臺灣博碩士論文加值系統

過去十年因骨科就診人數逐年上升，各大醫院紛紛增設骨科門診以應對骨科病患及 高齡人口骨頭的病痛，病理性骨折與創傷導致骨折，醫學上嚴重的移位性骨折常見使用 熟石膏裹覆患部固定患肢，若因裹覆力道過大造成壓迫可能會伴隨疼痛、血液循環不良、皮膚壞死、甚至導致截肢或死亡。但若裹覆力道過鬆，除了缺乏患肢固定效果外，也可能導致矯正畸形亦或關節脫落。當前臨床上或臨床教學尚無非侵入式設備系統用以偵測石膏裹覆時對患肢產生的壓力與溫濕度數值的變量及回饋，臨床醫師惟有透過資深主治醫師口述教學及其過往裹覆經驗教導，較欠缺可靠性、客觀性的依據進行石膏裹覆之治療教學。本研究目的設計一套量測系統，以石膏裹覆教學用上肢模型為例，量測石膏裹覆上肢模型時壓力與溫濕度數值，透過移動式設備的使用者圖形化介面呈現感測器之數值，供醫師進行石膏裹覆操作時作一判斷依據。
利用 6 組壓力感測器與 1 組溫濕度感測器， 使用上肢模型進行實驗。使用薄膜式壓力感測器與I2C溫濕度感測器，利用不鏽鋼砝碼及軟體演算法找出五個區段重量與電壓的轉換係數。先使用恆溫恆濕機對溫溼度感測器校正，校正後的量測結果誤差皆在可接受的範圍內，以短臂石膏法固定上肢模型為例， 將壓力感測器黏貼於模型骨頭突起處，溫溼度感測器則黏貼於手臂中間，以偵測裹覆過 程中的數值變化。使用者圖形介面即時顯示數值，後端將數值存入本地輕量級資料庫中，並同步上傳至雲端資料庫，提供使用者一套即時偵測和提示裹覆力道與溫濕度變化之反饋系統。
壓力感測器實驗測試最大誤差 1.5%內，溫度最大誤差 2%內，濕度誤差 4%內，感 測器驗證之結果皆在可接受的範圍內，證明偵測之數值具可靠性。經由林口長庚醫院骨 科部主治醫師高醫師使用使用本系統操作石膏裹覆，與探討之文獻閥值，證明系統的客 觀性及可靠性。另經由與實習醫師操作時壓力最大相差 6.84 mmHg 同樣在閥值內，但此與缺乏臨床經驗的醫學生力道相差過大，日後分析量測數據供醫學生未來裹覆操作時作為修正參考。

Within a decade, most hospitals have set up the bone clinic to treat patients with orthopedic problems or elders with pain in bone. Pathologic fracture or fractures from trauma are also the diagnosis and treatment projects. It is common to apply the hot plaster to the affected region of serious on displacement fracture. If you wrap it too harder, it may cause the critical consequence like pain, poor blood circulation or necrosis of skin. Even could lead to amputation and even death. On the contrary, wrap it with less strength would lack of treatment effect may lead to bad situations like deformity or dislocation of joint. So far, clinical medicine does not exist any kind of non-invasive device.
When the clinicians want to know the feedback and the data of pressure, temperature, humidity of affected extremity during hot plaster wrapped, they only could consult the experiences from senior visiting staff (VS) and one’s oral teaching. Most of them may lack the objectivity and reliability. The purpose of the research is to create a measurement system. Taking hot plaster covered for example, it can get the data of pressure, temperature, humidity of upper extremity models with using mobile devices. The data shown on device's GUI can provide the standard to the doctors who have to operate the surgery. Using six packs of pressure sensors and a pack of temperature and humidity sensor to experiment on the upper extremity models.
Using pressure sensors and I2C temperature and humidity sensor, via stainless steel weights and software algorithms to find the conversion factors of voltage and weight for the five segments then calibrate the pressure sensors. Temperature and humidity sensor calibrate by using a constant temperature and humidity machine. The error of consequence after correcting is within acceptable range. For example, using short arm cast to set on the upper extremity models, and stick pressure sensors on the apophysis of the bone models while temperature and humidity sensor sticking on the middle of the arm for detecting the changing of the data in the process of hot plaster covering. GUI shows the data immediately while backstage saving the data to local light database. Also uploading data to cloud database to supply the users a feedback system of detecting the changing of pressure, temperature or humidity. The highest detecting error of pressure sensors is within 1.5% and the error of temperature is within 2% while 4% of humidity. The results of sensors are in acceptable range that proved the data of detecting is reliable.
Dr. Kao who is from orthopedic clinic of the Linkous Chang Gung Memorial Hospital has used this system on hot plaster covering and threshold of the studies are enough to prove its reliability and objectivity. The consequence of data is known in threshold as the same as the detecting result of interns while the differences of pressure is between 6.84 mmHg, but quite different with medical students who lack clinical experience. These data can ba a standard for them to consult during the surgery in the future.

摘要 i
ABSTRACT iii
誌謝 vi
目錄 vii
表目錄 x
圖目錄 xi
第一章 緒論 1
1.1 研究動機 2
1.2 研究目的 3
1.3 論文架構 5
第二章 文獻探討 6
2.1 骨折介紹 6
2.1.1 石膏裹覆使用之材料與工具 7
2.1.2 石膏裹覆-短臂固定法 8
2.1.3 腔室症候群 9
2.2 石膏裹覆之壓力與溫溼度 9
2.2.1 石膏裹覆之傷口溫濕度影響 10
2.2.2 操作型技能直接觀察評量 11
2.3 無線通訊介面 12
2.3.1 藍牙通訊 12
2.3.2 Wi-Fi 通訊 13
第三章 材料與方法 14
3.1 微控制器與感測器模組 15
3.1.1 微控制器 16
3.1.2 壓力感測器 17
3.1.3 溫濕度感測器 18
3.1.4 Wi-Fi 模組 19
3.2 訊號處理與分析 21
3.2.1 壓力感測器訊號處理 22
3.2.2 壓力單位之轉換 24
3.3 軟硬體設計 26
3.3.1 軟體使用者介面設計與功能介紹 27
3.3.2 資料庫設計-SQLite 31
3.3.3 雲端資料庫設計-ThingSpeak 31
3.3.4 微控制器和感測器硬體設計 32
第四章 結果與討論 34
4.1 壓力感測器驗證 34
4.2 溫濕度感測器驗證 36
4.3 量測實驗設計 39
4.3.1 實驗條件 39
4.3.2 實驗方法與系統架設 40
4.3.3 醫院骨科-DOPS 評估表 42
4.3.4 ASKING 線上問卷 44
4.4 實驗結果與討論 45
4.4.1 石膏裹覆之壓力探討 45
4.4.2 結果統計分析 52
4.4.3 DOPS 結果統計分析 53
4.4.4 使用者問卷調查 54
第五章 結論與未來研究方向 55
5.1 結論 55
5.2 未來研究方向 56
參考文獻 57
附 錄 60
A APP 功能介紹 60
B 演算法與軟韌體開發介面 61

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