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研究生:吳國禎
研究生(外文):Kuo-Chen Wu
論文名稱:腕隧道症候群患者開關罐動作之手指協調模式
論文名稱(外文):The Digits Coordinated Pattern of the Patient with Carpal Tunnel Syndrome during Jar Opening and Closing
指導教授:蘇芳慶蘇芳慶引用關係
指導教授(外文):Fong-Chin Su
學位類別:碩士
校院名稱:國立成功大學
系所名稱:醫學工程研究所碩博士班
學門:工程學門
學類:綜合工程學類
論文種類:學術論文
論文出版年:2009
畢業學年度:97
語文別:中文
論文頁數:87
中文關鍵詞:開罐腕隧道症候群關罐手指協調模式
外文關鍵詞:carpal tunnel syndromejar openingjar closingcoordinated pattern
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腕隧道症候群為正中神經於手腕受到壓迫,就會表現出手部(拇指、食指、中指及橈側之無名指)會有疼痛、灼熱、刺痛或麻木感,嚴重者可看到手掌拇指球肌萎縮及手腕無力,因而影響到手部功能。本研究的主要目地在於研究腕隧道症候群女性患者,右手開、關罐時,各手指力量協調和扭矩貢獻值。此外與常人進行差異分析。
本研究利用自行設計的罐子模擬器(罐子直徑8.0cm,內含有三顆六軸荷重元及一顆扭力計),本實驗分成兩組受測者,腕隧道症候群與正常受測者,各三十六位女性;皆收測右手於開罐和關罐動作時,手指所施的力量和總扭矩,分析出手指的拇指、食指和其他三指,施力點、力量和協調模式。
腕隧道症候群於摩擦係數、抓握力、指捏力、側捏力和總扭力矩均小於正常受測者,在統計上皆有顯著差異,且開關罐總扭力矩比值變小。拇指、食指和其他三指施力點相距角度與正常人相似,食指則具靈活調控地位。
腕隧道症候群受測者於開關罐動作手指力量上,與正常人相比均下降,但其他三指於開關罐動作的差異不大,足顯其他三指於開關罐動作中扮演穩定協助角色。由貢獻度來看,大拇指為主要貢獻者。與正常人相比,腕隧道症候群受測者,主要是正向力貢獻度下降,應與正中神經於手腕受到壓迫有關。而切線力貢獻度未變,應與其主要貢獻者為外部肌群有關。
利用此開關罐模擬器,可以快速、客觀與數位化顯示測量數據,且可以一台測量儀收測多樣數據,確可較全面性手部功能客觀性、快速性評估右手開關罐方式。
Carpal tunnel syndrome is caused by increased pressure on median nerve entering the hand through the confined space of the carpal tunnel at wrist. The most common symptoms are tingling, numbness, weakness, or pain felt in the radial three and one-second fingers. With long-lasting carpal tunnel syndrome (CTS), the thenar muscles can get atrophy and loss some hand strength. The purpose of this study was to investigate the coordination of applied force and the contribution ratio of twisting torque of the right digits in jar opening and closing in female patient with carpal tunnel syndrome. In addition, the difference between patients and normal subjects was analyzed.
There were two female groups, one was CTS group and another was normal group. Each group had thirty-six subjects. Right hand was divided to three parts, thumb & thenar, index finger and others three finger for analysis. Using the simulated jar apparatus (diameter 8.0 cm, equipped with three six-axis load cells and one torque cell) to measure the maximal strength of the thumb at lateral pinch, tip pinch and power grip. All subjects were recruited to measure the total twisting torque. The force amount, coordination and contribution were respectively analyzed.
CTS group was small than normal group in the items of lateral pinch, tip pinch, power grip. The maximal torque generated by CTS group was smaller than normal group in jar opening and closing. But the amount of decrease between CTS and normal group, closing jar was larger than opening jar. The angle between the point of combined force application of the three parts of hand were different between opening jar and closing jar no matter CTS or normal group. But comparing CTS and normal group, only the angle between thumb and index finger had difference no matter opening jar or closing jar. Comparing total force between opening jar and closing jar, only the three fingers part hadn’t difference no matter CTS or normal group. Dividing the total force of thumb to normal, tangential and axial force, only tangential force had difference between opening jar and closing jar. Analyzing the contribution at CTS group, thumb plays the most important role no matter opening jar or closing jar. Comparing with normal group, the contribution of normal force decreased at the three parts of CTS hand. But the contribution of tangential and axial force, only index finger had difference.
CTS patient is difficult to tighten jar than normal subject. From the analysis of the contribution of normal, tangential and axial force, it seems to prove median nerve compressed affects jar opening and closing. Thumb plays the most important role no matter opening jar or closing jar. Index finger plays the important role in finger coordination. The other three fingers part plays the steady role when opening jar or closing jar.
中文摘要 I
誌謝 V
目錄 VI
表目錄 IX
圖目錄 X
第一章 前言 1
1.1 腕隧道症候群 1
1.2 手部骨骼肌肉神經系統 5
1.2.1. 骨骼與關節 5
1.2.2. 肌肉 9
1.2.3. 神經 13
1.3 手部力學評估與開、關罐 16
1.4 研究目的 20
第二章 實驗方法及理論分析 21
2.1 受測者 21
2.2 設備 23
2.3 手指與罐蓋間之作用力與反作用力分析 26
2.4 實驗步驟 32
2.5 資料分析 36
第三章 結果 37
3.1 基本資料分析 37
3.2 腕隧道症候群受測者開關罐動作力學表現 39
3.2.1. 開關罐動作手指相對施力點 39
3.2.2. 開關罐動作手指力量 48
3.2.3. 開關罐動作手指協調模式分析 57
第四章 討論 64
4.1 腕隧道症候群受測者的變化 64
4.1.1. 拇指及手掌魚際部份對開關罐動作扭矩影響 64
4.1.2. 食指的變化及各手指的相對位置改變 70
4.1.3. 其他三指的變化 73
4.2 開關罐模擬器 74
4.3 實驗限制 76
第五章 結論與未來工作 78
5.1 結論 78
5.2 未來研究方向 81
參考文獻 82
附錄一 85
自述 87
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