(3.237.20.246) 您好!臺灣時間:2021/04/15 10:08
字體大小: 字級放大   字級縮小   預設字形  
回查詢結果

詳目顯示:::

我願授權國圖
: 
twitterline
研究生:王俊翔
研究生(外文):Chun-Hsiang Wang
論文名稱:到院前頸椎固定流程分析與固定產品設計
論文名稱(外文):Analysis of Prehospital Spinal Immobilization Procedure and Immobilization Device Design
指導教授:吳豐光吳豐光引用關係
指導教授(外文):Fong-Gong Wu
學位類別:碩士
校院名稱:國立成功大學
系所名稱:工業設計學系碩博士班
學門:設計學門
學類:產品設計學類
論文種類:學術論文
論文出版年:2004
畢業學年度:92
語文別:中文
論文頁數:53
中文關鍵詞:頸圈到院前頸椎固定流程產品設計
外文關鍵詞:product designcollarprehospital spinal immobilization procedure
相關次數:
  • 被引用被引用:1
  • 點閱點閱:146
  • 評分評分:系統版面圖檔系統版面圖檔系統版面圖檔系統版面圖檔系統版面圖檔
  • 下載下載:0
  • 收藏至我的研究室書目清單書目收藏:2
  本研究針對台灣現行到院前頸椎固定流程,探討頸椎固定術之步驟與頸椎固定產品之成效。

  研究分為三個階段:〈一〉到院前頸椎固定流程之探討:訪談救護人員以瞭解現有到院前頸椎固定流程之問題與需求,評估現有頸椎固定器材與流程之適用性。進行實驗量測到院前頸椎固定流程中傷患頸椎運動模式。〈二〉頸椎固定產品設計:建立頸椎固定產品評估原則與設計方針,進行構想發散,並選擇方案製作功能模型。〈三〉設計評估與驗證:評估頸圈與新式頸椎固定器固定效能與使用者痛苦尺度。

  實驗結果發現在現有頸椎固定流程中,頸圈可能因為安置不完善、尺寸不合適等因素造成固定效果不足,無法有效防止傷患頸椎運動。在頸椎固定流程比較實驗裡,使用頸圈傷患在前傾的運動角度上明顯大於未使用頸圈傷患,而在轉動的角度上則具有顯著的效果。而設計出的新式頸椎固定器,能加速頸椎固定流程並有效防止傷患頸椎運動,與原頸圈的效能比較,新式頸椎固定器在前傾、左偏、左轉的運動向度上明顯小於原有頸圈。在使用者痛苦尺度評比上,使用頸圈的痛苦指數在枕骨處高於頸椎固定器;在下顎骨與前頸部兩處頸椎固定器的痛苦較高於頸圈。使用者所有部位的痛苦程度皆位於無痛苦到稍微痛苦之間。

  另外本案探討了頭部固定器在頸椎固定上的效果,在使用頭部固定器以後,傷患的頸部運動範圍在前傾、左偏、左轉等三個軸向上產生明顯的減少。可見頭部固定器的使用仍在頸椎固定流程中有其重要功效。
The main purpose of this research was to discuss the procedure of the prehospital spinal immobilization and the effect of the immobilization device at present.

This research includes three stages:
1. Interview paramedic to estimate the suitability of the device, and to analyze the prehospital spinal immobilization procedure by measuring patients’ spinal movements. 2. Follow the design suggestion, we made a mock-up to attempt design goals. 3. An experiment was conducted to evaluate users discomfort scales and the product efficiency.

The results indicated that cervical collars couldn’t immobilize effectively because of improperly set or wrong size. In the experiment, patients with collar flex apparently larger than patients without collar, but rotate lesser. The new design device could immobilize faster and more efficient in flexion, left bending and left rotation. In comparison with user discomfort scales scores, collar is higher than new design in occiput, but lower in mandible and front neck. Discomfort scales of all region are between no discomfort and little discomfort.

The study also found that using Head immobilizer can appearancetly reduce patients movement in flexion, left bending and left rotation.
第一章 緒論
1-1 研究背景與動機1
1-2 研究目的與重要性2
1-3 研究範圍界定3
1-4 研究方法3
1-5 研究架構5

第二章 文獻與理論探討
2-1 頸椎位置與動作之相關文獻探討6
2-1-1 頸椎生物力學6
2-1-2 頸椎運動學相關研究6
2-2 到院前緊急救護頸椎固定術相關研究6
2-2-1 台灣現有緊急醫療體制探討6
2-2-2 頸椎受傷事故類型與傷害7
2-2-3 現有急救固定脊椎器具7
2-2-3-1 頸椎固定器材7
2-2-3-2 頸圈的設計相關研究8
2-2-3-3 頸椎固定產品對於人體生理影響8
2-3 動作分析之相關文獻探討8

第三章 到院前頸椎固定流程動作分析
3-1 頸椎固定器材動作探討11
3-1-1 頸椎固定器材分析11
3-1-2 頸椎固定流程探討12
3-1-3 救護人員訪談13
3-1-3-1 訪談目的14
3-1-3-2 結構式訪談問題清單14
3-1-3-3 訪談結果15
3-1-4 小結17
3-2 頸椎固定流程實驗規劃17
3-2-1 實驗目的17
3-2-2 實驗設計17
3-2-2-1 實驗變項17
3-2-2-2 實驗動作18
3-2-3 實驗設備19
3-2-4 實驗場景規劃20
3-2-5 實驗方法與程序21
3-3 頸椎固定流程實驗分析結果22
3-3-1 頸部運動模式22
3-3-2 T檢定23
3-4 小結24

第四章 實務設計發展
4-1 建立設計準則目標25
4-1-1 設計目標設定25
4-1-2 現有產品分析26
4-2 產品設計構想發展27
4-3 評估選擇28
4-4 最終功能模型29
4-5 產品特點與操作說明29

第五章 評估驗證
5-1 頸椎固定效果評估實驗31
5-1-1 實驗設計31
5-1-2 實驗變項31
5-1-3 實驗設備32
5-1-4 實驗場地規劃32
5-1-5 實驗內容33
5-1-6 實驗流程34
5-2 主觀感受尺度評估35
5-2-1 主觀感受尺度問卷設計35
5-2-2 問卷調查36
5-3 實驗結果與統計分析36
5-3-1 受測者基本資料36
5-3-2 受測者人體因素與固定效果分析38
5-3-3 頭部、頸部固定器對固定效果的影響42
5-3-4 主觀感受結果分析44

第六章 結論與討論
6-1 結論47
6-2 討論與建議49

參考文獻-英文
參考文獻-中文
附錄
一、英文部分

1.An, K.N., Jacobsen, M.C., Berglund, L.J., 1988, Application of a magnetic tracking device to kinesiologic studies. J Biomechanics, 21: pp.613-620.
2.Arne Lundberg. 1996. On the use of bone and skin markers in kinematics research. Human Movement Science 15(1996): pp.411-422.
3.Brumbaugh, R.B., Crowninsbield, R.D., Blaur, W.F., and Andrews, J.G., 1982, An in vivo study of normal wrist kinematics. Journal of Biomechanical Engineering, 104: pp.176-181
4.Butman, A. M. and R. W. Vomacka 1991. Spinal immobilization:part I. Emergency 23: pp.48-51.
5.Close, J.R., Inman, V.T., Poor, P.M.and Todd, F.N., 1967, The function of the subtatar joint. Clinical Orthopaedics and Related Research. 50: pp.159-179.Chandler, D. R., C. Nemejc, et al. 1992. Emergency cervical spine immobilization. Ann Emerg Med 21: pp.1185.
6.Craig, G. R. and M. S. Nielsen 1991. Rigid cervical collars and intracranial pressure. Intensive Care Med 17: pp.504
7.Croft, A. C., P. Herring, et al. 2002. The neck injury criterion: future considerations. Accident Analysis and Prevention 34: pp.247-255.
8.Daniel G, Robert A. Spinal Immobilization in the Field: Clinical Clearance Criteria and Implementation. Turtle Creek Coference ,Dallas, Texas, 2000
9.Davies, G., C. Deakin, et al. 1996. The effect of a rigid collar on intracranial pressure. Injury 27(9): pp.647-649.
10.Dennis C, Richard G, et al. The effect of Spinal Immobilization on Healthy Volunteers. Ann Emerg Med. 23(1):pp.48-51
11.Dick, T. and R. Land 1983. Cervical extrication devices. Journal of Emergency Medicine Service 8: pp.23-26.
12.Engin, A.R. and Chen, S.M., 1988, On the Biomechanics of the human hip complex in vivo. I. Kinematics for determination of the maximal voluntary hip complex sinus. Journal of Biomechanics, 21: pp.785-795
13.Garfin, S. R., M. M.Katz, et al. 1987. Prehospital care of spine cord injuries. Topics Emerg Med 9: pp.37-49.
14.Graziano, A., E. A. Scheidel, et al. 1987. A radiographic comparison of prehospital cervical immobilization methods. Ann Emerg Med 16: pp.1127.
15.Harryman, D.T., Sidles, J.A., Harris, S.L., and Matsen, F.A., 1992, Laxity of the normal glenohumeral joint:a quantitative in vivo assessment. Journal of shoulder and Elbow Surgery, 1: pp.66-76
16.Hewitt, S. 1994. Skin necrosis caused by a semi rigid cervical collar in a ventilated patient with multiple injuries. Injury 64: pp.139.
17.Jeanneret, B., F. Magerl, et al. 1991. Overdistraction: A hazard of skull traction in the management of acute injuries of the cervical spine. Arch Orthop Trauma Surg 110: pp.242-245.
18.Jones, J., C. 1992. Design Methods. Van Nostrand Reinhold. New York.
19.Koh, T.J., Grabiner, M.D., and De Swart, R.J., 1992, In vivio tracking of the human patella. Journal of Biomechanics, 25: pp.627-643.
20.Karlsson, Lundberg, D. A., Sperber, A., and Wredmark, T., 1995, Motions of the articulating surfaces in the shoulder joints. Biomechanics Seminar 9 (ISSN 1100-2247)
21.Lafortune, M.A., Cavanagh, P.R., Sommer, H.J., and Kalenak, A., 1992, Three-dimensional kinematics of the human knee during walking. Journal of Biomechanics, 25: pp.347-357
22.Lee, Y.H., Chiou, W.K., Chen, W.J., Lee, M.Y., Lin, Y.H., 1995, Predictive model of intersegmental mobility of lumbar spine in the sagittal plane from skin markers. Clinical Biomechanics, 10(8): pp.413-420.
23.Levens, A.S., Inman, V.T., and Blosser, J.A., 1948, Transverse rotation of the segments of the lower extremity in locomotion, Journal of Bone and Joint Surgery 30-A: pp.859-872.
24.Lorenzo, R. A. D. 1996. A review of spinal immobilization techniques. The Journal of Emergency Medicine 14(5): pp.603-613
25.Marion, D. and G. Clifton 1991. Injury to the vertebrae and spinal cord. M. EE, M. KL and e. Feliciano DV. Norwalk, Trauma: pp.61-75.
26.McCann, P.D., Wootten, M.E., Kadaba, M.P., 1993, A kinematic and electromyographic study of shoulder rehabilitation exercises. Clinical Orthop and Related Res 288: pp.179-188.
27.Meskers, C.G.M., Vermeulen, H.M., de Groot, J.H., van der Helm, F.C.T., Rozing, P.M., 1998, 3D shoulder position measurements using a six-degree-of-freedom electromagnetic tracking device. Clinical Biomechanics, 13: pp.280-292.
28.Lorenzo, R. A. D. 1996. A review of spinal immobilization techniques. The Journal of Emergency Medicine 14(5): pp.603-613
29.Lundberg, A., Winson, I.G., Nemeth, G.., Josephson, A., 1992, Joint motion assessment by opto-electronic analysis. In vivo accuracy in rigid body kinematics. European Journal of Experimental Muscular and Skeletal Research, 1: pp.217-219.
30.Nielsen J.1994. Usability Engineering . Academic Press, Nc.
31.Robert S.Hamilton,MD and Peter T. Pons,MD,FACEP, 1996, The efficacy and comfort of full-body vacuum splints for cervical-spine immobilization, joural of Emerg Med, 14(5): pp.553-559
32.Rosen, P. B., N. E. McSwain, et al. 1992. Comparison of two new immobilization collars. Ann Emerg MED 21: pp.1189.
33.Podolsky, S. M., J. R. Hoffman, et al. 1983. Neurologic complications following immobilization of cervical spine fracture in a patient with ankylosing spondylitis. Ann Emerg Med 12: pp.578-580.
34.Ronsky, J.L., Nigg, B.M., Fisher, V., 1995, Correlation between physical activity and the gait characteristics and ankle joint flexibility of the elderly. Clinical Biomechanics, 10(1): pp.41-49.
35.Roye, W. J., E. Dunn, et al. 1988. Cervical spine and injury-a public catastrophe. J Trauma 28: pp.1260.
36.Small, C.F., Pichora, D.R., Bryant, J.T., and Griffiths, P.M., 1994, Precision and accuracy of bone landmarks in characterizing hand and wrist position. Journal of Biomedical Engineering, 15: pp.371-378.
37.Straker, L.M. Body Discomfort Assessment Tools,
38.Stephen D, Barry M, et al. 1999, The Efficacy of Head Immobilization Techniques During Simulated Vehicle Motion, SPINE, 24(17): pp.1839-1844.
39.Taylor, N.F., Evans, O.M., and Goldie, P.A., 1996, Angular movements of the lumber spine and pelvis can be reliably measured after 4 minutes of treadmill walking. Clinical Biomechanics, 11(8): pp.484-486.
40.Victor, H. F. And Margereta N, 1980, Basic Biomechanics Of The Musculoskeletal System, Incldes Lea & Febiger.USA.
41.Wagner, F. C. and R. M. Johnson 1982. Cervical bracing after trauma. Medical Instrument 16: pp.287-288.
42.Wolf, J. W. and R. M. Johnson 1989. Cervical orthoses. The cervical spine. Philadelphia, JB Lippencott: pp.97-105

二、中文部分

1.胡明一、陳懿惠、謝慧瑛、孫穆乾編譯。人體解剖學。藝軒圖書出版社。1998。
2.胡勝川。實用到院前緊急救護 編著-台北市。金名圖書。2000。
3.夏祖怡 編著。事故現場脊椎損傷之緊急醫療救護技術圖解。財團法人急重症醫療發展基金會。2002。
4.張紹勳、張紹評、林秀娟等著。Spss For Windows 統計分析-初等統計與高等統計。2001。
5.劉耀宗。1994。低溫成型頸支架對頸椎固定之研究。國立成功大學醫學工程研究所。碩士論文。
6.顏瑋廷。2001。應用類神經網路法於表皮及肩胛骨之運動分析。國立成功大學工業設計研究所。碩士論文
連結至畢業學校之論文網頁點我開啟連結
註: 此連結為研究生畢業學校所提供,不一定有電子全文可供下載,若連結有誤,請點選上方之〝勘誤回報〞功能,我們會盡快修正,謝謝!
QRCODE
 
 
 
 
 
                                                                                                                                                                                                                                                                                                                                                                                                               
第一頁 上一頁 下一頁 最後一頁 top
系統版面圖檔 系統版面圖檔