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題名：功能性膝支架對於前十字韌帶重建手術運動員在膝關節動作之生物力學分析
作者：張曉昀 引用關係
作者(外文)：Hsiao-Yun Chang
校院名稱：國立體育學院
系所名稱：體育研究所
指導教授：黃啟煌
學位類別：博士
出版日期：2007
主題關鍵詞：膝關節；前十字韌帶傷害；膝支架；功能性動作；運動學；Knee brace；Anterior cruciate ligament injury；Knee joint；Kinematics；Functional activity
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研究背景：前十字韌帶重建的運動員會造成膝關節的生物力學運動模式改變，這些手術後的運動員在重回運動場之前，需要經過膝關節的檢查與評估以了解運動員復原狀況，但是這些評估方式無法實際反映出運動員在接受前十字韌帶重建手術後膝關節運動過程中的關節活動情形。再者，前十字韌帶受傷或斷裂及重建之後，需穿著功能性膝支架，功能性膝支架是否會影響膝關節運動學的變化也一直是爭議性的問題。研究目的：本研究之目的為比較正常健康之運動員、前十字韌帶損傷者與接受前十字韌帶重建運動員在有無穿著功能性膝支架對膝關節運動學影響之差異。研究方法：本研究選取7位健康者、7位接受前十字韌帶重建手術之大學運動員、及4位前十字韌帶損傷運動員進行研究，以Zebris CMS-HS超音波三維動作分析儀進行實驗，測量的動作包括下蹲、垂直跳、往前跳、上樓梯、及下樓梯等五個動作。收集並記錄每個動作過程中的最大角度(膝彎曲、外翻、內翻、外轉、內轉、最大膝外轉時之彎曲角度、最大膝外翻時之彎曲角度、最大膝內翻時之彎曲角度)，再擷取膝彎曲末端0~30°的膝外翻角度與外轉角度計算關節滑動軌跡路徑長度等九個變項。統計方法：本研究以混合設計二因子變異數分析比較健康者、前十字韌帶損傷者與接受前十字韌帶重建之運動員在有無穿著功能性膝支架時的膝關節運動學差異。結果及臨床運用：由研究結果顯示，有無穿著功能性膝支架對於健康者、前十字韌帶損傷者與前十字韌帶重建者在膝關節運動學上並無顯著的影響。三個族群在最大膝外翻角度及發生最大膝外轉時的膝關節彎曲角度均有明顯的差異，最大膝外翻角度均以前十字韌帶損傷組角度最大，其次為前十字韌帶重建組，健康組外翻角度最小。顯示前十字韌帶損傷後會增加膝關節外翻角度，但是接受前十字韌帶重建手術的患者可以改善膝關節過度外翻的情形。在發生最大膝外轉時的膝關節彎曲角度部分，前十字韌帶重建組在膝關節剛開始彎曲時已經發生最大的膝外轉動作，顯示在接受手術後會產生膝關節提早外轉的情形，表示在手術後膝關節還是呈現轉動性不穩定的情形。
Background: Recent research suggests athletes after anterior cruciate ligament (ACL) reconstruction leads to alterations in gait adaptation and knee kinematics. Before return the athletes with ACL reconstruction to their previous sports level, there were needs to evaluate the knee function after ACL reconstruction surgery. Most of the used methods could not reflect the actual joint movements of knee after ACL reconstruction during activities. Secondly, the athletes after ACL reconstruction had to wearing functional knee brace (FKB). Wearing functional knee brace was also a controversial issue. Purpose: The aims of this study were to compare the difference of knee kinematics among normal, subjects with anterior cruciate ligament(ACL) injuries and athletes with ACL reconstruction in bracing or un-bracing condition during 5 functional activities (squat, vertical jump, hop, up- and down-stair). Methods: The study was conducted on 7 collegiate athletes following ACL reconstruction surgery, 4 ACL injuries subjects and 7 healthy athletes. Knee kinematics analysis was performed by applying the Zebris three-dimensional ultrasound-based system during squatting, up- and down-stair, vertical jump and hop. A Mix-design two-way ANOVA was used to determine the difference among healthy, ACL injuries subjects and athletes following ACL reconstruction. Results: The results were shown that: (1) there was no significant difference between bracing and un-bracing knee movements during 5 measured activities. It was no instantly significant change before and after wearing functional knee brace for three groups. (2) There was significant difference among normal, ACL injuries subjects and athletes with ACL reconstruction in 5 functional activities, especially maximal knee abduction angle and knee flexion degree at maximal knee external rotation. (3) ACL injuries group had more knee abduction angle. The results indicated that ACL injuries group increased knee abduction after injuries. (4) Early tibial external rotation was found in knee flexion for athletes with ACL reconstruction. It was an indication that athletes with ACL reconstruction exhibited rotatory instability.
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