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研究生: 張思瑀
Ssu-Yu Chang
論文名稱: 運動族群及非運動族群之膝關節生物力學與影像參數之相關性
Relationship between Biomechanical Factors and Image Parameters in Athletes and Non-athletes
指導教授: 許維君
Wei-Chun, Hsu
口試委員: 曹昭懿
Jau-Yih Tsauo
王子娟
Tzyy-Jiuan Wang
吳家麟
Wu Jia-Lin
李永祥
Yung-Hsiang Lee
學位類別: 碩士
Master
系所名稱: 應用科技學院 - 醫學工程研究所
Graduate Institute of Biomedical Engineering
論文出版年: 2020
畢業學年度: 108
語文別: 中文
論文頁數: 95
中文關鍵詞: 運動員核磁共振成像生物力學因子靜態下肢特徵
外文關鍵詞: athlete, MRI, biomechanical factor, static lower extremity alignment
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動態與靜態膝關節變形(knee malalignment) 是退化性膝關節炎(knee osteoarthritis; knee OA)病程進展的有力預測指標,同時與退化性膝關節炎發生率及與核磁共振成像(magnetic resonance imaging; MRI)檢查的軟骨損傷有關。臨床上,常見藉由影像學檢查來鑑別退化性膝關節炎嚴重度與量化關節變形,其中MRI可於x-ray可鑑別膝關節面變窄和膝關節變形前,即提供關節內部的病理變化情況。研究上,常見藉由步態分析,探討膝關節內外翻變形對膝關節內外側的負荷程度和分布之影響,先前研究指出膝關節負荷相關之重要生物力學參數,包括膝關節內收力矩(knee abductor moment;KAM)、膝關節屈曲力矩(KFM; knee flexion moment)、膝屈曲角度( knee flexion angle;KFA)、膝內收角度( knee adduction angle;KAA)以及內翻推力( varus thrust;VT),多著重於膝關節本身冠狀面與矢狀面的方向力學參數,但是動態膝關節控制上,髖關節與踝關節在水平面動作所扮演之角色,與臨床上膝關節排序相關之危險因子等,皆與保守性治療之效果(如卸載式護膝、鞋墊、步態訓練…等等)息息相關。此外,物理治療常見之理學檢查,如量測靜態下肢特徵 (SLEA; static lower extremity alignment),以及利用3D MRI重建膝關節軟骨與半月軟骨等結構,可以輔助目前藉由x-ray檢查所缺少的水平面訊息。有鑑於過去少有文獻將不同膝變形族群之MRI影像參數、動態生物力學參數,以及SLEA同時納入評估已探討參數之間之相關性,因此本研究第一個目的為比較各組間基本資料、選擇性生物力學變數、SLEA測量值,功能性測試與問卷。第二個研究目的為確定不同下肢變形患者(如膝內翻、膝外翻變形),其膝關節形態學參數(如膝關節軟骨體積、厚度…等)、生物力學危險因子(如KAM、KAA、KFM、KFA、VT)與理學檢查中靜態下肢排列特徵 (Static lower extremity alignmet; SLEA) 之相關性。第三個研究目的為比較各組內MRI中雙側膝關節及內外側軟骨位置與厚度之差異。


Dynamic and static knee malalignment were reported as strong predictors of the progression of knee osteoarthritis (OA), and were shown to be associated with the incidence of knee OA and cartilage erosion revealed by finding of magnetic resonance imaging (MRI). X-ray is commonly used to quantify the severity of OA and the degree of joint deformities, while MRI can be used to explore the pathological changes within the joint before the space narrowing and malalignment at knee joint can be detected by X-ray. Malalignment could alter load distribution and mechanically stress at the knee. With majority of emphasis have been on the frontal and sagittal planes, previous biomechanical studies have shown several biomechanical parameters, such as knee abductor moment (KAM), knee flexor moment (KFM), knee flexion angle (KFA), knee adduction angle (KAA), and varus thrust(VT), were associated with knee mal-alignment. However, in dynamic control of the knee, the roles that the hip and ankle play in horizontal plane may also be correlated to outcome of conservative treatment (i.g., unloading knee brace) to restore knee joint alignment. The measurement of static lower extremity alignment (SLEA) and reconstructed articular cartilage and meniscus by 3D MRI can also provide those missing information on horizontal plane. There was relatively less evidence in the literature to explore interactive correlation among findings of MRI, biomechanical parameters, and SLEA. Therefore, the first purpose of study was to investigate the between-difference groups of the T2 value and cartilage thickness, with KAM, KAA, KFM, KFA, VT, and SLEA. The second purpose was to investigate the relationship between the T2 value and cartilage thickness, with KAM, KAA, KFM, KFA, VT, and SLEA in patients. The third purpose was compared the T2 value and cartilage thickness of medial-lateral region of a knee and bilateral knees.

中文摘要 III ABSTRACT IV 誌謝 V 第一章、緒論 6 1-1、研究背景與動機 6 1-2、研究目的 7 1-3、研究假設 8 1-4、研究範圍 8 1-5、研究限制 8 第二章、文獻回顧 9 2-1、膝關節排列異常危險因子有關之下肢臨床評估及醫學影像檢查 (Physical Examination and Magnetic Resonance Imaging;PE and MRI) 9 2-2、MRI-based之肌肉骨骼模型之內在結構參數與其步態特徵之相關研究 11 2-3、膝關節排列不正與步行之相關力學變數 13 2-4、膝關節軟骨厚度與步態力學變數的關係 15 第三章、研究方法 17 3-1、研究對象 17 3-2、實驗儀器與設備 17 3-3、實驗方法 20 3-3-1、醫學影像檢查 20 3-3-2、臨床評估問卷 21 3-3-3、功能性測試 22 3-3-4、受試者動作 22 3-3-5、反光球位置 23 3-3-6、靜態下肢特徵 24 3-3-7、肌電黏貼位置 27 3-4、實驗步驟與流程 32 3-4-1、力學實驗流程圖 33 3-4-2、實驗步驟 33 3-4-3、MVC測試 33 3-4-4、受試者靜態校準 33 3-4-5、平地行走 33 3-5、資料處裡 34 3-6、統計方法 39 第四章、結果與討論 40 4-1、受試者基本資料 40 4-2、生物力學參數 46 4-3、影像參數因子與MRI影像之相關性 48 4-4、生物力學因子與MRI影像之相關性 51 4-5、生物力學因子與靜態下肢排列特徵、功能性測試、問卷、AMA之相關性 68 4-6、AMA與靜態下肢排列特徵、問卷之間的相關性 70 4-7、膝關節患側與健側MRI影像之相關性 72 第五章、討論 85 5-1、靜態下肢排列特徵 85 5-2、生物力學參數 85 第六章、結論 86 參考文獻 87 附錄 1

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