臺灣博碩士論文加值系統

本研究針對髕骨疼痛症候群(Patellofemoral painsyndrome, PFPS)患者建構一套可攜式肌電訊號（Electromyogram , EMG）系統及電刺激裝置(Stimulator)，降低PFPS患者中因為股內斜肌(Vastus medialis obliquus, VMO)與股外側肌(Vastus lateralis, VL)之間的失衡所造成的疼痛。
對於PFPS病患之VMO收縮的時間相對於VL慢、VMO之EMG相對於VL較弱時，使得股四頭肌群之間喪失協調性將髕骨外拉，造成關節面的承受壓力增大，而產生之疼痛等問題，提出一套解決方法。本研究將以電子系統為架構，設計一套可以快速偵測VMO及VL之EMG量測系統，以及可以立即給予肌肉適當時間之電刺激，輔助VMO肌肉收縮，將髕骨拉回於股骨滑車溝中，以降低及改善PFPS病人之疼痛感。
本研究所提出之EMG量測電路及電刺激之裝置，特別針對VMO及VL所設計，具有即時波形記錄與分析功能，同時可上傳量測資料至電腦分析或儲存。系統可即時計算與記錄VMO、VL兩者EMG發生之時間差及訊號強度。當系統偵測到VL 的EMG訊號開始產生剎那，立即快速運算及處理，並經由電刺激單元回饋刺激VMO肌肉，以誘發VMO肌肉收縮。本系統具有可手動或自動調控電刺激訊號大小、刺激時間與順序..等等之功能。

This research constructs a portable Electromyogram (EMG) system and a stimulator for patellofemoral painsyndrome (PFPS) patients, to reduce the pain caused by the imbalance between the Vastus medialis obliquus (VMO) and the Vastus lateralis (VL).
To the problems that PFPS patients have longer VMO contraction time and weaker EMG of VMO compared to the VL, making their quadriceps femoris muscles lose coordination and pull out their patella, and therefore leading to the increased pressure of the articular surface and pain caused by it, we propose a solution. Based on the electrical system, this research will design a measurement system which can quickly detect the EMGs of the VMO and VL, and instantly give muscles adequate time of electrical stimulation to assist VMO in contracting and pulling the patella back to the femoral trochlear groove, to reduce PFPS patients’ pain.
The EMG measurement circuit and electrical stimulation device proposed by this research are specifically designed for VMO and VL, possess real-time waveform recording and analyzing functions, and can upload their measurement data to the computer for storage and analysis. The system can calculate and record the time difference between the EMGs of VMO and VL, and the signal strengths of both EMGs. At the moment the system detects generation of the EMG of VL, it quickly calculates and processes the event and stimulates the VMO as feedback through electrical stimulation units, to induce it to contract. The system can adjust the signal strength, time length and sequence of the electrical stimulation manually and automatically.

中文摘要 i
ABSTRACT ii
致謝 iii
目錄 iv
表目錄 vi
圖目錄 vii
符號說明 x
第一章 緒論 1
1.1 研究背景 1
1.2 研究動機與目的 5
1.3 文獻回顧 5
1.4 論文大綱 7
第二章 材料與方法 8
2.1 整體系統架構介紹 8
2.2 VL與VMO肌電訊號量測單元 10
2.2.1 肌電訊號的概述 10
2.2.2 肌電圖測量電路方塊圖 12
2.2.3 EMG表面電極 13
2.2.4 前置放大器 14
2.2.5 隔離電路 17
2.2.6 增益放大電路 18
2.3 神經肌肉電刺激單元 19
2.3.1 神經肌肉電刺激的概述 19
2.3.2 脈衝電流的參數及其意義 22
2.3.3 電刺激波形樣式 23
2.3.4 電刺激電路工作原理 24
2.3.5 電刺激波形量測 26
2.4 電刺激觸發偵測訊號電路 29
2.5 電刺激強度顯示器電路 35
2.6 臨床試驗測量平台 37
2.7 步伐偵測裝置 38
2.7.1 步伐分析概述 38
2.7.2 步伐裝置設計與實測 39
2.8 微控制器架構 43
2.8.1 微控制器硬體架構 43
2.8.2 微控制器軟體流程 45
2.9 實驗對象與方法 50
2.9.1 實驗測試對象 50
2.9.2 電極片放置位置 50
2.9.3 EMG量測流程 51
2.9.4 電刺激步行訓練流程 53
2.9.5 電刺激步行訓練使用注意事項 54
第三章 結果與討論 55
3.1 整體系統整合與波形量測 55
3.2 治療儀器實體模組及安裝 57
3.3 EMG訊號量測結果 59
3.2 疼痛指數測量 65
3.2.1 VAS評估 65
3.2.2 Kujala Questionnaire評估 66
第四章 結論與未來展望 68
4.1 結論 68
4.2 未來展望 68
參考文獻 69

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