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研究生:黃景珊
研究生(外文):Jing-Shan Huang
論文名稱:不同功能性膝支架之生物力學分析
論文名稱(外文):Biomechanical analysis of the different functional knee braces
指導教授:陳振昇陳振昇引用關係
指導教授(外文):Chen-Sheng 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:2014
畢業學年度:102
語文別:中文
論文頁數:77
中文關鍵詞:膝支架生物力學肌電圖膝關節關節力矩
外文關鍵詞:knee bracebiomechanicsEMGknee jointjoint moment
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功能性膝支架常見於前十字韌帶損傷或是前十字韌帶重建的患者身上,其功能是改善膝關節穩定度。然而,市面上相同功能之膝支架產品多樣化且支架能提供的保護程度無從得知。本研究目的是調查不同的膝支架對於膝關節帶來的生物力學效應。研究進行人體動作與肌電圖訊號分析實驗,以常見活動作為主要測試動作,包含走路和上下樓作為測試之動作,分別探討無穿戴支架與Xeleton和Armor支架之間膝關節生物力學之差異,包含站立早期之最大垂直地面反作用力、最大膝彎曲角度、最大膝彎曲力矩、肌肉活性以及共同收縮比值。實驗結果顯示,有無穿戴支架於不同測試活動下,兩組支架皆不會明顯影響地面反作用力、膝彎曲角度、肌肉活性和共同收縮比值。然而,在力矩上,上樓時穿戴Xeleton和Armor支架,皆顯著增加未穿戴支架時之膝關節彎曲力矩高峰值的52%和26%。於走路和下樓,僅Xeleton支架分別顯著增加未穿戴時之彎曲力矩高峰值41%和119%。支架間比較,於上樓時之力矩值,Xeleton增加的力矩量為Armor支架的一倍,且達顯著差異。而本研究結論,有無穿戴支架比較下,穿戴Xeleton和Armor支架皆顯著增加上樓時之膝彎曲力矩值。於走路和下樓活動,只有Xeleton支架顯著增加力矩值。支架間比較,於上樓時之力矩,Xeleton增加的力矩量為Armor支架的一倍。
Functional knee braces (FKBs) have become a popular adjunct to manage anterior cruciate ligament (ACL) injury or ACL reconstruction. They are selectively used during the rehabilitation process to improve the knee stability. However, the knee brace in market is variety and few study is focused on effect of protection of knee joint. To investigate the biomechanical effect between the different knee joint braces. This study underwent human motion analysis and electromyography(EMG) measurement. Subjects are asked to perform three daily activities including walking, stair ascent, and stair descent. The biomechanical alterations are investigated under three conditions consisted of no brace, Xeleton and Armor brace. During early stance phase, each subject’s peak vertical ground reaction (vGRF), peak knee flexion angle, peak knee flexion moment, muscle activity and co-contraction ratio (CCR) were measured. Experimental results indicated no significant difference in peak vGRF and vertical knee flexion angle, muscle activity and CCR between wearing and un-wearing the braces under different movement. However, during stair ascent, both braces had increased the flexion moment in the 52% and 26%, respectively. Compared to un-wearing, only Xeleton brace had significance in the 41% and 191% increased for walking and stair descending, respectively. There is significant difference in flexion moment between Xeleton and Armor braces, and Xeleton was one time as much as Armor brace during stair ascent. The conclusions is both braces had increased the flexion moment during stair ascent between wearing and un-wearing the braces. Between two braces, Xeleton brace increased the flexion moment was one time as much as Armor brace during stair ascent.
目錄
致謝 I
中文摘要 II
ABSTRACT III
目錄 IV
圖目錄 VI
表目錄 VIII
第一章 前言 1
1-1 前十字韌帶損傷背景 1
1-2 膝關節解剖構造 4
1-3 膝關節之生物力學 7
1-4 文獻回顧 9
1-4-1 支架種類 9
1-4-2 膝支架結構 9
1-4-3 常見膝支架介紹 10
1-4-4功能性膝支架對行走的效能 16
1-4-5 功能性膝支架對功能性活動的效能 23
1-5 研究動機與目的 25
第二章 材料與方法 27
2-1 研究對象與測試之膝支架 28
2-1-1 研究對象 28
2-1-2 鞋具與測試之膝支架 28
2-2動作分析與肌電圖訊號系統 31
2-3步態資料與表面肌電圖訊號擷取 34
2-4實驗步驟 36
2-5實驗之資料處理 40
2-5-1 動作分析資料 40
2-5-2 肌電圖訊號處理 41
2-5-3 統計分析 41
第三章 結果 43
3-1舒適度調查表 43
3-2垂直地面反作用力(VGRF) 45
3-3膝關節彎曲角度(ROM) 47
3-4 膝關節彎曲力矩 49
3-5肌電圖訊號分析 51
3-5-1 肌肉活性 51
3-5-2 肌肉共同收縮比值(CCR) 53
第四章 討論 54
4-1垂直地面反作用力討論 54
4-2膝關節彎曲角度討論 56
4-3膝關節彎曲力矩討論 59
4-4肌電圖訊號分析討論 63
4-5 研究限制與模型假設討論 65
4-6 未來研究發展 67
第五章 結論 68
參考文獻 69
附錄一、舒適度調查表 77

圖目錄
圖1-1 膝關節彎曲角度與前十字韌帶受力之關係圖6 3
圖1-2 損傷與術後族群和健康人之步態-膝關節內外轉10 3
圖1-3 膝關節解剖示意圖 28 5
圖1-4肌肉示意圖29 6
圖1-5膝關節六個主要動作30 8
圖1-6膝支架種類31 11
圖1-7功能性膝支架結構32 12
圖1-8 DONJOY功能性膝支架41 14
圖1-9 O¨SSUR功能性膝支架58 14
圖1-10 OTTOBOCK功能性膝支架42 15
圖1-11 LU等學者的研究21 19
圖1-12 STANLEY等學者的研究34 19
圖1-13 BUTLER等學者的研究22 20
圖1-14 DIAZ等學者的研究35 21
圖1-15 ALKJAER等學者研究之結果38 22
圖1-16 LEPORACE等學者的研究39 22
圖1-17 THAMBYAH等學者的研究41 24
圖2-1 實驗流程圖 27
圖2-2 實驗使用之鞋具與膝支架 30
圖2-3 實驗設置 32
圖2-4 實驗儀器及設備圖44,45 33
圖2-5 步態資料擷取範圍46 35
圖2-6 表面肌電電極片之貼法47 35
圖2-7 PLUG-IN GAIT反光球模型49,51 38
圖2-8 實驗動作示意圖 39
圖3-1受試者標示不舒適之位置 44
圖3-2不同支架在各測試活動下的VGRF之比較。(A)走路,(B)上樓,(C)下樓。 46
圖3-3不同支架在各測試活動下的ROM之比較。(A)走路,(B)上樓,(C)下樓。 48
圖3-4 不同支架在各測試活動下的膝關節彎曲力矩之比較。(A)走路,(B)上樓,(C)下樓。 50
圖4-1本研究與STACOFF等學者48的研究在VGRF的比較。(A)走路,(B)上樓,(C)下樓。 55
圖4-2本研究與KADABA等學者49和GAO等學者50的研究在ROM的比較。(A)走路,(B)上樓,(C)下樓。 58
ZABALA等學者 61
本研究 61
圖4-3本研究與ZABALA等學者的研究53在彎曲力矩的比較。(A)走路,(B)上樓,(C)下樓。 61
表4-1本研究與HOLLISTER等學者的研究59之COR比較 62
圖4-4 本研究與HORTOBAGYI等學者56的研究在CCR的比較。(A)走路,(B)上樓,(C)下樓。 64

表目錄
表1-1 常見之功能性膝支架6 13
表1-2支架差異比較 26
表2-1 符合M號支架尺寸42,43 29
表3-1支架舒適度之比較 44
表3-2 VGRF的高峰值之比較 45
表3-3彎曲角度高峰值之比較 47
表3-4彎曲力矩高峰值之比較 49
表3-5 VL活性之比較 52
表3-6 BF活性之比較 52
表3-7 CCR之比較 53
表4-1本研究與HOLLISTER等學者的研究59之COR比較 62



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