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系統識別號 U0026-2308201016021500
論文名稱(中文) 內側楔型足墊對髕股退化性關節炎患者下肢髕股關節排列及關節受力之影響
論文名稱(英文) The influences of medially wedged insoles on the alignment and kinetics of the patellofemoral joint in individuals with patellofemoral joint osteoarthritis
校院名稱 成功大學
系所名稱(中) 物理治療研究所
系所名稱(英) Department of Physical Therapy
學年度 98
學期 2
出版年 99
研究生(中文) 李宜蓉
研究生(英文) I-Jung Lee
學號 t6697101
學位類別 碩士
語文別 英文
論文頁數 81頁
口試委員 指導教授-林呈鳳
口試委員-徐阿田
口試委員-楊俊佑
口試委員-王建國
中文關鍵字 髕股關節壓力  下樓梯  坐到站  足部輔具  股四頭肌肉活性 
英文關鍵字 Patellofemoral joint stress  stair descent  sit-to-stand  foot orthotics  quadriceps activity 
學科別分類
中文摘要 背景與目的:隨著高齡化,膝關節退化性關節炎是目前造成嚴重疼痛及失能很常見的慢性關節問題之一,其中研究發現有膝疼痛症狀之患者中其實大多數在髕股關節有退化表徵。目前臨床上對於髕股關節退化炎尚未有治癒的方法,疾病末期通常以關節置換手術為主,但對於高齡族群手術過程和術後復健及併發症亦是一沉重的負擔,目前臨床上建議在關節炎初期治療以非藥物方法進行較佳。故本研究主要目的為針對髕股退化性關節炎患者使用內側楔型鞋墊前後,對於髕股骨關節排列症狀、關節受力及症狀的影響為何。方法: 大於50歲的13位髕股退化性關節炎患者及12位無膝疼痛症狀受試者參與本實驗,所有的受試者須接受走路、坐到站、下樓梯三種功能性活動測試,其中髕股退化性關節炎患者須在穿著內側楔型鞋墊後,再重複同樣三種功能性活動測試。結果: 穿著內側楔型足墊可立即且明顯地減少髕股退化性關節炎患者髕骨外移及向外脫臼現象;執行下樓梯時,穿著鞋內墊可使髕股關節受力下降和疼痛程度下降,改善股外與股內肌不平衡之現象;此外執行坐到站時疼痛程度明顯下降,並且同時降低股外側肌活性及髕股關節壓力;而執行走路任務,會降低股外與股內肌不平衡之現象。結論: 內側楔型足墊可以改善髕骨排列和股外、股內肌不平衡之現象,也能降低髕股關節的受力及壓力,以上所敘現象可能和患者在從事功能性活動時的立即疼痛下降有關,而穿著鞋墊的效果程度可能和從事的任務難度有關係。
英文摘要 Abstract
Background and purpose: Knee osteoarthritis (OA) has become the major cause of chronic pain and disability among men and women. Previous studies primarily focused on tibiofemoral (TF) OA due to the extensive use of anterior-posterior X-rays. In fact, the patellofemoral (PF) joint is one of the most involved compartments among the knee joint compartments. So far, there is no conclusive intervention for the condition and the treatment for the end course of the disease is joint replacement surgery. However, the symptoms may relapse if the underlying abnormal mechanism leaves uncorrected and the excessive loading on the PF joint still exits. The current clinical guidelines recommend the use of non-pharmacologic strategies as the first line management of OA symptoms. Therefore, the purpose of this study is to determine the effects of the medially wedged insoles for improving the symptoms, PF joint alignment and mechanics in the individuals with PF OA. Methods: 13 subjects with predominant PF OA and 12 subjects without knee pain participated in this study. All subjects were asked to perform three functional activities including walking, sit-to-stand, and stair descent in both pre and post-insole conditions. Further, the OA group received a 4-week insole intervention after completing the data collection. Results: The subjects with PF OA showed the patellar medial glide change and the decreased patella subluxation after the insole application. In addition, the pain level, PF joint reaction force significantly decreased in post-insole condition compared to pre-insole condition during sit-to-standand stair-descent, but not during walking. VMO to VL ratio significantly increased during walking and stair descent. Conclusions: The medially wedged insoles could improve the PF joint alignment and imbalance between VMO and VL muscles, and decreased the PF joint force and stress. These might associated with the decreased pain level in the individuals with predominant PF OA during the functional activities. The extent of these effects might depend on the difficulties of the tasks.
論文目次 摘要 I
ABSTRACT II
誌謝 III
CONTENTS IV
LIST OF TABLES VII
LIST OF FIGURES VIII
CHAPTER 1. INTRODUCTION 1
1.1 BACKGROUND 1
1.2 THE MECHANISMS OF PATELLOFEMORAL OSTEOARTHRITIS 2
1.2.1 Patellofemoral joint reaction force 2
1.2.2 Patellofemoral joint contact area 3
1.3 ELECTROMYOGRAPHIC ACTIVITY OF THE QUADRICEPS 4
1.4 HIGH FLEXION ACTIVITIES 5
1.5 CLINICAL PRESENTATION OF PATELLOFEMORAL OSTEOARTHRITIS 6
1.6 IMAGING EXAMINATION 6
1.7 THE MANAGEMENTS OF KNEE JOINT OSTEOARTHRITIS 9
1.8 THE PURPOSE 11
1.9 HYPOTHESES 11
CHAPTER 2. METHODS 13
2.1 SUBJECTS 13
2.2 EQUIPMENTS 14
2.2.1 Marker sets 14
2.2.2 Electromyographic recordings 15
2.2.3 Stair apparatus 15
2.2.4 Imaging instruments 16
2.2.5 Medially wedged insoles 16
2.3 EXPERIMENTAL PROCEDURES 16
2.3.1 MRI and radiographic examination 17
2.3.2 Data collection 18
2.3.3 Tasks 19
2.3.4 The insole intervention protocol 20
2.3.5 The follow-up procedure 20
2.4 DATA ANALYSIS 21
2.4.1 Electromyographic activity and onset timing difference of quadriceps muscles 21
2.4.2 Alignment of the patellofemoral joint 21
2.4.3 Kinetics and kinetics of the knee joint and the ankle joint 23
2.4.4 Patellofemoral joint contact area 24
2.4.5 Patellofemoral joint kinetics 24
2.4.6 Movement velocity and movement time 26
2.5 STATISTIC ANALYSIS 26
CHAPTER 3. RESULTS 28
3.1 INTERTESTER RELIABILITY 28
3.2 MOVEMENT VELOCITY AND MOVEMENT TIME 28
3.3 LOWER EXTREMITY ASSESSMENT 29
3.4 PAIN AND PHYSICAL FUNCTION 30
3.5 IMAGING EXAMINATION 31
3.5.1 Alignment of the patellofemoral joint 31
3.5.2 Patellofemoral joint contact area 31
3.6 PEAK JOINT ANGLE 38
3.6.1 Knee joint angle 38
3.6.2 Ankle joint angle 39
3.7 PEAK GROUND REACTION FORCE 40
3.8 PEAK KNEE JOINT MOMENT 41
3.8.1 The peak flexion moment 41
3.8.2 The peak adduction moment 42
3.9 PEAK PATELLOFEMORAL JOINT REACTION FORCE 43
3.10 PEAK PATELLOFEMORAL JOINT STRESS 46
3.11 ELECTROMYOGRAPHIC INTENSITY OF QUADRICEPS ACTIVATION 52
CHAPTER 4. DISCUSSION 55
4.1 THE INFLUENCES OF THE MUSCLE STRENGTH AND THE FLEXIBILITY ON THE PATELLOFEMORAL JOINT 55
4.2 PAIN LEVEL AND PHYSICAL FUNCTION 57
4.3 PATELLOFEMORAL JOINT ALIGNMENT 57
4.4 PATELLOFEMORAL JOINT CONTACT AREA 58
4.5 PEAK KNEE JOINT ANGLE 61
4.6 PEAK GROUND REACTION FORCE 63
4.7 PEAK KNEE JOINT MOMENT 64
4.8 PEAK PATELLOFEMORAL JOINT REACTION FORCE AND STRESS 66
4.9 ELECTROMYOGRAPHIC INTENSITY OF QUADRICEPS ACTIVATION 68
4.10 ONSET TIMING DIFFERENCE BETWEEN VMO AND VL 69
4.11 LIMITATION 71
4.12 CLINICAL RELEVANCE 72
CHAPTER 5. CONCLUSION 73
REFERENCES 74
APPENDIX 78

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