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系統識別號 U0026-0308201617202500
論文名稱(中文) 探討扳機指屈指肌腱的生物機械特性
論文名稱(英文) Biomechanical Behavior of the Flexor Tendon in Patients with Trigger Finger
校院名稱 成功大學
系所名稱(中) 生物醫學工程學系
系所名稱(英) Department of BioMedical Engineering
學年度 104
學期 2
出版年 105
研究生(中文) 蔡郁平
研究生(英文) Yuh-Ping Tsai
學號 p86024140
學位類別 碩士
語文別 英文
論文頁數 53頁
口試委員 指導教授-蘇芳慶
口試委員-郭立杰
口試委員-周一鳴
口試委員-孫永年
中文關鍵字 屈指深肌  屈指淺肌  超音波  扳機指  肌腱機械材料特性 
英文關鍵字 flexor digitorum superficialis  flexor digitorum profundus  ultrasound  Trigger finger  mechanical property 
學科別分類
中文摘要 在臨床上扳機指(trigger finger)或稱為狹窄性腱鞘炎為常見之手部疾病,雖發病位置可能僅為患者之單一或數個手指,但對於病患之手部功能、整體日常生活工作表現及生活品質等卻有極大的影響。目前由臨床觀察歸因於屈指肌腱與腱鞘之結構尺寸不合所造成肌腱滑動的不順暢,過去許多研究認為是病變發生於環狀腱鞘系統,然而,近期研究發現,扳機指肌腱的基因及病理表現與跟腱炎呈現相關性,進而推斷扳機指亦可能是一種肌腱炎的形式。已有許多研究利用超音波影像針對肌腱病變作機械與材料特性的探討,大部分都是對於跟腱、脛前肌腱、腓腸肌腱等下肢肌腱進行研究,結果顯示,肌腱炎會導致肌腱的機械與材料特性改變。
過去關於扳機指的超音波影像研究大多探討腱鞘系統,尚未有研究針對扳機指的屈指肌腱做進一步的生物力學特性分析,因此本研究為提供更多扳機指肌腱病變的相關資訊,欲透過自行開發的等速肌力評估系統及超音波系統以非侵入性方式觀察扳機指患者與健康受試者在執行不同手指動作及屈曲角度下施力時,屈指淺肌及屈指深肌兩條肌腱滑動與手指力量值之相對關係,藉此了解屈指淺肌及屈指深肌之肌腱生物力學特性,此外,在影像學方面也會利用超音波分別探討屈指深肌腱與屈指淺肌腱的厚度。
本研究以15位手部健康之受測者及6位扳機指病患為研究對象,健康受測者當中會對於慣用手進行測試,病人部分則以患指為主。結果顯示,在扳機指患者的屈指淺肌腱及屈指深肌腱的厚度都比健康組來得厚。對於肌腱之機械特性探討,扳機指患者肌腱之勁度(stiffness)在兩條肌腱上也都呈現比較高的狀態。此外針對不同指關節角度的改變,發現控制組隨著指關節角度變大,力量會有下降的趨勢,反之病人組則沒有明顯趨勢。
此研究運用超音波影像技術、力學設計及臨床觀察等研究方法,探究了手部健康之受測者及扳機指病患在不同手指姿勢運動下肌腱滑移與力量之間的關係。 藉由此實驗結果能提供更多扳機指肌腱病變的相關資訊,期能提供建議給予臨床扳機指治療介入或疾病預防的方式。
英文摘要 Trigger finger (TF), also called stenosing tenosynovitis, is a disease commonly seen in hand clinics. The disease may affect one or several digits, impairs hand function, and is likely to negatively affect working ability and quality of life. According to the current clinical observation, the cause of TF is attributed to the disparity in size between the flexor tendon and the A1 pulley. The pathophysiologic mechanism behind trigger digits remains controversial. It has generally been ascribed to primary changes in the first annular pulley. However, in recent findings, the gene expression and the pathology of TF resemble that of tendinosis in the Achilles tendon, and thus it has been speculated that TF may be a form of tendinosis and the mechanical properties of tendon may be affected. Previous studies investigated the tendon’s mechanical properties in vivo, and focused on the lower-extremity. The results indicated that tendinopathy might change the mechanical and material properties of the tendon.
The purpose of this study is to better understand the mechanical properties of flexor tendons and variations in the morphologies of the flexor digitorum tendon between normal and trigger fingers when in various positions. Sonographic and custom-designed isokinetic dynamometer are used to measure tendon force at different finger flexion angles. The measurements of the force and tendon displacement are used to learn more about the mechanical properties of flexor digitorum superficial (FDS) and profound tendons (FDP).
In this study, we recruited 15 healthy controls who did not have any hand disease or injury, and 6 patients with trigger finger. The results demonstrate that both the FDP and FDS tendons of the patients with trigger finger are significantly thicker and stiffer than in the controls. As a result, greater tendon forces were needed for the trigger finger patients to reach the same amount of tendon displacement. Our research also explored the effects of different joint postures on force production and tendon stiffness between the two groups. In both the distal and proximal interphalangeal joints of the healthy participants, the tendon force decreased when the joint angle was increased, and tendency not seen in the patient group. In conclusion, this study used imaging technology and the mechanical design to investigate the effects of different finger-joint positions on tendon force production and tendon displacement between healthy participants and patients with trigger finger. It is hoped that the findings from this experiment may provide some information to be used in clinical diagnosis, assessment, and care for patients suffering from trigger finger in the future.
論文目次 中文摘要 I
Abstract III
致謝 V
Contents VI
List of Table i
List of Figure i
Chapter 1 Introduction 1
1.1 Research Background 1
1.2 Anatomy of Finger 2
1.3 Trigger Fingers 4
1.4 Medical Imaging Evaluation on Trigger Finger 6
1.5 Flexor Tendon Excursion 7
1.6 Tendon Stiffness 9
1.7 Motivation 11
1.8 Specific Aims 13
Chapter 2 Materials and Methods 14
2.1 Subjects 14
2.2 Design of Finger Isokinetic Dynamometer 15
2.3 Experimental Setup 17
2.4 Experimental Procedure 18
2.5 Messurement of Finger Flexor Tendons Thickness 21
2.6 Measurement of Tendon Moment Arm and Tendon Displacement 22
2.7 Measurement of Tendon Force 24
2.8 Measurement of Tendon Stiffness 24
2.9 Statistical Analysis 25
Chapter 3 Results 26
3.1 Thickness of Flexor Digitorum Tendons 26
3.2 Interphalangeal Joint Flexion Torque 27
3.3 Tendon Force 30
3.4 Tendon Displacement 32
3.5 Tendon Stiffness 34
Chapter 4 Discussion 38
4.1 Tendon Thickness 38
4.2 Tendon Force 39
4.3 Tendon Stiffness 43
4.4 Limitations 47
Chapter 5 Conclusion 48
References 49
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