臺灣博碩士論文加值系統

螢幕終端機(VDT)使用者使用電腦的時間和頻率增加，會造成肌肉疲勞、酸痛、僵硬等上肢肌肉骨骼相關問題（upper extremity musculoskeletal disorders, UEMSDs）發生。
本研究利用表面肌電圖觀察23位具有上肢肌肉疼痛女性與30位健康年輕的女性打字作業人員，分別於90及120分鐘連續打字後其肌肉疲勞表現的情況。量測的肌肉包括伸指肌（extensor digitorum communis）、屈指淺肌(flexor digitorum superficialis)，及上斜方肌(bilateral upper trapezius)。量測到的肌肉活動以頻率與振幅合併分析法(joint analysis of spectra and amplitude, JASA)進行分析。並在打字實驗前後透過自評式問卷收集受試者的生理、心理疲勞程度。
長時間打字作業後，健康組與上肢肌肉疼痛組受試者手部伸指肌及屈指淺肌經肌電圖頻率與振幅合併分析法分析後顯示兩組分別有70% (84/120)與71.7% (66/92)肌肉發生疲勞；另外，上肢肌肉疼痛組受試者上斜方肌肌電圖經頻率與振幅合併分析法分析後顯示有52%(24/46)肌肉發生疲勞。另以自評式問卷評估健康組與上肢肌肉疼痛組受試者打字前後上肢肌肉疼痛及心理疲倦感，結果發現受試者經過90-120分鐘長時間打字後其肌肉疼痛及心理疲倦感均有增加，兩組受試者打字後心理疲倦感自評分數分別增加4.53 ± 2.10與 3.57 ± 1.73分。在上肢肌肉部位，健康組於打字後肩頸部位酸痛幅度改變量較大（2.67±2.47分），上肢肌肉疼痛組則以左手手指（3.00±1.91分）及左肩（3.00±2.22分）的酸痛幅度改變量最大。然而，比較兩組受試者於打字後的心理疲倦及上肢肌肉疼痛部位的表現，並無達到統計上顯著差異。整體而言，長時間打字作業，即使施力低於1.5﹪最大自主收縮（MVC）下，利用肌電圖仍可觀察到大多數的健康組與上肢肌肉疼痛組受試者打字作業後肌肉疲勞情形。

The positive association has been demonstrated between the development of the upper extremity musculoskeletal disorders (UEMSDs) and the prolonged use of computer among the visual display terminal (VDT) users.
The purpose of the present study was to investigate the forearm muscles activity in female typing workers with UEMSDs (N=23) after 90 -120 minutes of typing work by means of surface EMG. Thirty asymptomatic volunteers served as controls. The recorded muscles included bilateral extensor digitorum communis、flexor digitorum superficialis and upper trapezius. Joint analysis of spectra and amplitudes (JASA) was used to demodulate the EMG registrations at individual level. Self-administrated questionnaire were also used to evaluate the muscle discomfot and psychological demands of the subjects.
Results of JASA indicated that 70% muscle fatigue in bilateral extensor digitorum communis (EDC) and flexor digitorum superficialis (FDS) showed muscle fatigue among the asymptomatic group, while 71.7% of these type of muscles experienced fatigue among symptomatic group. Meanwhile, there was 52% of bilateral upper trapezius of the symptomatic group subjects showed muscle fatigue. All the subjects reported substantially increased muscle discomfort and mental fatigue after the 90-120 minutes of typing work.
The increase of mental fatigue in the symptomatic and asymptomatic subjects was 4.53 ± 2.10 and 3.57 ± 1.73. In addition, the greatest increase of muscle discomfort was found in left fingers (3.00±1.91) and left shoulder (3.00±2.22) among the symptomatic subjects while it was of neck and shoulder region in the asymptomatic subjects (2.67±2.4). However, the above difference of mental fatigue and muscle discomfort between 2 groups didn’t reach the significant level.
Overall, the results showed that even at the low-force dynamic muscle contraction (＜1.5% MVC), the surface EMG analysis could mostly detect the increasing amplitude and the decreasing frequency in subjects with or without UEMSDs.

目錄
摘 要……………………………………………………………………………I
Abstract…………………………………………………………………………Ⅲ
目錄………………………………………………………………………………i
表目錄…………………………………………………………………………..iii
圖目錄…………………………………………………………………………..vi
第一章 前言
1.1 研究重要性……………………………………………………………….1
1.1.1 研究背景 …………………………………………………………....1
1.1.2 研究動機……………………………………………………………..2
1.1.3 電腦使用者之肌電圖研究…………………………………………..3
1.2 研究目的………………………………………………………………….3
第二章 文獻回顧
2.1 螢幕終端機使用者相關健康效應……………………………………….4
2.2 造成螢幕終端機使用者肌肉疼痛之危險因素………………………….5
2.2.1 個人因素……………………………………………………………..5
2.2.2 與工作相關之因素…………………………………………………..5
2.2.3 工作站(workstation)…………………………………………………6
2.2.4 工作姿勢因素………………………………………………………..8
2.2.5 社會心理因素………………………………………………………..9
2.3 過度使用之傷害………………………………………………………...10
2.4 螢幕終端機使用者相關肌電圖研究…………………………………...10
2.4.1 肌電圖的產生………………………………………………………13
第三章 材料與方法
3.1 研究設計………………………………………………………………...13
3.2 研究對象………………………………………………………………...13
3.3 現場打字作業環境……………………………………………………...15
3.4 測試工具………………………………………………………………...15
3.4.1 肌電圖儀器
3.4.1.1表面電極………………………………………………………..15
3.4.1.2 資料獲取系統………………………………………………….16
3.4.1.3 後續之肌電訊號分析…………………………………………16
3.4.1.3.1 肌電訊號處理-肌電訊號濾波……………………………17
3.4.1.3.2 肌電訊號分析……………………………………………….19
3.4.1.4 頻率與振幅合併分析…………………………………………19
(Joint Analysis of Spectra and Amplitude, JASA)
3.4.2 肌力測量器…………………………………………………………20
3.5打字前後自覺健康與肌肉疼痛表現問卷………………………………20
3.6實驗步驟…………………………………………………………………20
第四章 結果……………………………………………………………………23
4.1 受試者基本特徵………………………………………………………...23
4.2最大自主收縮(MVC)的肌電圖及肌力表現……………………………23
4.3 打字作業之肌電圖表現………………………………………………...25
4.4頻率與振幅合併分析……………………………………………………26
(Joint Analysis of Spectra and Amplitude, JASA)
4.4.1右手伸指肌………………………………………………………….26
4.4.2左手伸指肌………………………………………………………….27
4.4.3右手屈指淺肌……………………………………………………….26
4.4.4左手屈指淺肌……………………………………………………….27
4.4.5上斜方肌…………………………………………………………….27
4.6打字前後上肢肌肉健康狀態問卷……………………………………....28
第五章 討論…………………………………………………………………29
5.1打字作業後的疲勞表現…………………………………………………29
5.1.1健康組與上肢肌肉疼痛組打字前後最大自主收縮表現………….29
5.1.2 肌電圖頻率與振幅合併分析之比較………………………………30
5.1.2.1健康組與上肢肌肉疼痛組……………………………………..30
5.1.2.2上肢肌肉疼痛組手部和斜方肌肌電圖頻率與振幅合併
分析之比較…………………………………………………….31
5.1.2.3上肢肌肉疼痛組斜方肌肌電圖之頻率與振幅合併
分析之比較…………………………………………………….32
5.3肌肉負荷值……………………………………………………………....33
第六章 結論與建議………………………………………………………….34
參考文獻…………………………………………………………………….35
附件………………………………………………………………………….74
附件一：理學檢查項目及部位……………………………………………..74
附件二：工作站相關硬體設備配置建議值……………………………….76
附件三：受試者自填試問卷……………………………………………….77
表目錄
表2.1 與電腦有關之上肢肌肉骨骼傷害發生百分比………………………..43
表2.2 與電腦有關之發生上肢肌肉骨骼傷害在身體各分佈比例………….43
表4.1 受試者的基本資料……………………………………………………..44
表4.2 上肢肌肉疼痛理學檢查………………………………………………..44
表4.3 以Mixed Model比較時間、組別及手部肌肉對肌電圖最大自主收縮
之影響…………………………………………………………………..44
表4.4 健康組受試者打字前後手部肌電活動(EA)最大自主收縮量測結果.45
表4.5 上肢肌肉疼痛組受試者打字前後手部及上斜方肌上肢部位肌電
活動(EA)最大自主收縮量測結果……………………………………..46
表4.6 上肢肌肉疼痛組打字前後執行最大自主收縮的肌力表現…………..47
表4.7 比較健康組與上肢疼痛組打字前後左右手部的肌電活動(EA)
最大自主收縮值比較………………………………………………….48
表4.8 比較健康組與上肢肌肉疼痛組打字後與打字前左右手
肌電活動(EA)最大自主收縮之差值………………………………….49
表4.9 健康組打字期間後的肌電圖肌電活動及頻率變化之斜率………….50
表4.10 上肢肌肉疼痛組打字期間後的肌電圖肌電活動及頻率變化之
斜率…………………………………………………………………...50
表4.11 比較健康組與上肢肌肉疼痛組手部肌肉頻率與振幅合併分析
(JASA)表現分布之檢定結果…………………………………………51
表4.12 健康組受試者手部肌肉肌電圖肌電活動(EA)與中位頻率(MDF)
合併分析(JASA)之結果……………………………………………..51
表4.13 上肢肌肉疼痛組受試者手部肌肉肌電圖肌電活動(EA)與中位
頻率(MDF)合併分析之(JASA)結果…………………………………..52
表4.14 上肢肌肉疼痛組受試者兩側斜方肌肌電圖肌電活動(EA)與中位
頻率(MDF)合併分析之(JASA)結果………………………………….53
表4.15 比較健康組與上肢肌肉疼痛組受試者手部肌肉頻率與振幅合併分析
(JASA)結果比較……………………………………………………………54
表4.16 健康組與上肢肌肉疼痛組打字前自覺健康與肌肉疼痛狀況(n=53).55
表4.17 健康組與上肢肌肉疼痛組打字前後自覺健康與肌肉疼痛狀況…..56
表4.18 比較健康組與上肢肌肉疼痛組打字前後之自覺健康與肌肉疼痛表現差值之表現(n=53)…………………………………………………….57
表5.1 健康組與上肢肌肉疼痛組打字作業後的肌電活動表現……………..58
圖目錄
圖2.1 與水平面傾斜20度的鍵盤…………………………………………….59
圖2.2 kinesis鍵盤…………………………………………………………….59
圖2.3 疲勞形成之機制……………………………………………………….60
圖2.4 肌電訊號產生的示意圖………………………………………………..60
圖3.1 現場打字作業環境的配置……………………………………………...61
圖3.2 伸指肌電極片貼附方式………………………………………………...62
圖3.3 屈指淺肌電極片貼附方式……………………………………………...62
圖3.4 上斜方肌肌電極片貼附方式…………………………………………...63
圖3.5 原始肌電資料透過傅立葉轉換得到的中位頻率與平均頻率……….63
圖3.6 頻率與振幅合併分析方法(Joint Analysis of Spectra and Amplitude, JASA)…………………………………………………………………...64
圖3.7 右伸指肌最大自主收縮之肌力測試………………………………….65
圖3.8 右屈指淺肌最大自主收縮之肌力測試……………………………….65
圖3.9 左上斜方肌最大自主收縮之肌力測試……………………………….65
圖3.10 實驗步驟流程圖……………………………………………………….66
圖4.1某健康組受試者右手伸指肌原始肌電圖圖譜…………………………67
圖4.2某健康組受試者受試者打字後的右手伸指肌電活動(EA)變化………67
圖4.3某受試者打字後的右手伸指肌肌肉頻率(MDF)變化圖譜……………68
圖4.4健康組受試者右手伸指肌肌電圖肌電活動(EA)與中位頻率(MDF)合併分析圖(JASA)………………………………………………………….69
圖4.5 上肢肌肉疼痛組受試者右手伸指肌肌電圖肌電活動(EA)與中位頻率(MDF)合併分析圖(JASA)…………………………………………….69
圖4.6 健康組受試者左手伸指肌肌電圖肌電活動(EA)與中位頻率(MDF)合併分析圖(JASA)………………………………………………………….70
圖4.7 上肢肌肉疼痛組受試者左手伸指肌肌電圖肌電活動(EA)與中位頻率(MDF)合併分析圖(JASA)…………………………………………….70
圖 4.8 健康組受試者手右手屈指淺肌電圖肌電活動(EA)與中位頻率(MDF)合併分析圖(JASA)…………………………………………………….71
圖 4.9 健康組受試者右手屈指淺肌肌電圖肌電活動(EA)與中位頻率(MDF)合併分析圖(JASA)…………………………………………………….71
圖4.10健康組受試者左手屈指淺肌肌電圖肌電活動(EA)與中位頻率(MDF)合併分析圖(JASA)…………………………………………………….72
圖4.11上肢肌肉疼痛組受試者左手屈指淺肌肌電圖肌電活動(EA)與中位頻率(MDF)合併分析圖(JASA)………………………………………….72
圖4.12 上肢肌肉疼痛組受試者右上斜方肌肌電圖肌電活動(EA)與中位頻率(MDF)合併分析圖(JASA)…………………………………………….73
圖4.13上肢肌肉疼痛組受試者左上斜方肌肌電圖肌電活動(EA)與
中位頻率(MDF)合併分析圖(JASA)………………………………….73.

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