臺灣博碩士論文加值系統

背景：職業災害分為職業傷害與職業病兩種，前者為執行工作時所造成的外傷、後者為執行工作時所造成的疾病。經勞動部職業安全衛生署統計，受傷占比較高的行業皆需要良好的雙手抬舉負重能力。當勞工肩部受傷接受手術後，仍可能會伴隨疼痛、關節角度受限和肌力恢復有限等狀況，進而影響雙手抬舉負重的表現。因此，透過本篇研究，希望探討在雙手抬舉負重時，肩部受傷者與健康者之間的相異之處，期望設計出更精準有效的復健訓練，幫助職災勞工更快恢復身體與工作能力。

方法：本篇研究為橫斷性研究，招募20-64歲有工作經驗的男性，分成健康組(N=16)與受傷組(N=13)。所有受試者都會完成表單問卷(肩痛及失能指數量表、體能活動適應能力問卷、工作所需勞動體力)、身體評估(手指/肩膀/眼睛高度、身體組成分析、握力、關節活動度、肌肉力量、雙手抬舉負重能力)、儀器測量(雙手抬舉重物時，雙手肌肉表面肌電訊號)。主要結果為觀察受傷者與健康者兩組之間，進行三種高度雙手抬舉負重時肩部肌群肌肉活化的差異；次要結果為觀察其肩膀關節活動度、肌肉力量、疼痛與失能狀況之差異。

結果：兩組間在各抬舉高度下的肌肉活化量沒有顯著性差異，但兩組的組內變化卻有不同的趨勢:當抬舉高度高於胸口以上時，健康組肱二頭肌的肌肉活化量會顯著性減少；而受傷組雖有減少，但未達顯著性差異。當抬舉高度高於胸口以上時，健康組前三角肌與上斜方肌的肌肉活化量會顯著性增加；而受傷組雖有增加，但未達顯著性差異。與健康組相比，受傷組肩膀屈曲的關節活動角度明顯減少、肩膀外展的肌肉力量明顯減少、肩痛與失能指數明顯增加和雙手抬舉測驗負重能力明顯減少。

結論：肩關節受傷的勞工即使接受手術、復健並成功復工後，仍伴隨著疼痛、關節角度受限、肌肉力量衰退與抬舉負重能力退步等問題。這些問題也使他們自行發展出新的動作模式來適應生活與工作所需: 當抬舉高度高於胸部以上時，受傷者會傾向依賴肱二頭肌替代較無力的上斜方肌和前三角肌。

Background: Occupational accidents are divided into two types including occupational injuries and occupational diseases. The occupational injuries are traumas caused when performing work, and the occupational diseases are diseases caused when performing work. According to the reports from the Occupational Safety and Health Administration of the Ministry of Labor, industries with a high rate of injuries require good lifting abilities. When a worker undergoes surgery for a shoulder injury, he or she may still experience pain, limited joint angles, and limited improvement in muscle strength, which in turn affects the performance in lifting.Therefore, through this study, we hope to discover the differences between people with shoulder injuries and healthy people when lifting, and hope to design more precise and effective rehabilitation training to help workers in occupational injuries regain their physical and work capacity faster.

Methods: This study is a cross-sectional study, recruiting men aged between 20-64 with work experience and dividing them into a healthy group (N=16) and an injured group (N=13). All subjects completed questionnaires (Shoulder Pain and Disability Index Scale, Physical Activity Readiness Questionnaire, and Physical functional elements of work), physical assessments (finger/shoulder/eye height, body composition analysis, grip strength , joint range of motion, muscle strength, lifting ability), and instrument measurement (muscle activation measurement during weight lifting). The primary outcome was to observe the differences in muscle activation of the shoulder muscles when lifting between the injured and healthy subjects; the secondary outcome was to observe the differences in shoulder joint mobility, muscle strength, pain and disability.







Results: There was no significant difference in the amount of muscle activation at each lifting height between the two groups, but the intra-group differences in each of the two groups had different trends. When the lifting height is higher than the chest, the muscle activation of biceps brachii in the healthy group significantly reduced, while in the injured group, there is no significant reduction. When the lifting height is higher than the chest, the muscle activation of the anterior deltoid and upper trapezius muscles in the healthy group show significantly increased, while in the injured group, there is a no significant increased. Compared with the healthy group, the injured group had significantly reduced joint range of motion of shoulder flexion, a significant reduction in shoulder abduction muscle strength, a significant increase in shoulder pain and disability index, and a significant decrease in the weight-bearing capacity of lifting tasks.

Conclusion: Even after workers with shoulder joint injuries undergo surgery, rehabilitation and successfully return to work, they still suffer from problems such as pain, limited joint angles, muscle strength and weight-bearing capacity decline. These problems also cause them to develop new movement patterns to adapt to the needs of life and work: When lifting above the chest, the injured person would tend to rely on the biceps brachii to compensate the weaker upper trapezius and anterior deltoid muscles.

目錄
中文摘要 I
英文摘要 III
致謝 V
目錄 VI
表目錄 VIII
圖目錄 IX
第一章 緒論 1
第一節 研究背景 1
第二節 研究目的 2
第三節 研究假設 3
第二章 文獻探討 4
第一節 什麼是職業災害 4
第二節 勞工上肢常見的受傷部位、類型與處置方式 5
第三節 醫療師能顧問之商並休養天數 8
第四節 職業所需的能力與分類 9
第五節 職災勞工之職能復健 12
第六節 功能性能力評估之力量分測驗可預測復工 15
第七節 力量分測驗中雙手抬舉測驗的生理與生物力學 17
第八節 肩膀進行抬手動作的生理與生物力學工 21
第三章 研究方法 23
第一節 研究方法設計 23
第二節 實驗流程 33
第三節 統計方法 35
第四章 結果 37
第一節 同質性與信度分析 37
第二節 受試者基本資料 38
第三節 身體組成分析 41
第四節 身體能力評估 42
第五節 雙手抬舉測驗負重能力 44
第六節 儀器測量 45
一、 雙手抬舉測驗時，兩組間肌肉活化量(iEMG)之差異 45
二、 雙手抬舉測驗時，各組內肌肉活化量(iEMG)之差異 46
第五章 討論 48
第一節 在基本資料、身體能力評估與雙手抬舉負重能力上的差異 48
第二節 雙手抬舉負重時，肌肉活化量之差異(iEMG) 49
第三節 受傷組中，肩鎖關節脫位與鎖骨骨折之差異 52
第四節 研究限制與未來研究 53
第六章 結論 54
參考文獻 55
附錄 65
【附錄一、人體研究新案同意申請書】
【附錄二、肩痛及失能指數量表】
【附錄三、體能活動適應能力問卷】

表目錄
表1、受傷組13位受試者的分類 40
表2、基本資料 41
表3、工作狀態 42
表4、身體組成分析 44
表5、身體能力評估-關節角度與柔軟度 45
表6、身體能力評估-力量與自覺疼痛指數 45
表7、雙手抬舉測驗負重能力 47
表8、兩組受試者在雙手抬舉測驗時肌肉活動量之差異(iEMG) 48
表9、雙手抬舉測驗時在不同高度下肌肉活動量之差異(iEMG) 50
表10、受傷組內之身體能力評估-力量與自覺疼痛指數 55











圖目錄
圖1、職業所需的能力 13
圖2、職業所需的五大類型工作能力 14
圖3、功能性能力評估示意圖 17
圖4、生理工作能力強化訓練示意圖 17
圖5、職業輔導評量示意圖 17
圖6、職務再設計示意圖 17
圖7、工作所需勞動體力 28
圖8、兩手向後摸之距離 29
圖9、握力與側握指力施測 30
圖10、環境配置 30
圖11、木製搬運箱 31
圖12、重物 31
圖13、雙手抬舉測驗指引 32
圖14、疼痛主觀感受圖 33
圖15、負重主觀感受圖 33
圖16、表面肌肉電訊號電極黏貼位置 34
圖17、實驗流程圖 37
圖18、兩組職業類別占比 43

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