臺灣博碩士論文加值系統

肩關節是人體中活動度最大的關節之一，其中肩胛骨是負責協調肩部其他骨骼與肌肉相關位置的重要骨骼，當肩胛骨位置不當會導致肩部發生病變，因此找出一個簡易方法評估肩胛骨是否正常運作，和準確辨別出肩胛骨運動位置就顯得相當重要。
本研究針對正常年輕族群探討肩胛骨位置較低時對於靜止時與聳肩後上、下斜方肌的壓力疼痛閥值（Pressure Pain Threshold, PPT）與肌肉基本狀態，分析表面肌電圖在連續三次最大自主聳肩時肌肉延遲時間（Muscle Latency Time, MLT）及每次聳肩時最大中位頻率（Median Frequency, MF），並利用線性回歸法計算出連續三次最大自主MF的變化斜率（Hz/ms），作為肌肉疲勞指標。
本研究臨床收案有效樣本共20人，包含正常12人（男生5人、女生7人）與肩胛骨位置較低8人（男生5人、女生3人），經由統計分析後發現肩胛骨位置較低者，其上、下斜方肌確實都有明顯較低的PPT值（P<0.05），肌肉基本狀態沒有顯著差異（P＞0.05），在聳肩時上斜方肌MLT有明顯延遲的現象發生（P<0.05），MF的斜率變化上無顯著差異。因此推測在肩部未患有任何症狀且活動正常的年輕人中，肩胛骨位置較低者，其上、下斜方肌深層的肌肉確實都有較低的壓力耐受值，但還是能維持正常的基本特性。運動時上斜方肌徵召運動單元時會需要較長的時間，但不影響肌肉緩解疲勞能力。

The shoulder joint is one of the most freely movable joint in the body. It possesses specialized structure and motion. Scapular is stabilised in or moved into a certain position to coordinate shoulder function during the movement of shoulder and arm and to achieve a ways movement of joint in athletic and daily activities. An alteration in the scapular position at rest or during arm movement is commonly associated with shoulder injury on dysfunction. Therefore, it is necessary to quantify and identify scapular dysfunction accurate by easily implemented clinical tests and measures.
The purpose of this study was to assess the influence of scapular with depressed position through the values of pressure pain threshold (PPT) and muscle properties of the up and lower trapezius muscles in a young healthy population. By using surface electromyography to evaluate muscle fatigue instructed to a sequence of three maximal shoulder shrugs with each held for 5s. Calculating each shrug’s muscle latency time (MLT) and a slope of the regression line (Hz/ms) that fits the maximum values of median frequency (MF) in a least-square sense was used as a fatigue index.
Twenty volunteers participated in this study, they were divided into normal shoulder (NS group, n=8, 5 men and 3 women) group and depressed shoulder (DS group, n=12, 5 men and 7 women) group. The results revealed significant difference between groups, with the DS group demonstrated lower mean PPT values(P&lt;0.05) when compared to NS group. Significant delayed in latency time(P&lt;0.05) of the upper trapezius muscle during the shoulder shrugs were observed. Although there were no significant difference(P&gt;0.05) in muscle properties and the slope of the regression line (P&gt;0.05) among the 2 section of the trapezius muscle.
Our results showed that healthy young subjects with depressed scapula position had significant lower PPT value than subjects with normal scapular position both in the up and lower trapezius muscle. There is no difference in muscle properties of upper and lower trapezius muscle in subjects with normal and depressed scapular position.

摘要 I
Abstract II
誌 謝 III
目 錄 IV
圖目錄 VII
表目錄 IX
第一章 緒論 1
1.1 前言與背景 1
1.2 文獻回顧 2
1.3 研究動機與目的 6
1.4 論文架構 7
第二章 基礎理論 8
2.1 肩胛骨的解剖學與生物力學機制 8
2.2 斜方肌（Trapezius Muscle） 10
2.3 表面肌電圖（surface Electromyography, sEMG） 11
2.3.1 肌肉延遲時間（Muscle Latency Time, MLT） 12
2.3.2 中位頻率（Median Frequency, MF） 13
2.4 壓力疼痛閥值（Pressure Pain Threshold, PPT） 14
2.5 肌肉機械特性 15
第三章 研究方法與步驟 16
3.1 肩胛骨位置拍攝裝置 16
3.2 壓力疼痛測試計（Pressure Threshold Algometer, PTA） 17
3.3 肌肉基本特性 17
3.4 肌電訊號擷取系統 19
3.4 實驗組別 24
3.5 臨床試驗設計 25
3.5.1 臨床試驗流程 25
3.5.2 受測者之篩選 25
第四章 成果與討論 27
4.1 實驗對象 27
4.2 臨床試驗結果與討論 28
4.2.1壓力疼痛閥值（PPT） 28
4.2.2 肌肉基本特性 29
4.2.3肌肉延遲時間（MLT） 30
4.2.4中位頻率（MF） 31
第五章 結論與未來展望 33
5.1 結論 33
5.2 未來展望 33
5.2.1 臨床收案部分 33
5.2.2 臨床實驗設計 33
參考資料 35
附錄 口試委員建議事項 40

圖目錄
圖 1 肩胛骨位置 3
圖 2 肌肉收縮時間延長與中位頻率、肌肉疲勞之關係[24] 5
圖 3 連續週期性自主收縮之肌電訊號變化[29] 5
圖 4 隨著作用時間延長，斜方肌各部位之中位頻率變化[30] 5
圖 5 右肩胛骨 9
圖 6 背部肌肉[33] 10
圖 7 兩組運動單元與連結之肌肉細胞[41] 12
圖 8 肌電圖訊號產生示意圖[44] 12
圖 9 肌電圖頻譜正規化後中心頻率與持續運動時間長度關係[47] 14
圖 10 肩胛骨拍攝裝置設置 16
圖 11 Pressure Threshold Algometer 17
圖 12 Myoton 肌肉特性量測系統 18
圖 13 myoton 量測圖形[57] 18
圖 14 肌電訊號擷取裝置（Power Lab 15T） 20
圖 15 電極貼片正反面 21
圖 16 肌肉收縮時間示意圖 21
圖 17 MF 分析示意圖 23
圖 18 肩胛骨位置（實際收案） 24
圖 19 臨床詴驗流程圖 25

表目錄
表 1 相關肌肉特性與計算公式[52] 19
表 2 Power Lab 15T 規格 20
表 3 受測者基本資料 27
表 4 壓力疼痛閥值（PPT）（Kg/cm2） 29
表 5 上斜方肌肌肉群基本特性 30
表 6 斜方肌肌肉群聳肩時肌肉延遲時間（MLT）（ms） 31
表 7 斜方肌肌肉群聳肩MF-slope （Hz/ms） 32
表 8 各組之間斜方肌肌肉群聳肩MF-slope （Hz/ms） 32

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