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研究生:陳慶駿
研究生(外文):Ching-Chung Chen
論文名稱:外側楔型足墊介入對於膝內側關節炎對足底壓力、步態以及臨床功能表現的影響
論文名稱(外文):Effects of lateral-wedge insole on plantar pressure distribution, gait and clinical outcome in individuals with osteoarthritis of medial knee joint
指導教授:陳文英陳文英引用關係
指導教授(外文):Wen-Yin 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:72
中文關鍵詞:退化性膝關節炎外側楔行足墊足底壓力
外文關鍵詞:knee osteoarthritislateral-wedge insoleplantar pressure
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  • 收藏至我的研究室書目清單書目收藏:2
背景與目的:退化性膝關節炎盛行於老年人,伴隨有疼痛失能與生活品質下降等問題,其中又以內側關節面受影響較大。膝關節因為先天解剖力學結構關係,加上後天使用方式與姿勢問題,使得膝關節內外側受力不平均導致膝關節內收力矩加大,進而導致內側關節面需承受較大壓力導致關節磨損退化。改善方法之一是外側楔形足墊的使用。這種外側加高5-10度的足墊可以改善腳掌與踝關節的受力方式進而影響膝關節的內收力矩趨勢。經過先前的研究發現可以減輕疼痛,增加生活功能,並改善生物力學參數表現;但是臨床療效證據支持仍然有限。而且較少觀察在日常活動中內外側壓力的改變情形。因此我們針對膝內側關節炎病患使用外側楔行足墊後的足底壓力與步態進行研究。
研究方法:針對膝內側關節炎病患進行隨機雙盲分成兩組測試。提供實驗組一個外側較高5到10度的楔形足墊,以及控制組一個有類似厚度的平底足墊。依據病患行走15分鐘後的感覺調整修正其適切高度。提供足墊前後重複測試其足底壓力與步態相關參數,以及填寫功能問卷,包括膝關節炎疼痛功能指數(WOMAC)以及生活品質健康指數(SF36)等量表評估其疼痛與功能變化。使用足墊三個月之後再追蹤測試其足壓、步態、疼痛功能與生活品質。
統計分析:疼痛程度與生活功能等臨床變數以二維重複測量、多項次變數分析法(2x2 two-way repeated measures MANOVA)分析實驗組與對照組在足墊介入前後的差異。足壓分佈將以重複測量、多項變數三維分析法(2x2x3 three-way repeated measures MANOVA)分析兩組在足墊介入前後、內外足壓之差異。步態分析中之各參數也將以重複測量、多項變數二維分析法(2x3 two-way repeated measures MANOVA)分析兩組在足墊介入前後之差異。
結果與討論:最後共有37名受試者完成追蹤測試(實驗組18人,控制組19人)。兩組之間基本資料無差異。追蹤三個月後比較發現控制組內外側足底尖峰受力(peak force)與受力時間積分(force-time integer)落差有明顯改善。足底尖峰壓力(peak pressure)與壓力時間積分(pressure-time -integer)則無明顯改善。疼痛與生活功能和步態相關參數亦無明顯變化。
結論:膝內側關節炎患者使用外側楔行足墊可以改善內外側受力狀態進而改善內收力矩,改善膝內側關節負荷過大之問題,但可能需要更長時間穿帶並加以運動治療方可減緩臨床症狀與促進生功能。
Background and Purpose: Knee osteoarthritis is a degenerative disease that prevails in older population. It often accompanies pain, disability and lowered quality of life. The degeneration affects medial knee compartment much more than the lateral compartment because of its anatomical alignment and biomechanical manifestations. One of the treatment strategies that aim to decrease the loading on the medial knee compartment is to use a laterally elevated wedge insole. Previous studies have reported effects of lateral-wedge insole application on pain reduction, functional improvement, and biomechanical enhancements in subjects with medial knee osteoarthritis. But evidences of its clinical effectiveness are still limited. There is a need to investigate clinical effects together with medial-lateral loading change and gait improvement associated with the application of lateral-wedge insole. The purpose of this study was to investigate effects of lateral wedged insole on pain, function, quality of life, as well as gait and plantar pressure change in individuals with medial compartment osteoarthritis of the knee (MCOA).
Methods: We recruited 37 individuals (18, 19) diagnosed with MCOA and randomly assigned them to a wedged (5-10º) or a flat insole treatment group. We collected basic information, knee pain and disability data then measured gait variables with the GAITRite system and plantar pressure distribution with the PEDAR system (pretest). Then we fitted each subject either wedged or flat insoles according to the group assignment. After the subject walked 15 minutes to be accustomed to the insoles, measurements on gait and plantar pressure was preformed again (posttest). Plantar surface was divided into medial and lateral by a line connecting the center of the heel and the second toe. We calculated peak force (PF), peak pressure (PP), pressure-time integer (PTI) and force-time integer (FTI) separately for the medial and lateral plantar surfaces of the affected side. The gait variables included step length, cadence, and velocity. After 3 months, the subject was tested again on all the clinical and gait/plantar pressure variables (follow-up).
Statistical Analysis: We used 3-way multivariate analyses of variance with repeated measures to analyze differences between the insole condition (wedge or flat), side (medial or lateral), and time (pretest, posttest, and follow-up) to examine the effect of lateral-wedge insole on plantar pressure distribution. We used a 2-way multivariate analysis of variance with repeated measures to analyze differences between the insole condition (wedge or flat) and time (pretest, posttest, and follow-up) on the gait variables. Separate 2-way multivariate analyses of variance with repeated measures were used to analyze differences between the insole condition (wedge or flat) and time (pretest and follow-up) on pain, function, and quality of life
Results: The wedge-insole (n=18) and the flat-insole (n=19) groups were equivalent in all the basic characteristics and baseline gait and plantar pressure parameters. Gait analysis revealed subjects walked with similar step length, speed, or cadence regardless of the insole type. However, the wedge-insole group walked with a more balanced loading on the medial side as compared to the lateral side of the foot (p < .05) while the flat-insole group did not significantly change the medial-lateral loading pattern. We found peak force (PF) and force-time integer (FTI) significantly changed after 3 months follow-up in the wedge- insole group. Nevertheless, there was no significant change in clinical measurements of pain, function, and quality of life after insole application for 3 months.
Conclusion & Clinical Relevance: Lateral wedge helped to re-distribute loading on the medial-lateral aspect of the foot. However the results could not be translated to clinical improvement on pain, function, and quality of life. Subjects with MCOA may benefit from lateral wedge with its loading re-distribution effect by using it as an adjunct to carry out weight bearing physical activities to obtain better clinical improvement.
表目次 iii
圖目次 vi
摘要 vii
第一章 簡介 1
第二章 第一節 研究背景與動機 1
第二節 研究目的 2
第三節 研究假設 2
第四節 重要性 3
第二章 文獻回顧 4
第一節 膝關節解剖 4
第二節 膝關節關節炎病理生理學 4
第三節 退化性膝關節炎影響因子 5
第四節 膝內側關節增加負荷的生物力學因子 8
第五節 外側械型足墊(lateral-wedged insole)的生物力學機制 9
第六節 外側楔型足墊的臨床效果 12
第七節 外側楔型足墊傾斜角度的臨床研究 14
第三章 研究方法 15
第一節 研究設計 15
第二節 研究材料與研究方法 15
第三節 資料處理與分析方法 19
第四章 研究結果 21
第五章 討論 24
參考文獻 29
附錄 72
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