 35。and 100。. The average absolute errors of caretakers are much higher than that of office-workers. During open-chain exercises we also observed that the occupation and weight alone could be used as predictors to evaluate total average absolute error.
As a conclusion, we have proved in this study that caretakers who require long standing or walking hours would easily get WRMD in knee position. The WRMD really infect the accuracy of knee joint position sense and also influence the coordination of motor control. We recommend the caretakers should be educated to know the causes of WRMD by reinforcing their muscle strength of knee joint and training the knee joint with proper activity to reduce WRMD injuries.
目 錄
中文摘要I
英文摘要III
目 錄V
第一章 緒 論1
第一節 研究背景1
第二節 研究動機2
第三節 研究目的4
第四節 研究範圍4
第五節 研究假定5
第六節 名詞解釋5
第二章 文獻探討9
第一節 本體感覺神經生理機能9
第二節 本體感覺與職業性肌肉骨骼症狀之相關性13
第三節 開放鏈運動或閉鎖鏈運動對於關節體位感覺的表現14
第四節 不同膝關角度對關節體位感覺之影響16
第三章 研究方法17
第一節 研究流程17
第二節 研究對象19
第三節 研究工具20
第四節 實驗步驟21
第五節 資料分析與統計方法24
第四章 結  果26
第一節 問卷回收分析26
第二節 下肢膝部職業性肌肉骨骼症狀教保人員與行政人員之基本資料
分析 30
第三節 教保人員與行政人員之平均絕對誤差值比較32
第四節 開放鏈運動和閉鎖鏈運動之平均絕對誤差值比較35
第五節 不同關節角度位置與絕對誤差角度之關係36
第五章 討  論38
第一節 職業性肌肉骨骼傷害對本體感覺之影響38
第二節 開放鏈運動與閉鎖鏈運動膝屈曲對平均絕對誤差角度之影響40
第三節 不同關節角度位置與絕對誤差角度之探討42
第四節 研究限制44
第六章 結論與建議45
第一節 結論45
第二節 研究建議46
第三節 對後續研究者之建議47
參考文獻49
附錄
附錄一 身心障礙福利機構教保人員膝本體感覺測驗指引54
附錄二 研究問卷55
附錄二 開放動力鏈膝關節屈曲各角度測試56
附錄四 閉鎖動力鏈膝關節屈曲各角度測試57
附錄五 測試流程58
表目錄
表4-1.1 肌肉骨骼不適之教保人員27
表4-1.2 無膝部症狀之行政人員28
表4-1.3 教保人員肌肉骨骼傷害部位之分佈情形28
表4-1.4 教保人員膝部肌肉骨骼不適症狀持續時間29
表4-2.1 膝部肌肉骨骼傷害教保人員與無膝部症狀之行政人員基本資料31
表4-2.2 教保人員(N=13)與行政人員(N=13)之個人基本資料的比較32
表4-3.1 教保人員與行政人員肢膝節屈曲平均絕對誤差角之平均值
與標準差33
表4-3.2 教保人員與行政人員平均絕對誤差角度之多變量考驗結果34
表4-3.3 教保人員與行政人員平均絕對誤差角度之多變量變異分析
     摘要表34
表4-4.1 教保人員下肢開放鏈和閉鎖鏈運動平均絕對誤差之比較35
表4-4.2 行政人員下肢開放鏈和閉鎖鏈運動平均絕對誤差之比較36
表4-5.1 三種不同膝屈曲角度與平均絕對誤差角度之重覆量數單因
     子變異數分析之多變量檢定37
表4-5.2 三種不同膝屈曲角度與平均絕對誤差角度之重覆量數單因
     子變異數分析之成對比較分析摘要表37
圖目錄
圖2-1 神經肌肉控制路徑10
圖3-1 研究步驟18
圖4-1 實驗流程32
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