臺灣博碩士論文加值系統

背景：前十字韌帶重建(anterior cruciate ligament reconstruction, ACLR)的患者期望可以在術後回到受傷前的運動水平，但回場(Return to play,RTP)的比率並不如預期，心理的恐懼可能會是造成無法回場的關鍵，而發力率(rate of torque development, RTD)更適合代表術後運動功能的恢復，但尚未有同時以發力率和心理準備用於評估術後膝關節功能的研究。
目的：本研究目的為追蹤術後發力率和心理準備的發展變化，找出影響術後膝關節功能恢復之因素，並分析肌力指標和心理準備之間的相關性，希望可依此研究發現，提供前十字韌帶重建患者運動功能恢復的指標並輔助擬訂更完善的訓練計畫，藉此增強心理準備，最大程度提高回場成功率。
研究方法：本實驗收取單獨前十字韌帶斷裂且接受腿後肌腱重建手術之患者，追蹤術後膝關節功能和心理準備的變化，分別在術前及術後3、6、9、12 及18個月進行膝功能量表、心理量表、理學檢查、肌力測量功能性測試。根據IKDC 分數分成膝關節功能良好組與不良組，比較兩組肌力指標與心理量表分數的差異，並探討肌力指標與心理量表分數間的相關性以及通過回場功能性檢測與否之間發力率的差異。統計方法使用單因子變異數分析(One-way ANOVA)比較各時期數據差異；使用皮爾森積差相關分析(Pearson correlation)探討心理準備和肌力指標間的相關性；使用獨立樣本t檢定(Independent Sample t test)比較膝關節功能分組的各項數據差異以及有無通過功能性檢測兩組間膝伸肌早期發力率和發力率的差異；使用接受者操作特徵曲線(Receiveroperating characteristic curve, ROC 曲線)分析發力率閾值，設p＜0.05 達統計上顯著差異。
研究結果：等速肌力和發力率在術後皆呈顯著正相關(r=0.325~0.845)，但術後18 個月等速肌力和發力率相較於術後12 個月有下降的現象；膝關節功能良好組有較高的ACL-RSI分數(73.64±16.40 vs 54.37±16.09分)以及膝伸肌早期發力率(14.35±5.21 Nm*s-1*kg-1 vs 9.89±5.75 Nm*s-1*kg-1)；復健前期(3至6個月)ACL-RSI 分數與IKDC、膝伸肌早期發力率和發力率以及膝屈肌早期發力率及發力率達顯著中等相關性(r=0.331~0.405)，而 IKDC 分數與發力率、等速肌力皆達顯著相關(r=0.312~0.517)。復健後期(9 至18 個月) ACL-RSI 分數則與IKDC、膝伸肌60º/s 等速肌力和發力率以及膝屈肌60º/s 等速肌力和早期發力率達顯著中等相關性(r=0.311~0.531)，IKDC 分數僅與膝伸肌發力率(r=0.294)以及膝屈肌等速肌力和發力率達顯著相關(r=0.285~0.353)。另外，有15 位受測者通過等速肌力標準進行功能性檢測，結果顯示單腳向前跳通過率為47%，單腳垂直跳和單腳側向跳則皆為40%，但通過組和未通過組兩組間膝伸肌發力率並無顯著差異。
結論：本研究發現術後9 個月後擁有良好膝關節功能的患者會有較高的ACL-RSI 分數和膝伸肌早期發力率，而發力率與等速肌力間存在正相關性，此外，復健後期ACL-RSI 分數會與膝伸肌60º/s 等速肌力、發力和膝屈肌60º/s 等速肌力、早期發力率有關。心理準備和膝伸肌早期發力率會是術後患者能否恢復膝關節功能的關鍵，當肌力與發力率增加時，會使心理有更正向的反應，故本研究建議患者應在有足夠肌力後，透過大重量訓練或是彈震式訓練，以達到神經適應而提升爆發力，藉由訓練同時增強心理準備，進而恢復良好的膝關節功能，成功回到運動場上。

Background: Patients expect to return to their pre-injury sports levels after anterior cruciate ligament reconstruction (ACLR) However, the rate of return to play (RTP) is out of anticipation, and the main reason might be psychological fear. To properly present the recovery function of postoperative exercise, the rate of torque development (RTD) is more suitable than maximal muscle strength. Nevertheless, there is no study which both evaluate RTD and psychological readiness for knee function recovery after ACLR yet.
Purpose: The purpose of this study is to investigate the postoperative changes of RTD and psychological readiness in patients with ACLR, and reveal potential factors that affect the recovery of postoperative-knee function. Moreover, analysis of correlation between muscle strength indicators and psychological readiness are showed in this study. In order to help ACLR patients plan a complete training program, enhancing psychological readiness and maximizing the rate of RTP.
Method: ACLR patients with hamstring tendon autograft were recruited in this study. The test included knee-function questionnaire, ACL-RSI scale, various physical examinations and muscle strength measurements which respectively been tested at preoperation, 3, 6, 9, 12, 18 months after ACLR. According to the IKDC scores, participants were divided into a good knee-function group and one with poor knee function. To compare the differences of muscle strength indicators and ACL-RSI scale score between the two groups, and to investigate the correlation between muscle strength indicators and ACL-RSI scale score. Compare the RTD differences whether they passed the functional test or not. One-way ANOVA was used to compare the differences of various data in each period. Pearson correlation was used to analyze the correlation between psychological readiness and muscle strength indicators. Independent sample T-test was used to compare the difference of RTD between the two groups whether passed functional test or not and the differences of various data in knee function grouping. ROC curve was used to analyze the threshold of RTD.
Results: Isokinetic strength were significantly positively correlated with RTD(r=0.325~0.845). However, the isokinetic strength and RTD were lower at 18 months postoperatively than 12 months postoperatively. The good knee function group had higher ACL-RSI score (73.64±16.40 vs 54.37±16.09) and knee extensor early RTD (14.35±5.21 Nm*s-1*kg-1 vs 9.89±5.75 Nm*s-1*kg-1). In the early stage of rehabilitation (3 to 6 months), the ACL-RSI score has significantly moderate correlation with IKDC, the early RTD and RTD of knee extensors, and the early RTD and RTD of knee flexors (r=0.331~ 0.405). IKDC has significant correlation with RTD and isokinetic strength in this period. In the late stage of rehabilitation (9 to 18 months), ACL-RSI score has significantly moderate correlation with IKDC, 60º/s isokinetic strength, RTD of knee extensors, 60º/s isokinetic strength and early RTD of knee flexors (r=0.311~0.531). IKDC has significant correlation with RTD of knee extensors (r=0.294), and isokinetic strength and RTD of knee flexors (r=0.285~0.353) in this period. In addition, 15 subjects performed functional tests. The pass rate of single leg for distance was 47%. The pass rate of single leg for height and single leg side hop were both 40%. There was no significant difference in knee extensor RTD between pass group and no pass group.
Conclusion: The psychological readiness and early RTD of knee extensor were found to be the key indicators to functional recovery after ACLR. When muscle strength and RTD increase, there will be a more positive response to psychological aspect. Therefore, patients are suggested to use heavy-weight training or ballistic training to achieve neural adaptation, and then improve power after they have sufficient muscle strength. In conclusion, patients could meanwhile restore good-knee function and enhance psychological readiness after training, and return to sport successfully.

中文摘要 I
Abstract IV
致謝 VII
表目錄 XI
圖目錄 XII
第一章 緒論 1
1.1 研究背景 1
1.2 研究動機 3
1.3 研究目的 4
第二章 文獻探討 5
2.1 前十字韌帶重建後回場狀況 5
2.2 前十字韌帶重建後心理評估之應用 8
2.3 前十字韌帶重建後ACL-RSI分數與功能性檢測之相關性文獻探討 11
2.4 前十字韌帶重建後發力率應用之文獻 13
第三章 研究方法 17
3.1實驗對象 17
3.2實驗方法與流程 18
3.3實驗儀器與設備 20
3.4研究設計 21
3.5數據處理 28
3.6 統計方式 29
第四章 結果 30
4.1受試者基本資料、受傷前Tegner分數、IKDC、ACL-RSI量表分數結果 30
4.2受試者各時期發力率和等速肌力變化及其相關性 32
4.3膝關節功能Poor與Good兩組間ACL-RSI量表分數、等速肌力與發力率比較 37
4.4各時期ACL-RSI量表分數和IKDC分數、等速肌力及發力率相關性 39
4.5功能性檢測與膝伸肌發力率之分析 41
第五章 討論 43
5.1各時期等速肌力、發力率與心理準備 43
5.1.1肌力指標 43
5.1.2心理準備 45
5.1.3肌力指標與ACL-RSI量表分數的相關性 47
5.2 膝關節功能分組 48
5.2.1 IKDC與ACL-RSI量表分數、發力率的相關性 49
5.2.2發力率之訓練建議 50
5.3 功能性檢測與膝伸肌發力率 52
5.4 研究限制及未來研究 54
第六章 結論 55
參考文獻 56
【附錄一】Tegner活動量表 63
【附錄二】IKDC主觀膝關節功能性量表 64
【附錄三】ACL-RSI scale前十字韌帶受傷後回場問卷 67
【附錄四】人體研究新案同意證明書 69
【附錄五】受試者同意書 70

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