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研究生:方怡婷
研究生(外文):FANG, YI-TING
論文名稱:登山健行對運動傷害、身體組成、大腿肌肉形態功能與與股骨軟骨形態影響之探討
論文名稱(外文):Exploring the Possible Effects of Mountaineering Activities on Sports Injuries, Body Composition, Thigh Muscle Function and Femoral Cartilage Characteristics
指導教授:陳俊忠陳俊忠引用關係
指導教授(外文):Chen, Jin-Jong
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
論文出版年:2012
畢業學年度:100
語文別:中文
論文頁數:151
中文關鍵詞:登山膝蓋肌肉骨骼系統股骨軟骨軟骨型態彈性超音波
外文關鍵詞:mountaineeringkneemusculoskeletal systemfemoral cartilagemorphologyultrasound elastography
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背景:登山健行已成為一種普遍的運動,但目前國內相關研究多為登山之生理性反應,肌肉骨骼系統的研究十分有限,且台灣的登山環境迥異於國外,國外的登山研究結果並不完全適合台灣模式;因此,慢性運動傷害以及對身體理學表現的影響都尚待研究。故研究長期登山運動可能的肌肉骨骼影響以及對於膝關節軟骨的變化為何,就相當重要。 目的:本篇研究目的為比較不同年齡與有無登山健行運動習慣者,在運動傷害、身體組成、大腿肌肉型態功能與股骨軟骨型態之差異,探討登山健行運動對人體可能之影響。 研究方法:受試者皆為男性(84名),43位登山習慣受試者分為高山組(55.6±4.27歲)和郊山組(57.2±3.4歲),21位年齡配對的無規律運動者(56.8±3.9歲),和21位年輕受試者(24.1±2.0)。受試者簽署同意書後,首先填寫三份問卷,包含台灣中高齡登山族群運動傷害調查問卷、西安大略及麥可麥斯特大學關節炎量表(WOMAC)、台灣活動量短版問卷(IPAQ);然後是身體理學檢查,包括身體組成量測、膝屈曲肌和膝伸直肌的最大等長收縮力、起站測試之足部壓力掃描;最後才是股骨軟骨的彈性超音波影像檢查。使用獨立樣本檢定分析四組的連續變項,重複量數二分子變異數分析四組壓力前後的軟骨形態,多變項線性迴歸檢定軟骨形態的預測因子;顯著統計值訂於0.05。 結果:肌力部分主要呈現高山組表現最佳而無規律運動組最差,其中右膝屈肌肌力有顯著差異;股骨軟骨厚度部份,年輕組最厚且明顯厚於無規律運動組,但與兩登山組無差異性。除了肌肉量和肌力之外,費力活動佔總活動量之百分比和股四頭肌肌肉品質有相關性,左右兩腳的相關係數分別為0.33和0.38。股骨厚度經迴歸分析得到的預測因子有年齡、身高、膝伸直肌和膝屈曲肌之肌力、費力活動量以及登山習慣,股骨亮度的預測因子有下肢肌肉佔全身肌肉量百分比、體重和絕對對稱指標;相關性多為低度到中度相關。結論:大腿肌力、活動量、登山習慣、下肢肌肉量百分比、體重和絕對對稱指標是可以透過後天改善的軟骨形態預測因子,且登山族群的股骨軟骨形態並無發現明顯損傷,大腿肌力和股骨軟骨厚度更表現出老化延緩的趨勢;因此,對無已知膝蓋軟骨障礙的中高齡男性,登山健行或許是一項值得建議參與的運動項目。
Background: Mountaineering and hiking have become a popular and common activity, but related researches in Taiwan focus mainly on physiological reactions much more than musculoskeletal system. However, the foreign experiments can’t transfer directly due to the unique forest environment in Taiwan, chronic mountaineering injuries and derivative benefits on specific physical performances wait for further study. Therefore, it is important to investigate the possible relation between mountaineering habit and musculoskeletal or knee cartilage changes. Purpose: This research compared the difference of sports injuries, body composition, thigh muscle function and femoral cartilage characteristics between different age groups and among different mountaineering experiences to explore the possible effects of mountaineering activities. Methods: This study was a cross-sectional, exploratory design. 84 healthy male were recruited, including 43 people with regular mountaineering habit, who divided into high-mountain group (HM) (55.6±4.27 y/o) and low-mountain group (LM) (57.2±3.4y/o), 21 age-matched men without exercise habit were allotted to no exercise group (NE) and the remainders were 21 young men in young group (YM) (57.2±3.4y/o). After signing a consent form, participants started to fill three questionnaires which were self-designed sports-related injuries questionnaire, WOMAC index and IPAQ short version, and then underwent physical examinations on body composition, knee flexors and extensors strength test, and footscan. Last procedure was ultrasound elastography evaluation over femoral cartilage. One-way ANOVA was employed to assess continuous data of four groups, differences before and after stress in four groups were examined with two-way repeated measures ANOVA, and multiple linear regression was used to identify the most significant prediction model for cartilage morphology. Statistical significant was set at P<0.05. Results: HM presented the best knee strength compared with weakest performances in NE and was significant higher in right knee flexors. About femoral cartilage thickness, YM showed the thickest cartilage and significant better than NE, but didn’t obvious differ from HM and LM. The percentage of vigorous activity showed correlation with R’t quadriceps muscle quality (MQ) (r=0.38) and L’t quadriceps MQ (r= 0.33). The predict factors of femoral cartilage thickness were age, height, strength of knee flexors and extensor, quantity of vigorous activity, and mountaineering; the predict factors of femoral cartilage brightness were muscle mass percentage in lower extremity (LE), body weight (BW) and asymmetry index (ASI). Conclusions: Knee strength, activity quantity, mountaineering performance, muscle mass percentage in LE, BW and ASI were predict factors to cartilage morphology and which can be improved by acquired cultivation. Besides, no obvious femoral cartilage defects were discovered in mountaineering groups and a tendency of decreasing aging rate was found in knee strength and thickness. Therefore, mountaineering and hiking can probably be a recommended sport to middle-old aged men who without existing knee cartilage dysfunction.
目錄 I
表目錄 III
圖目錄 V
附錄目錄 VI
中文摘要 VII
第一章、前言 1
第一節 研究背景與動機 1
第二節 研究目的 3
第三節 研究假設 4
第四節 研究重要性 4
第二章、文獻回顧 5
第一節 登山健行運動 5
第二節 膝關節軟骨傷害之探討 9
第三節 承重壓力與膝關節軟骨之探討 12
第四節 彈性超音波之影像學檢查 15
第三章、研究方法 18
第一節 研究設計 18
第二節 研究對象 18
第三節 研究流程 19
第四節 研究工具與測量項目 20
第五節 資料處理與分析方法 28
第四章 研究結果 30
第一節 受測者基本資料 30
第二節 量表資料 31
第三節 理學檢查 33
第四節 影像學檢查 34
第五節 整體分析 36
第六節 股四頭肌肌肉品質與受測者基本資料、理學檢查和影像學結果之關係 36
第七節 影像學結果與受測者基本資料、理學檢查之關係 37
第八節 影像學結果之迴歸方程式 41
第五章 討論 45
第一節 基本資料、理學檢查和影像學檢查結果 45
第二節 壓力測試之前與之後的影像學結果 50
第三節 股四頭肌之肌肉品質 56
第四節 股骨軟骨厚度的預測因子 57
第五節 股骨軟骨亮度的預測因子 61
第六節 臨床意義 62
第七節 研究限制 63
第八節 未來研究方向 63
第六章 結論 64
參考文獻 65
表格 74
圖 124
附錄 137

表 1:高山組、郊山組、無規律運動組和年輕組四組受試者之基本資料 75
表 2:高山組、郊山組、無規律運動組和年輕組四組受試者之基本資料 77
表 3:高山組和郊山組登山健行情況調查 78
表 4:量表資料之四組受試者北歐肌肉骨骼問卷調查 79
表 5:量表資料之四組受試者IPAQ台灣活動量調查短版問卷 80
表 6:量表資料之四組受試者WOMAC INDEX 82
表 7:理學檢查之四組受試者膝伸直肌與膝屈曲肌最大等長肌力 83
表 8:理學檢查之四組受試者HQ ratio 84
表 9:理學檢查之四組受試者身體組成量測結果 85
表 10:理學檢查之足部壓力掃描和肌肉品質 87
表 11:影像學檢查之壓力測試前四組受試者軟骨厚度和亮度 88
表 12:影像學檢查之壓力測試後四組受試者軟骨厚度和亮度 90
表 13:壓力測試前後右膝蓋股骨滑車軟骨厚度改變之檢定結果 92
表 14:壓力測試前後右膝蓋股骨外踝軟骨厚度之檢定結果 93
表 15:壓力測試前後右膝蓋股骨內踝軟骨厚度之檢定結果 94
表 16:壓力測試前後左膝蓋股骨滑車軟骨厚度之檢定結果 95
表 17:壓力測試前之左膝蓋股骨外踝軟骨厚度之檢定結果 96
表 18:壓力測試前後左膝蓋股骨內踝軟骨厚度之檢定結果 97
表 19:壓力測試前後右膝蓋股骨滑車軟骨亮度之檢定結果 98
表 20:壓力測試前後左膝蓋股骨滑車軟骨亮度之檢定結果 99
表 21:四組受試者壓力測試前後軟骨厚度和亮度差異值 100
表 22:軟骨厚度與亮度的相關性 102
表 23:左右膝蓋軟骨影像學結果之比較 103
表 24:股四頭肌之肌肉品質與受試者基本資料、理學檢查和影像學結果之關係 104
表 25:壓力測試前軟骨厚度之影像學檢查與受試者基本資料、理學檢查之關係 106
表 26:壓力測試後軟骨厚度之影像學檢查與受試者基本資料、理學檢查之關係 109
表 27:軟骨亮度之影像學檢查與受試者基本資料、理學檢查之關係 112
表 28:壓力測試前後影像數值差異量與受試者基本資料、理學檢查之關係 115
表 29:影像學結果之迴歸方程式 119

圖 1:理學檢查儀器 125
圖 2:超音波檢查相關設備 126
圖 3:超音波多功能掃描儀之影像呈現 127
圖 4:超音波探頭擺放位置 128
圖 5:壓力測試前後右膝蓋股骨滑車軟骨厚度改變之檢定結果 129
圖 6:壓力測試前後右膝蓋外踝軟骨厚度之檢定結果 130
圖 7:壓力測試前後右膝蓋股骨內踝軟骨厚度之檢定結果 131
圖 8:壓力測試前後左膝蓋股骨滑車軟骨厚度之檢定結果 132
圖 9:壓力測試前後之左膝蓋股骨外踝軟骨厚度之檢定結果 133
圖 10:壓力測試前後之左膝蓋股骨內踝軟骨厚度之檢定結果 134
圖 11:壓力測試前後右膝蓋股骨滑車軟骨亮度之檢定結果 135
圖 12:壓力測試前後左膝蓋股骨滑車軟骨亮度之檢定結果 136

附錄 1 台灣中高齡登山健行族群運動傷害調查問卷 138
附錄 2 IPAQ 台灣活動量調查短版問卷 143
附錄 3 WOMAC INDEX 149


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