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題名：功能性不穩定與正常踝關節本體感覺與H反射之差異研究
作者：黎俊彥 引用關係
作者(外文)：Chun-Yen Li
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：2004
主題關鍵詞：習慣性不穩定踝關節；本體感覺；H反射；proprioception；functional instability ankle；Hoffmann reflex
原始連結：連回原系統網址new window
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踝關節扭傷是一種常見的下肢運動傷害，研究指出踝關節扭傷之後約有31％∼35％會有功能性不穩定(FI)的情形發生，而使踝關節更容易重複發生韌帶扭傷；後續研究也顯示FI患者會有較差的本體感覺能力，並導致身體姿勢穩定性的降低。然而最近部分的研究則顯示受傷腳與健側腳間並無顯著差異存在，顯示出類似的身體姿勢搖擺與干擾反應時間。有鑑於相關研究結果的不確定，再者有限的研究探討FI患者潛在的神經興奮機轉，因此本研究的目的是要探討FI與正常踝關節其本體感覺與比目魚肌H反射的差異，以瞭解其間的關係與可能的影響。22位受試者(10位正常踝關節受試者、3位單側功能性踝關節不穩定與9位双側功能性不穩定踝關節受試者)參與本研究，以BIODEX III等速肌力系統量測踝關節主動/被動復位誤差角度值，作為個體本體感覺功能的代表，以DANTEC Keypoint®誘發電位評估系統，測量比目魚肌H-reflex與M wave，作為個體Hoffmann反射神經興奮性的代表。所有數值以平均數±標準差來表示，以獨立樣本t考驗與Pearson相關係數來比較FI與正常踝關節各量測變項之差異與關係，統計顯著差異水準皆設為α=0.05。研究結果顯示：1. FI踝關節有顯著較大的主動與被動關節復位誤差角度；2. FI踝關節有顯著較小的H反射最大振幅與H/M反射最大振幅比率。本研究顯示功能性不穩定踝關節可能因受損的關節壓力感受器，而降低踝關節本體感覺功能，此外減少的神經興奮傳入訊息，也進而導致顯著較低的比目魚肌Hoffmann反射振幅，並顯現出顯著較低的H/M反射最大振幅比率。因此針對功能性不穩定踝關節的復建計畫不僅要著重於本體感覺功能的恢復，也應瞭解患者比目魚肌Hoffmann反射振幅的變化，以作為患者神經肌肉傳導功能是否復原的評估指標，以有效降低踝關節再度扭傷的機率。
Previous researches indicated that frequent ankle injury would induce “Fuctional Instability” (FI) ankle, and decrease the propriception sensitivity and the postural control ability. However, some of the recent studies showed conflicting results. Furthermore, none of any research examined the possible effects of FI on soleus motorneuron excitability. The purpose of this study was to compare the difference in proprioception and Hoffmann reflex between FI and normal ankles. Twenty-two subjects (10 with health normal ankles, 3 with unilateral FI ankle, and 10 with bilateral FI ankles) were recruited as subjects. The proprioception was measured by BIODEX III dynamometer as ankle active/passive reposition sense. The Hoffmann reflex was measured by DANTEC Keypoint® as H-reflex and M wave maximal amplitude. Independent t-test and Pearson correlation analysis were used to exam the difference and relationship between FI and normal ankles. The significant level was set atα=0.05. The results of this study showed that: 1) FI ankle has significant bigger absolute reposition error angle. 2) FI ankle has significant smaller H-reflex maximal amplitudes and the Hmax/Mmax ratio. This study indicated that impaired mechanoreceptors in functional instability ankle would decrease the sensitivity of ankle proprioception. The diminished afferent signals seemed to lower the maximal amplitude of soleus Hoffmann reflex. It was suggested that in order to reduce the probability of ankle sprain reinjury, rehabilitation program for FI ankle not only focus on restoring the full function of proprioception, but also monitor the soleus Hoffmann reflex amplitude as an index of neuromuscular indicator.
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