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系統識別號 U0026-0812200914072173
論文名稱(中文) 護理人員在床邊平移病人之腰薦椎關節三維生物力學分析探討
論文名稱(英文) 3D Biomechanical Analysis in Lumbosacral Joint during Horizontal Reposition the Patients on the Bed in Nurses
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 96
學期 2
出版年 97
研究生(中文) 徐敏
研究生(英文) Min Hsu
電子信箱 p8694118@mail.ncku.edu.tw
學號 p8694118
學位類別 碩士
語文別 中文
論文頁數 97頁
口試委員 口試委員-張志涵
口試委員-蘇芳慶
指導教授-張冠諒
中文關鍵字 下背痛  病人照護  生物力學 
英文關鍵字 Low back pain  patient-handling  Biomechanics 
學科別分類
中文摘要 背景與目的: 下背痛是在肌肉骨骼系統中常見的疾病之一,全世界約有百分之六十以上的人口都有過下背痛的經驗,也是勞動人口中常見的職業傷害。國內護理人員下背痛的發生非常普遍,約有78%的研究對象都有下背痛的經驗。因此本實驗則利用動作分析系統以及力板跟肌電圖所獲得的資料,配合人體計測資料,以三維靜態生物力學分析來獲得護理人員在床邊平移病人時所承受的腰薦椎受力值以及影響因素。
方法: 本實驗共有十位護理人員參與,因移動病人的方式分成兩組,A組為分段完成搬運組,B組為一次完成搬運組,運用力板以及動作分析系統的資料,利用逆向動力學推算出在移動病人時作用於受測者腰薦椎的外力及外力矩,再配合肌電圖的資料,搭配最佳化程式運算得到作用於腰薦椎的各肌肉施力以及關節的作用力以及肌肉收縮比例去比較兩組的不同;在算出每各受測者的受力值後,分別依照背痛病史的有無再分成兩組比較腰椎受力值是否會因為背痛有所差別。
結果: 本實驗的結果顯示,分段完成將病人在床上平移的A組腰薦椎關節受力值以及力矩值比一次完成的B組大,尤其以總力矩,彎曲力矩有明顯差距;並且發現軀幹的旋轉角度與彎曲力矩大小是有中度正相關的關係。在檢測背痛因子對於腰薦椎關節的受力以及力矩值並沒有明顯的差異,但是發現有背痛病史的受測者的軀幹彎曲
角度明顯比沒有背痛病史大,並且腰薦椎關節的垂直壓力與軀幹的彎曲角度有中度正相關的關係。
結論: 護理人員在平移病人在床上位置時,身體過度的彎曲以及旋轉都會產生過大的腰薦椎受力值,因此本實驗建議護理人員在平移移動病人在床上的位置時,應採取身體對稱的姿勢,將腰部盡量保持直立的姿勢使力,避免產生不必要的彎曲以及旋轉的角度,使身體肌肉可以增加共同收縮模式,以期減輕腰薦椎的負荷。
英文摘要 Background: Over 60% population of the world has had the most common musculoskeletal disease- low back pain. According to the nurse-based studies in our country, about 78% nursing staff has low back pain problem. But little was known about the real spinal loading when the nurses performed patient-handling tasks. The aim of this study is to calculate the spinal loading of the L5/S1 joint and analyze how the factors influence the spinal loading of the nurses who perform horizontal repositioning patients on the bed by using 3D static biomechanics. Method: 10 clinic nurses participated in this study (mean: 26.8 yrs with standard deviation: 1.3yrs), and were divided into 2 groups by the techniques of repositioning the patient: group-A repositioned the patient segmental, and group-B repositioned the patient non-segmental. The study calculated the external loads acting on the L5/S1 joint by using inverse kinetics, and estimated the internal force acting on the L5/S1 joint by using EMG assisted optimization. After getting the results, we would exanimate the difference between the groups by repositioning techniques and low back pain history existed or not. Result: As the results showed that the internal force acting on the L5/S1 joint and the moment caused by external loads were larger in group-A than that in group-B. There were significant differences in the bending moment and the total moment between the groups. We also found that there was a positive correlation with a statistical significance between the bending moment and the angle of trunk rotation. There was no statistical difference found in spinal loading when we compared the subjects who have the low back pain history with who don’t. But we found that the subjects with low back pain history had larger angle of trunk flexion when performing the task. Besides we also found there was a positive correlation with a statistical significance between the angle of trunk flexion and compression force of the L5/S1 joint. Conclusion: Excessive trunk rotation or flexion would increase spinal loading of the L5/S1 joint when nurses perform horizontal repositioning the patient on the bed. So we suggested that nurses should perform the repositioning task with symmetric and erect posture to avoid excessive spinal loading. Moreover, the erect posture would decrease the spinal loading by increasing the co-contraction of the trunk muscle.
論文目次 中文摘要...- i -
英文摘要...- iii -
誌謝.......- v -
目錄….....- vi-
圖目錄.....- ix-
表目錄.....- xii-
第一章 緒論 - 1 -
1.1 研究背景 - 1 -
1.2 腰椎解剖構造 - 2 -
1.3 護理人員下背痛因子 - 6 -
1.4 人體持重搬運腰椎生物力學模式演進 - 7 -
1.4.1 人體持重搬運腰椎二維生物力學模式 - 7 -
1.4.2 人體持重搬運腰椎三維生物力學 - 8 -
1.5 研究動機 - 12 -
1.6 研究目的 - 13 -
第二章 研究方法與步驟 - 14 -
2.1 實驗設備 - 15 -
2.1.1 動作分析系統 - 15 -
2.1.2 力板 - 17 -
2.1.3 肌電圖儀 - 17 -
2.1.4 可調式治療床 - 19 -
2.2 實驗方法流程 - 20 -
2.2.1 受測者資料 - 20 -
2.2.2 實驗探討因子 - 20 -
2.2.3 實驗流程 - 23 -
2.3 三維床邊平移腰椎生物力學外力模式建立 - 25 -
2.3.1 人體平移腰椎負重模形假設 - 25 -
2.3.2 關節中心以及骨盆座標系的建立 - 25 -
2.3.3 肢段質量、長度以及質量中心位置 - 30 -
2.3.4 力板左右腳分力計算 - 32 -
2.3.5 外力系統的計算 - 33 -
2.3.6 軀幹角度計算 - 39 -
2.3.7 力矩最大值決定 - 40 -
2.4三維床邊平移腰椎生物力學內力模式建立 - 43 -
2.4.1 肌電圖資料處理 - 43 -
2.4.2 內力最佳化處理 - 48 -
2.5 統計分析 - 55 -
第三章 研究結果 - 56 -
3.1 腰薦椎關節受力以及力矩值結果分析 - 57 -
3.1.1 有無背痛病史與受測者力矩分析結果 - 58 -
3.1.2 不同搬運方式與受測者受力結果分析 - 60 -
3.1.3 軀幹角度 - 62 -
3.2 肌肉內力分佈 - 64 -
3.2.1 背痛病史有無與肌肉內力分布之影響結果 - 65 -
3.2.2 搬運方式不同對於肌肉內力分布的影響結果 - 68 -
3.3 各組肌肉在進行搬運中的收縮比例 - 72 -
3.3.1 背痛病史有無與各組肌肉收縮比例 - 72 -
3.3.2 不同搬運方式與肌肉收縮比例 - 74 -
第四章 討論 - 76 -
4.1 有無背痛病史與腰薦椎生物力學之影響 - 76 -
4.2 不同搬運方式與腰薦椎生物力學之影響 - 80 -
第五章 結論 - 88 -
第六章 參考資料 - 90 -
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