臺灣博碩士論文加值系統

膝關節排列不正如膝內翻、膝外翻，不僅可能改變關節結構如關節間空間，且為造成諸如退化性關節炎、髕骨股骨退化性關節炎、前十字韌帶斷裂等傷害的因子。過去的研究指出膝關節排列不正對於步態、上下階及深蹲等動作會造成下肢力學變數改變。對於膝關節排列不正，矯正型護膝為常見的非手術性治療方式，其原理為利用三點施力的方式改變膝關節負荷，然而過去文獻指出矯正型護膝有助於減少膝關節負荷，但也有研究指出穿戴護膝前後，力學變數並沒有顯著差異，因此對於矯正型護膝的效益仍有待探究。另病患的腿部肌力同時也是影響下肢力學表現的因素之一，而過去的研究在探討肌力與力學變數的關聯性時，缺少一致性的肌力量測方式，不同的量測方式可能造成不同的結果。因此本實驗欲探討膝關節排列及力學矯正於步態、上下階、深蹲動作的交互作用，並利用不同肌力量測方式進一步探討力學變數與肌力之間的關聯性。結果顯示力學變數與肌力變數在膝關節和髖關節均有高度相關性，且不只在矢狀面，同時在額狀面及水平面也存在關聯性，顯示腿部肌力除了影響膝關節的表現外，同時也影響髖關節。而在膝關節排列與護膝的雙因子檢定分析中，針對步行動作之研究發現，護膝有助於減少步態時的膝關節負荷，並且增加患側與非患側的肌肉收縮，但同時也必須注意潛在的傷害因子。而在膝內翻及膝外翻族群比較上，膝內翻組伴隨有異常的髖外旋力矩、膝內收角度、膝外展力矩、踝外翻力矩和膝外旋角度，顯示額狀面的排列不正同時也會影響水平面的力學表現，且不只是膝關節，也影響著髖關節與踝關節。建議未來研究增加受試者數量，並進一步針對其他功能性動作做雙因子檢定之解讀，以全面性了解護膝以及膝關節排序對動作特徵之影響。

Mal-alignment at the knee could not only alter the knee compartment space, but also being reported as risk factor of several musculoskeletal disorders of the knee such as knee osteoarthritis, patella-femoral osteoarthritis, and anterior cruciate ligament injury. Previous studies suggested that mal-alignment affected biomechanical variables during level walking, squat and stair ascent/descent tasks, such as knee abductor moment, knee adduction angle, and knee internal rotation angle. Unloading knee brace could be used clinically as a non-surgical treatment for mild to moderate mal-alignment at the knee. It can alter knee loadings through three-point bending force-correction system. Researches have shown that unloading knee brace was helpful in decreasing knee loadings. However, some studies also reported no significant difference after applying unloading knee brace. The effect of unloading knee brace need more investigations. In addition, knee strength is also an important factor to influence biomechanical performance. Previous studies have adopted different means of strength evaluation methods to correlate with biomechanical variables. Nevertheless, there is no consensus about the muscle contraction type or speed to evaluate the strength. Therefore, the purpose of this study is to find the interactive effect of knee alignment and unloading knee brace in gait, squat, and stair ascent/descent tasks and to correlate biomechanical variables with knee strength through different strength evaluation methods. Results suggested that strength variables was highly correlated with biomechanical variables calculated at knee and hip joints, indicating that knee strength influences movements both at the hip and knee joints. These compensation of inadequate strength at the knee occurs not only in sagittal plane but also in frontal plane and transverse plane. For the effect of knee brace, positive effects during level walking were found that knee loading decreases while muscle contraction increases in both affected side and sound side when applying knee brace. However, caution should be paid as some variables were found as the risk factor of injury when applying knee brace. For the comparison between varus and valgus group, hip external rotation moment, knee adduction angle, knee abduction moment, and ankle invertor moment have been found to be significant different between groups. Between group difference was also found in knee external rotation angle, representing that frontal plane mal-alignment also affects transverse plane movement. In addition, these group difference happens not only in knee joint but also in hip and ankle joint. Increased sample size is suggested for future study in order to have sufficient statistical power and better application of the data. Two factors statistical analysis should be applied in various functional movements in order to have throughout understanding of the effect of brace and mal-alignment at the knee.

I. Introduction 1
1. Background 1
2. Study purpose 2
II. Literature Review 3
1. Alignment 3
2. Effect of alignment on gait 3
3. Effect of alignment on stair ascent and descent 4
4. Effect of alignment on squat 6
5. Unloading brace 6
6. Study of correlation between strength and biomechanical variables 8
III. Methods 10
1. Experiment design 10
2. Subject 10
3. Equipment 11
3.1. Motion capture system 11
3.2. Dynamometer 11
3.3. Knee brace 12
4. Experiment flow 12
4.1. MVC test 12
4.2. Subject static calibration 13
4.3. Protocol 14
4.4. Strength test 16
5. Data processing 17
5.1. Body segment building 17
5.2. Kinematics analysis 18
5.3. Kinetic analysis 20
5.4. EMG processing 20
5.5. Strength data processing 21
5.6. Statistical analysis 21
IV. Results and Discussion 22
1. Preliminary result 22
2. Subjects 27
3. Correlation between biomechanical variables and strength variables 27
3.1. Level walking 27
3.2. Squat 32
3.3. Stair up 35
3.4. Stair down leading leg 36
3.5. Stair down trailing leg 41
4. Effect of alignment and brace 43
4.1. Level walking 43
V. Conclusion 55
VI. Reference 56
Ⅵ. Appendix Ⅰ. Statistical Result of Correlation between Strength and Biomechanical Variables
Ⅶ. Appendix Ⅱ. Statistical Result of Alignment and Brace Effect
Ⅷ. Appendix Ⅲ. Consent Form

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