摘要
背景和目的：粘黏性關節囊炎又名“冰凍肩”，是由於肩關節囊急性或者慢性發炎，其病理變化使得肩膀活動角度受限及活動時產生疼痛。關節鬆動術則以普遍的運用於冰凍肩的物理治療。負荷和位移曲線 (load-displacement curve) 可以客觀描述與評估肩關節在執行關節鬆動術時受力的程度，如關節骨頭的相對位移以及線性勁度(linear stiffness)等相關生物力學特性。過去有很多研究以新鮮大體樣本來取得負荷﹣位移曲線，以探究肩關節的力學特性。但是對於患有冰凍肩的病人在做各個方向的關節鬆動術時肩關節的力學特性的研究是非常少的。因此，本文的目的就是探究患有冰凍肩的病人，在接受前後方向的關節鬆動術時，利用機器人手臂取得負荷位移曲線來探究盂肱關節的力學特性。
材料和方法：本實驗招募13名患有冰凍肩的受試者（平均年齡：58.46±5.36y/o）和16名健康的年齡相同的受試者（平均年齡：55.38±5.71y/o）。在垂直受試者肩胛骨平面的方向上，利用六軸機械手臂模擬盂肱關節前後向關節鬆動術。受試者仰躺在治療床上，手臂分別隨機放在外旋60度，正中姿勢以及內旋60度三個位置時，每個位置重複前後方向關節鬆動術5次，最大力量為7公斤。接下來分析機器人所測得負荷﹣位移曲線上面相應點和區域上的負荷，位移以及線性勁度等參數。運用重複量數二因子混合模型變異數分析( Mixed model 2-way ANOVA with repeated measures), 進一步討論冰凍肩以及關節位置對負荷，位移以及線性勁度的影響。
結果：冰凍肩組其負荷﹣位移曲線在趾區（toe region）和力量在7 公斤時所對應的位移值在外旋以及在內旋位置時小於同齡正常人。冰凍肩組在達到T2點(趾區與線性彈性區之交點)所需的力量顯著小於正常組。在趾區和線性彈性區域內，冰凍肩組的剛性大於於正常組。在冰凍肩組，一直維持外轉相較於內轉的位移量較小，在趾區以及線性彈性區，剛性較大
結論：冰凍肩的病人在接受前後方向的關節鬆動術治療時，在負荷﹣位移曲線上面位移較小，T2點力量較大，在趾區以及線性彈性區剛性較強。這是由於喙肱韌帶和肩袖間隙纖維囊變短變厚導致的。在外旋位置上所得到的位移量小於內旋位置，也說明肩關節在外旋位置時，做前後方向的關節鬆動術喙肱韌帶和肩袖間隙纖維囊為第一線的限制結構而不是一般所認定的後側關節囊。而手臂機器人是精準有信度的儀器，臨床上也可以將其應用在模擬物理治療技術以及客觀評估肩關節的物理特性。

ABSTRACT
Background and purpose: It is well known that patients with adhesive capsulitis suffer from pain and restricted ranges of motion (ROMs) of the glenohumeral joint. Load-displacement curve (LDC) is an objective method to describe the biomechanical properties of glenohumeral joint during mobilization. Most past cadaver studies reported the mechanical properties of the glenohumeral joint. But there are very few reports using quantitative measures to assess patients with adhesive capsulitis in various mobilization techniques applied at the glenohumeral joint. Therefore, the purpose of this study is to investigate the mechanical properties via LDC of the glenohumeral joint during anteroposterior glide mobilization in neutral and rotated positions in patients with adhesive capsulitis and their age-match controls.
Materials and methods: The frozen shoulder group (FG) included 13 subjects (mean age: 58.46±5.36y/o) and 16 aged matched controls (mean age: 55.38±5.71y/o) in control group (CG) participated. A 6-DOF robotic arm was employed to perform anteroposterior glide mobilization on glenohumeral joint of all participants on the greater tubercle of the humerus in a direction perpendicular to the plane of scapula. The participant laid on a firm treatment table and received 5 repetitions of anteroposterior glide mobilization in the following positions of arm rotation in a random order: 60° external rotation (ER), natural position NP, and 60° internal rotation (IR). The peak force applied was 7kg. The relationship between force applied by the robot (load) and response of the tissue (displacement) was established and analyzed. The magnitudes of displacement, force and stiffness of the specific point and region on load-displacement cure were calculated. A two-way mixed model ANOVA with repeated measures was employed to assess main effects (group and position) for displacement, force and stiffness.
Results: There was significant group difference at external rotation position (CG > FG, p<. 001) on Dspl_Toe. Position differences were found FG (NP>ER, t=-6.184, p<0.001, IR>ER, t=-4.953, p<0.001). There were significant group differences were found at ER (CG> FG, p=. 001) and IR (CG > FG, p=. 028) on Dspl_7 kg. There were significant group differences were found at ER (CG < FG, p= .015) and IR (CG < FG, p= .013) on force_Toe. There was significant group differences found at ER (CG < FG, P= .001) on stiff_T13. There were group differences found at ER (CG < FG, P< .001) and IR (CG < FG, P= 0.009). There were significant differences were found at ER (CG < FG, p< .001), NP (CG < FG, p= .032) and IR (CG < FG, P= .006) on stiff_LE.
Conclusion: On the load displacement curve, the magnitudes of displacement at toe region and at 7 kg were smaller in patients with adhesive capsulitis than those of the age matched controls. Patients with adhesive capsulitis have greater force registered at toe region and stiffness at the toe region and the linear elastic region than those of the control group. The magnitudes of displacement collected with the arm positioned in external rotation were smaller than that of internal rotation. Patients with adhesive capsulitis have contracture and thickened coracohumeral ligament and rotator interval capsule. Therefore, physical therapists make arm positioned in external rotation during anteroposterior glide mobilization on the patients with adhesive capsulitis in the future.

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