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研究生:毛歆瑜
研究生(外文):Hsin-Yu Mao
論文名稱:髕股關節疼痛症候群患者與健康成人之股內側斜肌形態差異--超音波研究
論文名稱(外文):Morphology of the Vastus Medialis Obliquus in Patients with Patellofemoral Pain Syndrome and Healthy Young Adults--A Sonographic Study
指導教授:詹美華詹美華引用關係
學位類別:碩士
校院名稱:國立臺灣大學
系所名稱:物理治療學研究所
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:2005
畢業學年度:93
語文別:中文
論文頁數:57
中文關鍵詞:髕股關節疼痛症候群股內側斜肌超音波股內側斜肌終點股內側斜肌體積
外文關鍵詞:Patellofemoral pain syndromevastus medialis obliquusultrasonographythe percent of VMO attachmentVMO volume attached to the patella
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背景:髕股關節疼痛症候群(PFPS)為一常見膝關節疾病,主要成因為髕骨不正常的向外側偏移造成髕股關節的壓迫。過去的研究指出股內側斜肌(VMO)為髕股關節的一個重要動態穩定者,負責將髕骨向內側做穩定。然而1998年,由Hubbard JK.等人解剖374具大體,欲觀察髕股關節磨損程度與VMO形態之相關性,結果卻顯示無顯著相關。以上研究在大體內進行,與活體內之情形不盡相同,因此本研究選用超音波量測VMO之各項參數。 目的:以超音波影像測量患有PFPS之50歲以下患者與正常無膝痛病史者之各項VMO參數是否有差異。方法:以31位PFPS患者及與其配對之31位健康對照組為受試者,以HDI 5000超音波儀器量測VMO之各項參數,包括VMO終點連接到髕骨位置佔髕骨總長的百分比、肌纖維走向與股骨之夾角、連接到髕骨上之VMO體積以及連接到髕骨上之VMO形狀變化率。 結果:兩組各有可互相配對的51筆資料。在各項VMO形態參數中,只有VMO終點連接到髕骨位置佔髕骨總長的百分比一項顯示統計上的差異(p<0.05)。PFPS組平均值為40.61% (±11.99%),健康組為46.46% (±7.6%)。兩組之VMO終點連接到髕骨位置的長度,在髕股關節疼痛症候群組平均值為2.07cm (±0.63cm),健康組為2.43cm (±0.48cm),兩組差了將近0.4cm。將兩組的VMO體積與具統計差異的VMO終點連接到髕骨位置佔髕骨總長的百分比做相關性的分析,結果顯示PFPS組之VMO體積與VMO終點連接到髕骨位置佔髕骨總長的百分比有顯著的中度相關,R=0.695(p<0.000),在健康組同樣呈現顯著的中度相關,R=0.517(p<0.000)。而14位單側為患側之PFPS病人,比較其患側與非患側之各項參數,在所有VMO形態參數皆無顯著差異。 討論:臨床上對於此類病人的訓練著重於股內側斜肌的肌力訓練,但本研究中唯一有差異的參數,肌肉終點的位置無法經由肌力訓練而改變。對於肌肉終點位置較靠近端(proximal)的病人,肌力訓練的成效可能較不如預期,以手術的方式將髕股關節做整形可能是較可行的方法。以我們目前的研究結果無法指出到底終點接在多少的患者是可以訓練,而少於多少得訓練效果不彰,未來研究可將患者依照終點連接位置作分組訓練,以驗證我們的假設。 結論:各項VMO形態參數中,只有VMO終點連接到髕骨位置佔髕骨總長的百分比一項在PFPS組與健康組比較中顯示統計上的差異(p<0.05)。VMO終點連接到髕骨位置佔髕骨總長的百分比和VMO連接到髕骨上之體積有中度相關,可作為VMO體積大小的參考指標。
Background:Patellofemoral pain syndrome(PFPS) is a common knee disorder characterized by anterior or retropatellar pain associated with activities that load the patellofemoral joint. Previous studies reveal that the vastus medialis obliquus(VMO) is an important dynamic medial stabilizer of the patellar. Insufficiency of the VMO leads to lateral shift of the patella and the increases the patellofemoral contact force. An in vitro study conducted by Hubbard JK. et al. claimed that there were no significant relationship between several morphologic characteristics of the VMO and the extent of patellofemoral joint deterioration. We consider that the condition might be different in vivo, so we chose ultrasonogrphy as the measurement tool to examine the morphology of the VMO in PFPS patients and healthy controls. Purpose:To determine if there are significant differences in several morphologic parameters of the VMO between patients with PFPS and healthy controls under 50. Method:31 PFPS patients and 31 matched healthy adults under 50 were recruited for the study. The HDI 5000 ultrasonography machine was used to evaluate morphologic parameters of the VMO, including the percent of patella attachment, fiber angle, the volume attached to the patella, and the change of shape of the VMO. Result:51 data were collected in each of the two groups and were perfectly matched by age, gender, and BMI. The only parameter that revealed significant difference was the percent of patella attachment (p<0.05). The mean percentage of the PFPS group was 40.61%, while that of the healthy group was 46.46% (±7.6%). The actual length of the VMO attachment on the patella was 2.07cm (±0.63cm) in the PFPS group and 2.43cm (±0.48cm) in the healthy group, revealing a 0.4 cm difference. Furthermore, we found that there is a moderate correlation between VMO volume attached to the patella and the percentage of VMO insertion in both groups, R=0.695(p<0.000)in the PFPS group and R=0.517(p<0.000) in the healthy group. On the other hand, comparing the affected and non-affected side of the 14 unilateral affected PFPS patients, all parameters failed to reveal significant difference. Discussion:Training programs for PFPS patients usually include strength training of the VMO muscle, but the only morphological parameter which revealed significant difference in our study, the percent of VMO attachment, was not capable of being trained. For those PFPS patients who have a proximally inserted VMO, strength training might not be effective and surgery might be a better choice for treatment. Conclusion:The only parameter which revealed significant difference between the two groups is the percent of VMO attachment (p<0.05). There is a moderate correlation between the percent of VMO attachment and VMO volume.
第一章、 前言 1
第一節、 研究背景與動機 1
第二節、 研究目的 2
第三節、 實驗假說 3
第四節、 使用名詞定義 5
第二章、 文獻回顧 6
第一節、 髕股關節之構造及其生物力學 6
第二節、 髕股關節疼痛症候群之定義、盛行率及相關研究 7
第三節、 髕股關節疼痛症候群之成因 8
第四節、 股內側斜肌之解剖特徵及在髕骨關節所扮演之角色 12
4-1股內側斜肌之解剖特徵 12
4-2股內側斜肌功能不足及形態對髕股關節之影響 15
4-3評估工具之信效度 17
第三章、 研究方法 19
第一節、 受試者 19
第二節、 實驗儀器及測量工具 20
第三節、 實驗步驟與流程 21
第四節、 資料分析與統計 24
第四章、 結果 26
第一節、 基本資料與骨骼排列參數分析 26
第二節、 股內側斜肌各項參數在兩組間的比較 26
第三節、 單側患側病人之患側與非患側比較 27
第五章、 討論 28
第一節、 基本資料與骨骼排列參數 28
第二節、 股內側斜肌各項參數在兩組間的比較 28
2-1 股內側斜肌終點連接到髕骨上位置佔髕骨總長百分比 28
2-2 連接到髕骨上之股內側斜肌體積 30
第三節、 單側患側病人之患側與非患側比較 30
第六章、 參考文獻 32
第七章、 附圖 38
第八章、 附表 50
第九章、 附錄 53
1.Crossley K, Bennell K, Green S, Cowan S, McConnell J. Physical therapy for patellofemoral pain: a randomized, double-blinded, placebo-controlled trial. Am J Sports Med 2002; 30(6): 857-65.
2.Lichota DK. Anterior knee pain: symptom or syndrome? Current Women’s Health Reports 2003; 3: 81-86.
3.Csintalan RP, Schulz MM, Woo J, MacMahon PJ, Lee TQ. Gender differences in patellofemoral joint biomechanics. Clin Orthop Re Res 2002; 402: 260-9.
4.Fulkerson JP. Diagnosis and treatment of patients with patellofemoral pain. Am J Sports Med 2002; 30(3): 447-57.
5.Thomee P, Thomee R, Karlsson J. Patellofemoral pain syndrome: Pain, coping strategies and degree of well-being. Scand J Med Sci Sports 2002; 12: 276-81.
6.Powers CM. rehabilitation of patellofemoral joint disorders: A critical review. J Orthop Sports Phys ther 1998; 28(5): 345-54.
7.Gerber C, Hoppler H, Claassen H, Robotti G, Zehnder R, Jakob RP. The lower-extrimity musculature in chronic symptomatic instability of the anterior cruciate ligament. J Bone Joint Surg 1985; 67A(7): 1034-43.
8.Cowan SM, Bennell KL, Hodges PW, Crossley KM, McConnell J. Delayed onset of electromyographic activity of vastus medialis obliquus relative to vastus lateralis in subjects with patellofemoral pain syndrome. Arch Phys Med Rehabil 2001; 82: 183-89.
9.Lieb FJ, Perry J. Quadriceps function. An anatomical and mechanical study using amputated limbs. J Bone Joint Surg 1968; 50A: 1535-48.
10.Hubbard JK, Sampson HW, Elledge JR. The vastus medialis oblique muscle and its relationship to patellofemoral joint deterioration in human cadavers. J Orthop Sports Phys Ther 1984; 6:95-103.
11.Sakia N, Luo ZP, Rand JA, An KN. The influence of weakness in the vastus medialis oblique muscle on the patellofemoral joint: An in vitro biomechanical study. Clin Biomech 2000; 15:335-339.
12.Hubbard JK, Sampson HW, Elledge JR. Prevalence and morphology of the vastus medialis oblique muscle in human cadavers. Anat Record 1997; 249(1):135-42.
13.Raimondo RA, April EW, Ahmad CS, Grelsamer RP, Blankevoort L, Henry JH. Patellar stabilization: A quantitative evaluation of the vastus medialis obliquus muscle. Orthopedics 1998; 21(7): 791-5.
14.Mariani PP, Caruso I. An electromyographic investigation of subluxation of the patella. J Bone Joint Surg 1979; 61B(2): 169-71.
15.Cowan SM, Hodges PW, Bennell KL, Crossley KM. Altered vastii recruitment when people with patellofemoral pain syndrome complete a postural task. Arch Phys Med Rehabil 2002; 83: 989-95.
16.Cowan SM, Hodges PW, Bennell KL, Crossley KM, Hodges PW, McConnell J. Physical therapy alters recruitment of the vasti in patellofemoral pain syndrome. Med Sci Sports Exerc 2002; 34(12): 1879-85.
17.O’Reilly MARO, O’Reilly PMR, Bell J. Sonographic appearance of medial rectinacular complex injury in transient patellar dislocation. Clin Radiology 2003; 58: 636-41.
18.Trikha SP, Acton D, O’Reilly M, Curtis MJ, Bell J. Acute lateral dislocation of the patella: Correlation of ultrasound scanning with operative findings. Injury 2003; 34: 568-71.
19.Miyatani M, Kanehisa H, Kuno S, Nishijima T, Fukunaga T. Validity of ultrasonograph muscle thickness measurements for estimating muscle volume of knee extensors in humans. Eur J Appl Physiol 2002; 86: 203-8.
20.Heckmatt JZ, Pier N, Dubowitz V. Measurement of quadriceps muscle thickness and subcutaneous tissue thickness in normal children by real-time ultrasound imaging. J Clin Ultrasound 1988; 16: 171-6.
21.Carvalho AD, Jorgensen J, Schibye B, Klausen K, Anderson AD. Controlled ultrasonographic measurements of cross-sectional areas of the quadriceps muscle submitted to dynamic strength training. J Sport Med 1985; 25: 251-4.
22.Blazevich AJ, Gill ND, Bronks R, Newton RU. Training-specific muscle architecture adaptation after 5-wk training in athletes. Med Sci Sports Exerc 2003; 35(12): 2013-22.
23.Young A, Hughes I, Russell P, Parker MJ, Nichols PJR. Measurement of quadriceps muscle wasting by ultrasonography. Rheumatol. Rehabil. 1980; 110(3): 141-8.
24.Bemben MG. Use of diagnostic ultrasound for assessing muscle size. J Strength Conditioning Res. 2002; 16(1): 103-8.
25.Reeves ND, Maganaris CN, Narici MV. Ultrasonographic assessment of human skeletal muscle size. Eur J Appl Physiol 2004; 91: 116-8.
26.Bose K, Kanagasuntheram R, Osman MBH. Vastus medialis oblique: an anatomic and physiologic study. Orthopedics. 1980; 3(9): 880-3.
27.Thiranagama R. Nerve supply of the human vastus medialis muscle. J Anat 1990; 170: 193-8.
28.Weinstabl R, Scharf W, Firbas W. The extansor apparatus of the knee joint and its peripheral vasti: anatomic invetigation and clinical relevance. Surg Radiol Anat 1989; 11:17-22.
29.Gunal I, Arac S, Sahinoglu K, Birvar K. The innervation of vastus medialis obliquus. J Bone Joint Surg 1992; 74B: 624.
30.Jojima H, Whiteside LA, Ogata K. Anatomic consideration of nerve supply to the vastus medialis in knee surgery. Clin Orthop 2004; 423: 157-60.
31.Fox TA. Dysplasia of the quadriceps mechanism: Hypoplasia of the vastus medialis muscle as related to the hypermobile patella syndrome. Surg Clin Nor Amer 1975; 55(1): 199-226.
32.Goh JCH, Lee PY, Bose K. A cadaver study of the function of the oblique part of the vastus medialis. J Bone Joint Surg 1995; 77B: 225-31.
33.Travnik L, Pernus F, Erzen I. Histochemical and morphometric characteristics of the normal human vastus medialis longus and vastus medialis obliquus muscles. J Anat 1995; : 403-11.
34.Ritter MA, DeRosa GP, Babcock JL. Tibial Torsion? Clin Orthop 1976; 00: 159-63.
35.Matthews LS, Sonstegard DA, Henke JA. Load bearing characteristics of the patello-femoral joint. Acta Orthop Scand 1977; 48: 511-6.
36.Goodfellow J, Hungerford DS, Zindel M. Patello-femoral joint mechanics and pathology. 1. Functional anatomy of the patello-femoral joint. J Bone Joint Surg Br. 1976; 58: 287-90.
37.Grelsamer RP, Klein JR. The biomechanics of the patellofemoral joint. J Orthop Sports Phys Ther 1998; 28: 286-98.
38.Gross MT, Foxworth JL. The role of foot orthoses as an intervention for patellofemoral pain. J Orthop Sports Phys Ther 2003; 33: 661-670.
39.Messier SP, Davis SE, Curl WW, Lowery RB, Pack RJ. Etiologic factors associated with patellofemoral pain in runners. Med Sci Sports Exerc 1991; 23(9): 1008-15.
40.Thomee R, Augustsson J, Karlsson J. Patellofemoral pain syndrome. Sports Med 1999; 28(4): 245-62.
41.Powers CM, Maffucci R, Hampton S. Rearfoot posture in subjects with patellofemoral pain. J Orthop Sports Phys Ther 2003; 33: 155-60.
42.Holmes SW, Clancy WG. Clinical classification of patellofemoral pain and dysfunction. J Orthop Sports Phys Ther 1998; 28(5): 299-306.
43.Juhn MS. Patellofemoral pain syndrome: A review and guidelines for treatment. Am Fam Physician; 1999: 60: 2012-22.
44.Edwardson BM, Musculoskeletal Disorders Common Problems. San Dieago, California, Singular Publishing Group, Inc. 1995.
45.Magee DJ. Orthopedic Physical Assessment, Ch 11, 2nd ed.Philadelphia, W.B. Saunders Co., 1992.
46.Carson Jr. WG, James SL, Larson RL, et al. Patellofemoral disorders: Physical and radiographic evaluation, part II: radiographic examination. Clin Orthop. 1984; 185: 178-186.
47.Ruffin IV MT, Kiningham RB. Anterior knee pain: the challenge of patellofemoral pain syndrome. Am Fam Physician. 1993; 47: 185-194.
48.Davidson K. Patellofemoral pain syndrome. Am Fam Physician. 1993; 48:1254-62.
49.Kennedy JC, Alexander IJ, Hayes KC. Nerve supply of the human knee and its functional importance. Am J Sports Med. 1982; 10:329-334.
50.Post WR, Teitge R, Amis A. Patellofemoral malalignment: looking beyond the viewbox. Clin Sports Med 2002; 21: 521-46.
51.Johnson NA, Polgar J, Weightman D, et al. Data on the distribution of fiber types in thirty-six human muscles. An autopsy study. J Neurol Sci. 1973; 18:111-29.
52.Thomee R, Renstrom P, Karlsson J, et al. Patellofemoral pain syndrome in young women: I. A clinical analysis of alignment, common symptoms and functional activity level. Scand J Med Sci Sports 1995; 5:237-44.
53.Fairbank JC, Pynsent PB, van Poortvliet JA, et al. Mechanical factors in the incidence of knee pain in adolescents and young adults. J Bone Joint Surg Br. 1984; 66(5): 685-93.
54.Petreela JK, Kim JS, Tuggle SC, Hall SR, Bamman MM. Age differences in knee extension power, contractile veolocity, and fragibility. J Appl Physio 2005; 98(1): 211-20.
55.Toft I. Lindal S, Bonaa KH, Jenssen T. Quantitative measurement of muscle fiber composition in a normal population. Muscle & Nerve 2003; 28(1):101-8.
56.Armstrong AD, MacDermid JC, Chinchalkar S, Stevens RS. King GJ. Reliability of range-of-motion measurement in the elbow and forearm. Journal of Shoulder & Elbow Surgery 199; 7(6):573-80.
57.Aagaard P, Andersen JL, Dyhre-Poulsen P, Leffers AM. Wagner A. Magnusson SP, Halkjaer-Kristensen J, Simonsen EB. A mechanism for increased contractile strength of human pennate muscle in response to strength training: changes in muscle architecture. J Physio 2001; 534(2): 613-23.
58.Reeves ND, Narici MV, Maganaris CN. In vivo human muscle structure and function: adaptations to resistance training in old age. Experi Physio 2004; 89(6):675-89.
59.Trappe SW, Trappe TA, Lee GA, Costill DL. Calf muscle strength in humans. Inter J Sports Med 2001; 22(3):186-91.
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