臺灣博碩士論文加值系統

對於嚴重之退化性膝關節炎患者，全人工膝關節置換術已證明可提供良好之臨床結果。本研究之假設為：全人工膝關節置換術後，患者之動作會與未手術時不同。因此利用動作分析探討於不同動作（平地行走，上下樓梯，坐站交替）情況下，動作參數之變化；並利用測立板量測地面反衝力，據以計算膝關節韌度。
本研究共有十二名雙膝關節炎患者參加。皆接受單側 High-flex®全人工膝關節置換，得到以下結果：
1. 全人工膝關節置換對嚴重膝關節炎患者之臨床症狀有極佳之結果。
2. 在膝蓋彎曲角度項目：已手術側在上、下樓梯及平地行走上，皆較未手術側具有較大的彎曲角度並具有統計差異。
3. 下樓梯具有最大的彎曲角度，其次為上樓梯，最後為平地行走。
4. 平地行走時，雙峰式的步態週期型式於患已手術側與未手術側並無明顯差異。在下樓梯項目,
站立期時角度變化不大，而在擺盪期達到最大角度。在上樓梯項目，則出現雙波谷式的步態週期型式。
5. 已手術側在下樓梯及平地行走時有較大的韌度；而在上樓梯時則無統計上之差異。
本文將可提供High-flex®全人工膝關節之基本步態資料，並利用利用韌度之方式，提供臨床醫師另一個評估患者的工具。

目 錄
目 錄 1
圖目錄 3
表目錄 4
第一章 前言 6
第二章 文獻探討 8
第一節 正常膝關節之解剖構造及功能 8
第二節 退化性膝關節炎之發生，診斷與治療 17
第三節 全人工膝關節置換手術 27
第四節 動作分析簡介 38
第三章 研究架構與研究設計 51
第四章 研究材料與統計方法 52
第一節 研究材料及資料收集方式 52
第二節 資料處理 58
第五章 研究結果 61
第一節 臨床結果 61
第二節 步頻與步速 65
第三節 關節活動範圍 66
第四節 步態週期型式 71
第五節 地面反作用力 73
第六節 膝關節韌度 78
第六章 討論 80
第一節 結果討論 80
第二節 其他相關性討論 83
第七章 結論與建議 84
第八章 參考文獻 85
圖 目 錄
圖 1-1 臺灣地區人口結構----------------------------------------5
圖 2-1.1 膝關節之解剖構造--------------------------------------10
圖 2-1.2 脛骨與股骨之滾動與滑動 ----------------------------11
圖 2-1.3髕骨之有無與股四頭肌收縮力臂大小 -------------11
圖 2-1.4 髕骨之滑動 ----------------------------------------------12
圖 2-1.5 後十字韌帶與前十字韌帶之功能 -------------------12
圖 2-1.6 後滾現象 ------------------------------------------------13
圖 2-1.7 後十字韌帶缺乏時之上樓動作 -------------------14
圖 2-2.1 軟骨組織 ---------------------------------------17
圖 2-2.2 退化性關節炎之x光變化 ----------------------------23
圖 2-3.1 MacIntosh之金屬襯墊式植入物 -----------------29
圖 2-3.2 Freeman-Swanson 人工膝關節 --------------------29
圖 2-3.3 Guepar 人工膝關節 --------------------------------30
圖 2-3.4 全髁關節人工膝關節 -------------------------------30
圖2-3.5 脛骨高台中央凸塉設計 -------------------------------35
圖2-3.6 軸塉（cam-post）設計 ------------------------------35
圖2-3.7脫位安全係數 -------------------------------------------36
圖2-3.8髕骨症候群（patella clunk syndrome）---------------36
圖 2-4.1埃及Edwin Smith 紙草 -------------------------------37
圖 2-4.2 Hippocrates ---------------------------------------------37
圖 2-4.3 Marey之反光衣 ----------------------------------------38
圖 2-4.4 Sutherland之步態週期 --------------------------------39
圖 2-4.5 完整的步態週期 ---------------------------------------42
圖 2-4.6小腿彈簧示意圖 -------------------------------------43
圖 2-4.7 立體攝影術 --------------------------------------------45
圖 2-4.8 測力板 --------------------------------------------------46
圖 2-4.9 力板作用力 --------------------------------------------46
圖 4-1 實驗流程 -------------------------------------------------57
圖 5-1 步頻及速率相對關係 -----------------------------------64
圖5-2 膝關節彎曲角度－平地行走 ---------------------------66
圖5-3膝關節彎曲角度－上樓梯 -------------------------------66
圖5-4膝關節彎曲角度－下樓梯 -------------------------------67
圖5-5膝關節彎曲角度－不同動作比較 ---------------------67
圖5-6髖關節彎曲角度－平地行走 ---------------------------68
圖5-7髖關節彎曲角度－上樓梯 -------------------------------69
圖5-8髖關節彎曲角度－下樓梯 -----------------------------71
圖5-9髖關節彎曲角度－不同動作比較 -----------------------------------------------------70
圖5-10膝關節平地行走 ------------------------------------------------------------------------71
圖5-11膝關節下樓梯 ---------------------------------------------------------------------------72
圖5-12膝關節上樓梯 ---------------------------------------------------------------------------72
圖5-13地面反衝力－平地行走 ---------------------------------------------------------------73
圖5-14地面反衝力－上樓梯 ------------------------------------------------------------------74
圖5-14地面反衝力－上樓梯 ------------------------------------------------------------------74
圖5-15地面反衝力－下樓梯 ------------------------------------------------------------------75
圖5-16地面反衝力－坐站交替 -----------------------------------------------------------------75
圖5-17地面反衝力－不同動作比較 ----------------------------------------------------------76
表 目 錄
表 4-1 病患基本資料 ----------------------------------------------------52
表 4-2 下肢局部座標系統的骨標記定義 ----------------------------59
表 5-1a,b HSS score -------------------------------------------------------61
表5-2患者基本資料及臨床結果 ---------------------------------------63
表5-3步頻及速率 ---------------------------------------------------------64
表 5-4 地面反作用力比較-A ------------------------------------------77
表 5-5 地面反作用力比較-B ------------------------------------------77
表 5-6 膝關節韌度 --------------------------------------------------------79

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