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研究生:張曉昀
研究生(外文):Hsiao-Yun Chang
論文名稱:功能性膝支架對於前十字韌帶重建手術運動員在膝關節動作之生物力學分析
論文名稱(外文):Biomechanical Analysis of Functional Knee Brace for Athletes with Anterior Cruciate Ligament Reconstruction
指導教授:黃啟煌黃啟煌引用關係
指導教授(外文):Chi-Huang Huang
學位類別:博士
校院名稱:國立體育學院
系所名稱:體育研究所
學門:教育學門
學類:專業科目教育學類
論文種類:學術論文
論文出版年:2007
畢業學年度:96
語文別:中文
論文頁數:177
中文關鍵詞:膝關節前十字韌帶傷害膝支架功能性動作運動學
外文關鍵詞:Knee braceAnterior cruciate ligament injuryKnee jointKinematicsFunctional activity
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研究背景:前十字韌帶重建的運動員會造成膝關節的生物力學運動模式改變,這些手術後的運動員在重回運動場之前,需要經過膝關節的檢查與評估以了解運動員復原狀況,但是這些評估方式無法實際反映出運動員在接受前十字韌帶重建手術後膝關節運動過程中的關節活動情形。再者,前十字韌帶受傷或斷裂及重建之後,需穿著功能性膝支架,功能性膝支架是否會影響膝關節運動學的變化也一直是爭議性的問題。研究目的:本研究之目的為比較正常健康之運動員、前十字韌帶損傷者與接受前十字韌帶重建運動員在有無穿著功能性膝支架對膝關節運動學影響之差異。研究方法:本研究選取7位健康者、7位接受前十字韌帶重建手術之大學運動員、及4位前十字韌帶損傷運動員進行研究,以Zebris CMS-HS超音波三維動作分析儀進行實驗,測量的動作包括下蹲、垂直跳、往前跳、上樓梯、及下樓梯等五個動作。收集並記錄每個動作過程中的最大角度(膝彎曲、外翻、內翻、外轉、內轉、最大膝外轉時之彎曲角度、最大膝外翻時之彎曲角度、最大膝內翻時之彎曲角度),再擷取膝彎曲末端0~30°的膝外翻角度與外轉角度計算關節滑動軌跡路徑長度等九個變項。統計方法:本研究以混合設計二因子變異數分析比較健康者、前十字韌帶損傷者與接受前十字韌帶重建之運動員在有無穿著功能性膝支架時的膝關節運動學差異。結果及臨床運用:由研究結果顯示,有無穿著功能性膝支架對於健康者、前十字韌帶損傷者與前十字韌帶重建者在膝關節運動學上並無顯著的影響。三個族群在最大膝外翻角度及發生最大膝外轉時的膝關節彎曲角度均有明顯的差異,最大膝外翻角度均以前十字韌帶損傷組角度最大,其次為前十字韌帶重建組,健康組外翻角度最小。顯示前十字韌帶損傷後會增加膝關節外翻角度,但是接受前十字韌帶重建手術的患者可以改善膝關節過度外翻的情形。在發生最大膝外轉時的膝關節彎曲角度部分,前十字韌帶重建組在膝關節剛開始彎曲時已經發生最大的膝外轉動作,顯示在接受手術後會產生膝關節提早外轉的情形,表示在手術後膝關節還是呈現轉動性不穩定的情形。
Background: Recent research suggests athletes after anterior cruciate ligament (ACL) reconstruction leads to alterations in gait adaptation and knee kinematics. Before return the athletes with ACL reconstruction to their previous sports level, there were needs to evaluate the knee function after ACL reconstruction surgery. Most of the used methods could not reflect the actual joint movements of knee after ACL reconstruction during activities. Secondly, the athletes after ACL reconstruction had to wearing functional knee brace (FKB). Wearing functional knee brace was also a controversial issue. Purpose: The aims of this study were to compare the difference of knee kinematics among normal, subjects with anterior cruciate ligament(ACL) injuries and athletes with ACL reconstruction in bracing or un-bracing condition during 5 functional activities (squat, vertical jump, hop, up- and down-stair). Methods: The study was conducted on 7 collegiate athletes following ACL reconstruction surgery, 4 ACL injuries subjects and 7 healthy athletes. Knee kinematics analysis was performed by applying the Zebris three-dimensional ultrasound-based system during squatting, up- and down-stair, vertical jump and hop. A Mix-design two-way ANOVA was used to determine the difference among healthy, ACL injuries subjects and athletes following ACL reconstruction. Results: The results were shown that: (1) there was no significant difference between bracing and un-bracing knee movements during 5 measured activities. It was no instantly significant change before and after wearing functional knee brace for three groups. (2) There was significant difference among normal, ACL injuries subjects and athletes with ACL reconstruction in 5 functional activities, especially maximal knee abduction angle and knee flexion degree at maximal knee external rotation. (3) ACL injuries group had more knee abduction angle. The results indicated that ACL injuries group increased knee abduction after injuries. (4) Early tibial external rotation was found in knee flexion for athletes with ACL reconstruction. It was an indication that athletes with ACL reconstruction exhibited rotatory instability.
目 錄

中文摘要-------------------------------------------------------- I
英文摘要-------------------------------------------------------- III
致謝------------------------------------------------------------- V
目錄------------------------------------------------------------- VII
圖目錄----------------------------------------------------------- X
表目錄---------------------------------------------------------- XIII

第一章 緒論-------------------------------------------------- 1

第一節 前言------------------------------------------------ 1
第二節 研究動機------------------------------------------ 1
第三節 研究目的------------------------------------------ 5
第四節 研究範圍------------------------------------------ 7
第五節 研究限制------------------------------------------ 7
第六節 研究假定------------------------------------------ 8
第七節 名詞解釋及操作性定義-------------------------- 8

第二章 文獻探討-------------------------------------------- 10

第一節 膝關節之功能性解剖----------------------------- 10
第二節 膝關節之生物力學------------------------------- 24
第三節 前十字韌帶損傷的發生率----------------------- 30
第四節 前十字韌帶損傷的臨床處理原則--------------- 34
第五節 功能性膝支架的結構與功效--------------------- 38
第六節 前十字韌帶受傷或重建者之膝關節運動模式之相關研究----------------------------------------
51
第七節 功能性膝支架影響膝關節運動模式之相關研究--------------------------------------------------
55
第八節 結語------------------------------------------------ 58

第三章 研究方法--------------------------------------- 59

第一節 研究對象------------------------------------------ 59
第二節 實驗儀器與設備---------------------------------- 62
第三節 實驗設計及流程---------------------------------- 71
第四節 資料分析及統計方法----------------------------- 75

第四章 結果與討論------------------------------------- 83

第一節 研究結果------------------------------------------ 83
一、 下蹲動作------------------------------------------ 83
二、 垂直跳動作---------------------------------------- 91
三、 往前跳動作---------------------------------------- 99
四、 上樓梯動作---------------------------------------- 107
五、 下樓梯動作---------------------------------------- 115
第二節 討論------------------------------------------------ 126
一、 正常人、前十字韌帶損傷者與接受前十字韌帶重建手術運動員之膝關節三維運動學之比較-----------------------------------------------------

126
二、 功能性膝支架對前十字韌帶損傷及重建者之膝關節三維運動學之影響------------------------
130
三、 研究之限制及運動科學之臨床應用------------- 132

第五章 結論與建議----------------------------------------- 134

第一節 結論------------------------------------------------ 134
第二節 建議------------------------------------------------ 135
第三節 未來研究方向------------------------------------- 136

參考文獻------------------------------------------------------- 137

附錄------------------------------------------------------------- 153

附錄一 膝關節功能性量表------------------------------------ 153
附錄二 人體試驗委員會同意書------------------------------- 156
附錄三 膝關節三維運動學計算------------------------------- 157


圖 目 錄

圖2-1-1 膝關節的前側及後側骨骼結構-------------------- 13
圖2-1-2 股骨髁狀突起之比較------------------------------- 14
圖2-1-3 膝關節半月板--------------------------------------- 16
圖2-1-4 半月板的運動--------------------------------------- 16
圖2-1-5 膝關節主要韌帶結構------------------------------- 21
圖2-1-6 膝關節周邊的肌肉群------------------------------- 23
圖2-2-1 膝關節四連桿系統--------------------------------- 28
圖2-2-2 旋迴機制-------------------------------------------- 29
圖2-5-1 功能性膝支架的四個主要結構-------------------- 42
圖3-2-1 Zebris CMS-HS超音波三維動作分析儀---------- 65
圖3-2-2 三頭的超音波被動感應器放置處----------------- 66
圖3-2-3 座標系統-------------------------------------------- 67
圖3-2-4 Zebris CMS-HS超音波三維動作分析系統信效度測試及模型效度驗證-------------------------------
68
圖3-2-5 實驗用之功能性膝支架---------------------------- 69
圖3-3-1 實驗設計圖----------------------------------------- 73
圖3-3-2 實驗流程圖----------------------------------------- 74
圖3-4-1 下蹲動作之角度變化圖及擷取膝彎曲末端0~30°之範圍-----------------------------------------------
77
圖3-4-2 垂直跳動作之角度變化圖及擷取膝彎曲末端0~30°之範圍----------------------------------------
78
圖3-4-3 往前跳動作之角度變化圖及擷取膝彎曲末端0~30°之範圍----------------------------------------
79
圖3-4-4 上樓梯動作之角度變化圖及擷取膝彎曲末端0~30°之範圍----------------------------------------
80
圖3-4-5 下樓梯動作之角度變化圖及擷取膝彎曲末端0~30°之範圍----------------------------------------
81
圖4-1-1 控制組、前十字韌帶損傷組及前十字韌帶手術組在下蹲動作之膝關節彎曲末端0~30°角度的外翻動作角度變化圖------------------------------------

88
圖4-1-2 控制組、前十字韌帶損傷組及前十字韌帶手術組在下蹲動作之膝關節彎曲末端0~30°角度的外轉動作角度變化圖------------------------------------

89
圖4-1-3 控制組、前十字韌帶損傷組及前十字韌帶手術組在下蹲動作之膝關節彎曲末端0~30°角度的關節滑動軌跡變化圖------------------------------------

90
圖4-1-4 控制組、前十字韌帶損傷組及前十字韌帶手術組在垂直跳動作之膝關節彎曲末端0~30°角度的外翻動作角度變化圖---------------------------------

96
圖4-1-5 控制組、前十字韌帶損傷組及前十字韌帶手術組在垂直跳動作之膝關節彎曲末端0~30°角度的外轉動作角度變化圖---------------------------------

97
圖4-1-6 控制組、前十字韌帶損傷組及前十字韌帶手術組在垂直跳動作之膝關節彎曲末端0~30°角度的關節滑動軌跡變化圖---------------------------------

98
圖4-1-7 控制組、前十字韌帶損傷組及前十字韌帶手術組在往前跳動作之膝關節彎曲末端0~30°角度的外翻動作角度變化圖---------------------------------

104
圖4-1-8 控制組、前十字韌帶損傷組及前十字韌帶手術組在往前跳動作之膝關節彎曲末端0~30°角度的外轉動作角度變化圖---------------------------------

105
圖4-1-9 控制組、前十字韌帶損傷組及前十字韌帶手術組在往前跳動作之膝關節彎曲末端0~30°角度的關節滑動軌跡變化圖---------------------------------

106
圖4-1-10 控制組、前十字韌帶損傷組及前十字韌帶手術組在上樓梯動作之膝關節彎曲末端0~30°角度的外翻動作角度變化圖---------------------------------

112
圖4-1-11 控制組、前十字韌帶損傷組及前十字韌帶手術組在上樓梯動作之膝關節彎曲末端0~30°角度的外轉動作角度變化圖---------------------------------

113
圖4-1-12 控制組、前十字韌帶損傷組及前十字韌帶手術組在上樓梯動作之膝關節彎曲末端0~30°角度的關節滑動軌跡變化圖---------------------------------

114
圖4-1-13 控制組、前十字韌帶損傷組及前十字韌帶手術組在下樓梯動作之膝關節彎曲末端0~30°角度的外翻動作角度變化圖---------------------------------

120
圖4-1-14 控制組、前十字韌帶損傷組及前十字韌帶手術組在下樓梯動作之膝關節彎曲末端0~30°角度的外轉動作角度變化圖---------------------------------

121
圖4-1-15 控制組、前十字韌帶損傷組及前十字韌帶手術組在下樓梯動作之膝關節彎曲末端0~30°角度的關節滑動軌跡變化圖---------------------------------

122


表 目 錄

表2-1-1 膝關節主要韌帶結構及功能------------------------ 20
表2-3-1 不同運動項目及性別發生前十字韌帶傷害的發生率-----------------------------------------------------
32
表2-5-1 功能性膝支架之非人體試驗相關研究------------- 45
表2-5-2 功能性膝支架之人體試驗相關研究---------------- 47
表3-1-1 受試者基本資料表----------------------------------- 61
表3-2-1 Zebris超音波三維動作分析系統之再測信度結果--------------------------------------------------------
70
表3-2-2 Zebris超音波三維動作分析系統與關節量角器之同時效度結果----------------------------------------
70
表4-1-1 控制組、前十字韌帶損傷組及前十字韌帶重建組下蹲動作之平均數與標準差------------------------
85
表4-1-2 控制組、前十字韌帶損傷組及前十字韌帶重建組下蹲動作之二因子變異數分析摘要表-------------
86
表4-1-3 控制組、前十字韌帶損傷組及前十字韌帶重建組垂直跳動作之平均數與標準差---------------------
93
表4-1-4 控制組、前十字韌帶損傷組及前十字韌帶重建組垂直跳動作之二因子變異數分析摘要表----------
94
表4-1-5 控制組、前十字韌帶損傷組及前十字韌帶重建組往前跳動作之平均數與標準差---------------------
101
表4-1-6 控制組、前十字韌帶損傷組及前十字韌帶重建組往前跳動作之二因子變異數分析摘要表----------
102
表4-1-7 控制組、前十字韌帶損傷組及前十字韌帶重建組上樓梯動作之平均數與標準差---------------------
109
表4-1-8 控制組、前十字韌帶損傷組及前十字韌帶重建組上樓梯跳動作之二因子變異數分析摘要表--------
110
表 4-1-9 控制組、前十字韌帶損傷組及前十字韌帶重建組下樓梯動作之平均數與標準差---------------------
117
表4-1-10 控制組、前十字韌帶損傷組及前十字韌帶重建組下樓梯動作之二因子變異數分析摘要表----------
118
表4-1-11 控制組、前十字韌帶損傷組及前十字韌帶重建組之事後分析比較-------------------------------------
123
表4-1-12 穿著及未穿著膝支架之事後分析比較------------- 124
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