臺灣博碩士論文加值系統

肩關節是人類所有關節中活動度最大的關節，一但肩關節活動失能，則患者的許多生活功能長久受限，一般估計冷凍肩（frozen shoulder）約佔所有肩膀疼痛患者之2 % - 3 %。
早期研究指出對於冷凍肩的治療包括口服藥物、局部注射、物理治療以及外科手術去除沾黏性組織，但在執行上均有一定難度及副作用。而中醫針灸治療冷凍肩方面，在傳統中醫典籍上早已有明確記載且臨床上也已被證實。然而治療前後療效的評估仍是依賴目視或是精準度低的量尺進行量測。因此關於這部分的定量與科學驗證方面至今未曾被發表。本研究為首次將中醫針刺治療冷凍肩後，利用三維動態立體攝影技術(stereophotogrammetry)進行定量評估。
本研究中設立了三種狀態，分別為對照、偽穴與真實治療。對照狀態為受試者尚未接受任何治療，偽穴狀態是希望排除測試時的各種心理作用產生的影響，實穴治療為針刺條口(Tiao-kou , ST-38)透承山 (Chen-shan , UB-57)。利用三維動態立體攝影技術進行定量評估冷凍肩患者在這些狀態下的肩部活動情況。研究結果顯示針刺條口透承山穴後，確實能改善患者手臂外展情況且帶來了瞬間的療效。這樣的結果印證了中醫典籍上針刺治療對冷凍肩的說法。另外一方面證實整個肱骨外展(abduction)角度的改善是來自肩胛胸廓關節(scapulothoracic joint, ST joint)上的改變，而非病灶點盂肱關節(glenohumeral joint, GH joint)上。
冀希借此建立一套客觀的量測技術且有助於冷凍肩療效的診斷與機制的研究。

The shoulder joint is one of the most mobile joints in the body, playing an important role in the normal function of the upper extremity. Any injury or disease will cause degradation or even loss of function of the upper limb with huge impact on the daily living and a number of frozen shoulder patients comprise 2-3% of that of shoulder’s pain.
It has been pointed out that treatment with drugs, including taking orally or local injection, with physical therapy, and with surgery that dealt with adhesive tissues may come with other complications, however, there exists a certain degree of side effects and difficulty in practice. As to the therapy of frozen shoulder in Chinese acupuncture, the effect of the therapy is not only precisely documented in the classical Chinese medical literature but also proven in the clinical medicine. However, the efficacy of treatment was generally judged by subjective observations by the naked eye or by less accurate goniometers. Therefore no quantitative and scientific evidence has been reported. The study is the first in the world that used high precision three-dimensional video-based stereophotogrammetry to evaluate quantitatively the treatment effects of acupuncture therapy of frozen shoulders.
Three test conditions were included in the study: blank, fake and true treatment. The blank condition was tested first before the subject received any treatment. Fake test condition was used to test possible psychological effects of the acupuncture treatment. True treatment was that it treated with acupuncture at Tiao-kou (ST-38) and Chen-shan (UB -57). They were to evaluate quantitatively the motion of frozen shoulders by using video-based stereophotogrammetry and electromyography. The results reported in the present study are immediate treatment effects that the patients can abducing more after the therapeutic acupoints”ST-38 and UB-57”. This finding confirms the teachings described in the classical Chinese medical literature. Another result was showed the improvement of humeral abduction angle was form the scapulothoracic joint, was not the pathogeny of glenohumeral joint.
It is hoped that the efficacy of this treatment can be scientifically proven the developed measurement and evaluation technique will be helpful for the diagnosis of patients with frozen shoulders and will be helpful for the planning and implementation of long-term studies on the treatment mechanism and efficacy of acupuncture in frozen shoulder.

目錄 頁數
第一章 前言..............1
第二章 文獻探討..........5
第三章 材料及方法.......17
第四章 結果.............40
第五章 討論.............55
第六章 結論.............59
參考文獻................60
附件....................66
英文摘要................80
謝詞....................82
表目錄 頁數
表 2.1：肩部肌肉與手臂動作的關係表……………………………………07
表 3.1：受試者編號與資料…………………………………………………26
表 3.2：反光球黏貼位置……………………………………………………27
表 4.1：治療前肩胛胸廓關節與盂肱關節的角度量測值…………………41
表 4.2：偽穴治療後肩胛胸廓關節與盂肱關節的角度量測值……………42
表 4.3：條口透承山穴治療後肩胛胸廓關節與盂肱關節的角度量測值…43
表 4.4：治療前三角肌前、中、後與斜方肌上、中、下與背闊肌三處位置的EMG均方根值………………………………………………………………45
表 4.5：偽穴治療後三角肌前、中、後與斜方肌上、中、下與背闊肌三處位置的EMG均方根值…………………………………………………………46
表 4.6：條口透承山穴治療後三角肌前、中、後與斜方肌上、中、下與背闊肌三處位置的EMG均方根值………………………………………………47
表4.7：實驗前與偽穴治療後差異比較表…………………………………49
表4.8：偽穴與條口透承山穴治療後情況差異比較表……………………50
表4.9：實驗前與條口透承山穴治療後情況差異比較表…………………51
圖目錄 頁數
圖 2.1 肩部構造及其四個關節…………………………………………6
圖 2.2 肱骨韻律示意圖…………………………………………………7
圖 2.3 肩關節的五種活動度測試………………………………………8
圖 3.1 紅外線動態立體攝影機…………………………………………18
圖 3.2 肩胛固定器………………………………………………………19
圖 3.3 肩胛固定器定位示意圖…………………………………………19
圖 3.4 肌電圖儀分析儀器………………………………………………20
圖 3.5 肌電訊號探頭……………………………………………………21
圖 3.5 肌電圖儀訊號接收器……………………………………………21
圖 3.7 前置放大器………………………………………………………22
圖 3.8 實驗流程圖………………………………………………………23
圖 3.9 紅外線下表面反光球的表現情況………………………………28
圖 3.10 三角肌表面電極黏貼處示意圖Ⅰ………………………………31
圖 3.11 背闊肌與斜方肌表面電極黏貼處Ⅱ……………………………31
圖 3.12 實際受試者接受表面電極與反光球黏貼位置圖片……………32
圖 3.13 患者手臂舉高測試動作示意圖…………………………………33
圖 3.14 偽針之穴位………………………………………………………34
圖 3.15 偽針組試驗用電極片……………………………………………34
圖 3.16 條口穴位置………………………………………………………35
圖 3.17 透承山穴位置……………………………………………………36
圖 3.18 針刺條口透承山穴位之實際情況………………………………36
圖 3.19 肱骨改善角度在肩關節上的計算………………………………37
圖 3.20 肌電訊號原始圖譜………………………………………………38
圖 3.21 肌電訊號處理過程………………………………………………38
圖 4.1 受試者七個點經整流與平滑後的EMG圖………………………44
圖 4.2 治療前及偽針治療與正常人上舉之角度減少量比較圖………49
圖 4.3 偽穴與條口透承山穴治療與正常人上舉之角度減少量比較…50
圖 4.4 治療前及實針治療與正常人上舉之角度減少量比較圖………51
圖 4.5 實驗前與偽穴治療後，進行外展動作下三角肌、斜方肌與背闊肌的EMG均方根值結果比較圖…………………………………………………52
圖 4.6 偽穴與條口透承山治療後，進行外展動作下三角肌、斜方肌與背闊肌的EMG均方根值結果比較圖……………………………………………53
圖 4.7 實驗前與條口透承山治療後，進行外展動作下三角肌、斜方肌與背闊肌的EMG均方根值結果比較圖…………………………………………54

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