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系統識別號 U0026-0812200910353919
論文名稱(中文) 拇指運動學的量化分析
論文名稱(英文) Quantitative analysis of the thumb kinematics
校院名稱 成功大學
系所名稱(中) 醫學工程研究所碩博士班
系所名稱(英) Institute of Biomedical Engineering
學年度 91
學期 2
出版年 92
研究生(中文) 郭立杰
研究生(英文) Li-Chieh Kuo
學號 p8887108
學位類別 博士
語文別 英文
論文頁數 117頁
口試委員 口試委員-林高田
口試委員-陳協慶
口試委員-周一鳴
召集委員-鄭誠功
口試委員-張冠諒
指導教授-邱浩遠
口試委員-陳美津
指導教授-蘇芳慶
指導教授-威廉古尼
指導教授-安介南
口試委員-周有禮
中文關鍵字 運動學  動作分析  可行性  數學模型  大菱形掌指關節  拇指 
英文關鍵字 kinematics  Thumb  motion analysis  feasibility  mathematical model  Trapeziometacarpal joint 
學科別分類
中文摘要 由於拇指的解剖構造十分的複雜,造成臨床上對姆指關節動作量測的困難。加上拇指的動作型態特殊,使得目前的動作量測工具在對姆指及其受傷後的量測上增添許多困難性及不適切性。因此由於此動機及對於臨床上的需求,本研究整體上的目標乃再於發展一客觀、準確及具辨析性的方法以協助臨床在對姆指運動功能有關之疾病或傷害的診斷。
在運用動態分析方法研究肢體的動作前,最先決首要的就是了解我們使用的表皮感應器(標記)與其皮下骨頭肢段間的關係。在第二章中我們運用動態X光透視檢查及屍體的研究來研究骨頭標記與皮膚標記間在動態過程中的關係。結果顯示當我們使用動態分析系統及電磁感應儀器來記錄拇指動作時,我們可以用表皮感應器或標記來取代拇指各肢段的運動情形。
基於拇指指尖能在三度空間中動作的概念,我們在第三章中發展一個量化的方法用來評估拇指指尖的工作空間,以定義拇指的動作範圍。我們運用電腦輔助攝影的動態分析系統來量測拇指指尖的工作空間,藉由此量測法,拇指受損的程度將可用量化的方式表示並計算其與理想平均值間的關係,進而計算出受損程度的百分比。
先前的研究已經顯示出,學者在對姆指大菱形掌指關節的動作及生物力學特性研究的努力。然而,截至目前臨床上仍無一個合適的量測法運用在此關節活動的量測,雖然我們已在上一章發展出量測拇指指尖工作空間的方法,然而此方法並無法精確的顯示出大菱形掌指關節的動作情形,因此我們於第四章再發展一數學模型來量測大菱形掌指關節的最大工作空間。
我們研究最終的目的是希望能推展這些客觀及科學的方法以協助臨床上的用途,所以我們目前正在臨床上運用這些方法來量測拇指病人的動作情形。在美國梅約醫學中心我們正進行量測大菱形掌指關節在手術前及手術後於運動學上的表現。在成功大學醫學中心,我們則運用量測拇指指尖工作空間的方法來評估拇指傷後病人接受復健活動後的動作回復之狀況。我們預期我們的方法能逐步地克服我們在傳統臨床上對於無法精確量化量測拇指動作情形的困難。
英文摘要 Due to the intricate anatomical structures of the thumb, it is difficult to measure the motion of the thumb joint clinically. Complicated movements of the thumb make the present methods of joint motion assessment difficult in the measurement of thumb motion or thumb impairment. The purpose of this study was to develop an objective, accurate and discriminative method to aid clinical diagnoses of thumb movement impairment associated with disease or injury.
It is prerequisite to understand the relationship between surface sensors (markers) and the underlying bony segment before utilizing the motion analysis method to investigate movements of extremities. So in the first part of this study (Chapter 2), we investigated the relationship between the bony and skin landmarks of the thumb during dynamic motion by fluoroscopic examination with living volunteers and three-dimensional spatial tracking measurement with cadaver. The results indicated that the measurement of the motion of the thumb is feasible using surface markers in the video-based motion system or sensors of electromagnetic tracking device.
Based on the concept of the three-dimensional space within which the thumb-tip can move, hereafter the workspace of the thumb-tip (WOTT), we developed a quantitative WOTT method for evaluating the range of motion of thumb in the Chapter 3. A computerized video motion analysis system was used to provide quantitative measurement and evaluation of the thumb-tip workspace. By the WOTT method, degree of thumb motion impairment is evaluated as the percentage of actual thumb-tip workspace surface area relative to the ideal average for a given thumb length.
Although there are several studies to determine the movements and biomechanical properties of the trapeziometacarpal joint, in vitro. Clinical applications were limited and there is no appropriate method to measure either the range of motion or the maximal workspace of this joint in vivo. Due to the limitation of the WOTT method, we developed a mathematical model to evaluate the maximal workspace of the trapeziometacarpal joint in the Chapter 4.Our final goal of this study is to popularize these objective and scientific methods for clinical uses. Therefore, the clinical applications of these two methods are in progress for assessing the kinematics of the TM joint pre-op/post-op joint arthroplasty at Mayo Medical Center and other thumb impairments at National Cheng Kung University Hospital. We anticipate that the difficulties of measuring the complex kinematics of the thumb will be gradually overcome using our developed objective and quantitative methods.
論文目次 Table of Contents
ABSTRACT I
中文摘要 III
誌謝 V
TABLE OF CONTENTS VI
LIST OF TABLES VIII
LIST OF FIGURES IX
LIST OF FIGURES IX
CHAPTER 1. GENERAL INTRODUCTION 1
1.1 ROLES OF THE THUMB 1
1.2 ANATOMY AND KINESIOLOGY OF THE THUMB 2
1.3 BIOMECHANICS OF THE THUMB KINEMATIC CONSIDERATIONS 5
1.4 TOOLS FOR ASSESSING THE HAND MOTION 8
1.5 MOTIVATIONS AND CLINICAL RELEVANCE 15
1.6 SPECIFIC AIMS 16
CHAPTER 2. FEASIBILITY OF USING A VIDEO-BASED MOTION ANALYSIS SYSTEM AND AN ELECTROMAGNETIC TRACKING DEVICE FOR MEASURING THUMB KINEMATICS 18
2.1 INTRODUCTION 18
2.2 USE OF THE 2D VIDEOFLUOROSCOPIC SYSTEM TO ASSESS THE RELATIONSHIP BETWEEN SURFACE MARKERS AND BONY LANDMARKS OF THE THUMB 19
2.2.1. Background and Significance 19
2.2.2. Research Design and Methods 21
2.2.3. Results 26
2.2.4. Discussion 30
2.3 USE OF HUMAN CADAVER HANDS TO VERIFY THE FEASIBILITY OF USING SKINS SENSORS FOR ASSESSING MOTION OF THE TRAPEZIOMETACARPAL JOINT 33
2.3.1. Background and Significance 33
2.3.2. Research Design and Methods 35
2.3.3. Results 39
2.3.4. Discussion 44
2.4 SUMMARY 46
CHAPTER 3. VIDEO-COMPUTER QUANTITATIVE EVALUATION OF THUMB FUNCTION USING WORKSPACE OF THE THUMB 47
3.1 INTRODUCTION 47
3.2 RESEARCH DESIGN AND METHODS 49
3.3 RESULTS 55
3.4 DISCUSSION 60
3.5 SUMMARY 62
CHAPTER 4. A QUANTITATIVE METHOD FOR ASSESSING THE COMPLICATED TRAPEZIOMETACARPAL JOINT MOTION 63
4.1 INTRODUCTION 63
4.2 A BIOMECHANICAL AND MATHEMATICAL MODEL TO CALCULATE THE WORKSPACE OF THE TRAPEZIOMETACARPAL JOINT 64
4.2.1. Background and Significance 64
4.2.2. Research Design and Methods 66
4.2.3. Results 72
4.2.4. Discussion 76
4.3 A QUANTITATIVE METHOD TO MEASURE MAXIMAL WORKSPACE OF THE TRAPEZIOMETACARPAL JOINT - NORMAL MODEL DEVELOPMENT 79
4.3.1. Background and Significance 79
4.3.2. Research Design and Methods 82
4.3.3. Results 87
4.3.4. Discussion 92
4.4 SUMMARY 95
CHAPTER 5. CLINICAL APPLICATIONS 96
CHAPTER 6. CONCLUSIONS 105
REFERENCES 111
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