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研究生:許應勃
研究生(外文):Ying-Po Hsu
論文名稱:疼痛退化性脊椎病患平衡能力探討
論文名稱(外文):The impacts of painful vertebral degenerative disease on balance performance of elderly subjects
指導教授:陳俊忠陳俊忠引用關係
指導教授(外文):Jin-Jong Chen
學位類別:碩士
校院名稱:國立陽明大學
系所名稱:物理治療暨輔助科技學系
學門:醫藥衛生學門
學類:復健醫學學類
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:退化性脊椎平衡壓力中心
外文關鍵詞:degenerative vertebralbalance、centre of pressuresit to stand
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研究背景:隨著老年人口的增加,退化性疾病的影響就越加顯著,其中有退化性脊椎疾病的患者也佔了相當大的族群,相關疾病如椎間盤突出、脊椎滑脫、脊椎關節炎、脊椎神經孔狹窄、脊椎變形或是壓迫性骨折等,然而根據文獻指出有脊椎變形等退化性疾病產生時,有較高後續相關骨折的機會,而骨折的原因多為跌倒發生所致,但少有文獻針對疼痛退化性脊椎病患的平衡能力作探討,因此本研究主要目的在探討疼痛退化性脊椎病患動態及靜態的平衡能力。研究方法:經臨床骨科醫師檢查診斷為疼痛退化性脊椎病患,以及與年齡相符無背痛的受測者作為控制組,在收案後進行基本資料收集與動態平衡能力檢測:功能性前伸測試、起走測試、與靜態平衡能力檢測:壓力平台上壓力中心位移距離及速率等有關身體姿勢穩定性的平衡能力檢測,以及起站時間與最大地面反應力的檢測,研究結果以獨立樣本T檢定兩組間動靜態平衡能力的差異,以及使用皮爾森關係數檢驗動靜態平衡間相關性,研究結果:在動態平衡能力檢測方面,兩組間比較都有顯著的差異,但相較於功能性前伸測試,起走測試在兩組間有較高的區辨性;在靜態平衡能力檢測方面,兩組間在坐姿與站姿等四種測試姿勢位移量之差異並未達統計水準,但在壓力中心的位移速率,兩組間比較則有顯著的差異;另外有關起站能力指標,疼痛退化性脊椎病患在起站時間與起站最大地面反應力方面都有較差的表現。結論:疼痛退化性脊椎病患因受背痛影響,在腰部穩定性的控制能力較差,無法以快速微調的方式來維持身體姿勢的穩定性,可能較容易受到外力的影響而發生跌倒,起站能力的不足更容易限縮疼痛退化性脊椎病患活動的範圍,在面對此類患者的治療介入時,應將平衡能力的提昇及跌倒危險的預防納入相關的治療計畫。
PURPOSE: Significant impacts of painful vertebral degenerative disease (PVDD) on the elderly subjects’ physical function have been noted. But only few studies conducted to evaluate patients’ balance capacity due to severe intolerable pain. The purpose of this study was to investigate the impacts of PVDD on balance performance and transitional movements. METHODS: Thirty- five elderly subjects (69.5±7.1 years) from an orthopedic clinic with PVDD were examined before the surgery. Thirty age-matched community healthy elderly dwellers (72.5±5.4 years) were included in this study as control group volunteers (CG). The following measurements were conducted: (1) dynamic balance tests: functional reach (FR), and 3m Timed-Up and Go (TUG), and (2) static balance tests: open eye with arms rest and close eye with arms lift under sitting and standing posture. Sit-to-stand performance tests were conducted using a force plate to measure the maximum ground reaction force (MGRF) and time course from start to MGRF. RESULTS: The results demonstrated that PVDD group subjects had significant poor dynamic balance performance than the CG subjects, lower FR (20.8±6.9cm vs. 28.9±4.5cm, p<0.001) and slower TUG (14.99±8.79s vs. 10.20±2.06s, p<0.05). PVDD subjects demonstrated significant lower center of pressure (COP) velocity of postural control than control group during four static balance tests and poor sit-to-stand performance than the CG subjects. CONCLUSIONS: Due to insufficiency of proprioception and co-contraction on the PVDD’s lumbar spine, PVDD subjects showed poor dynamic, static balance and poor performance of sit to stand test.
謝誌 I
目錄 II
圖目錄 V
中文摘要 VI
Abstract VIII
第一章 緒論 1
第一節 研究背景 1
第二節 研究之重要性 2
第三節 研究目的 3
第二章 文獻回顧 4
第一節 疼痛退化性脊椎疾病之定義與流行病學 4
第二節 疼痛退化性脊椎疾病對生活品質之影響 6
第三節 疼痛退化性脊椎疾病對身體功能以及後續骨折之影響 7
第四節 跌倒發生與身體姿勢穩定性之關係 8
第五節 平衡能力檢測之方法與起站能力 10
第六節 文獻回顧之綜合探討 14
第三章 研究方法 16
第一節 研究設計 16
第二節 研究對象 16
第三節 實驗流程與步驟 17
第四節 測量工具與方法 18
第五節 資料擷取、處理與統計分析 20
第四章 研究結果 22
第一節 受測者基本特性 22
第二節 動態平衡能力檢測 22
第三節 壓力平台測試結果 23
第四節 起站時間與起站最大地面反應力結果 24
第五節 臨床測試結果與壓力平台檢測參數及疼痛之相關性 24
第五章 討論 26
第一節 疼痛退化性脊椎病變對臨床平衡測試能力的影響 26
第二節 影響疼痛退化性脊椎病患壓力平台測試表現因子 28
第三節 影響疼痛退化性脊椎病患起站測試表現因子 32
第四節 臨床測試、疼痛與起站測試之相關探討 34
第五節 研究限制 36
第六節 未來研究方向建議 37
第六章 結論 38
參考文獻 40
附錄一 受試者同意書 83
附錄二 受測者基本資料 86
附錄三 倫理評核表 87
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