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研究生： 石旭生
Shi, Shiuh-Sheng
論文名稱： 膝下截肢患者在不同走路速度與穿戴不同義足下之界面壓力與步態分析
Interface Pressure and Gait Analysis in different walking speeds and Prosthetic Feet on the Below-Knee Amputees with a Prosthesis
指導教授： 周有禮
Chou, You-Li
學位類別： 碩士
Master
系所名稱： 工學院 - 醫學工程研究所
Institute of Biomedical Engineering
論文出版年： 2003
畢業學年度： 91
語文別： 中文
論文頁數： 87
中文關鍵詞： 膝下截肢 、界面壓力 、義肢 、走路速度
外文關鍵詞： Interface stresses, transtibial amputation, prosthesis, walking speed
相關次數： 點閱：122  下載：3 
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    • 對於膝下截肢的患者，承套是為義肢與人體殘肢接觸的部分，並且是負責義肢在人體下肢荷重時的穩定支撐。因此，殘肢與承套間的界面壓力就顯得非常重要，若設計不良就會導致殘肢受力不均 ，易造成穿戴的併發症，如：水泡、紅腫、潰瘍。感染等。 輕者造成暫時無法穿戴義肢，造成日常生活不便，重者會因疼痛而產生代償動作，最後甚至需要再截肢。
    由於下肢的義肢主要是用來移動身體達到日常生活方便，所以走路時殘肢所承受的壓力與力量就非常重要。這跟靜態站立時殘肢所受的壓力與力量是完全不同的。本研究設計三種步頻(85 95 115 步/分)以控制速度，同時穿上不同義足，進行實驗，發現在步態分析部分，除了傳統義足的踝關節外，其他關節的活動角度與最大力矩皆隨著速度的加快而變大。在殘肢所受的最大力量與最大壓力部分，傳統義足隨著速度的加快而增大，而多軸義足則沒有太大的變化。力量對時間積分方面，慢速組中，三種義足並無太大不同 ，但在快速組中傳統義足就比另外兩種義足來的大，這些資料將可客觀的提供臨床義肢裝具師一個標準，同時也可作為不同族群的膝下截肢病患在選配義肢時的參考。

    Interface stresses are an important consideration in stump and socket for a prosthetic limb to a person with transtibial amputation. At the stance phase of the gait cycle, the prosthetic socket is expected to support and distribute the entire weight of the patient with an amputated limb. If the stresses are too large between stump and socket, it will induce pain, discomfort and breakdown. In severe case, no prosthesis use is possible, and surgical repair of the residual limb is necessary. The objectives of this study are to analysis gait, the maximum force and pressure between stump and socket during different walking speed.
    Using the motion analysis system investigated kinematics and kinetics of the gait and the Pedar system were used to investigate the maximum force and pressure between stump and socket during different walking speed.
    There are 15 male subjects with transtibial amputation participated in this research. Subjects were asked to walk in three different speeds (85 steps/min, 95 steps/min, 115 steps/min ). The maximum force, maximum pressure and force-time integrals in head of fibula, patellar ligament, medial condyle of tibia, tibial end and fibular end were measured at the same time.
    As the walking speed increased, the range of motion and the moment in hip knee and ankle will increased for all kinds of foot except for SACH foot in ankle. With the walking speed increased, the maximum force and pressure in those measured areas were increased significantly in SACH foot but no significant change in multiple axis foot. In slow walk speed, the force-time integrals were no significant difference for all kinds of feet, but in fast walking speed, the integral value of SACH foot was much more than single and multiple axis foot.
    Walking speed will influence the maximum force and pressure in SACH foot. Multiple axis foot is the most comfortable in various walking speed. The study provided an objective and subjective data for prosthetist or physician’s prescription for amputees.

    目錄 摘要(中)..................................................I 摘要(英).................................................II 誌謝....................................................III 目錄.....................................................IV 表目錄..................................................VII 圖目錄..................................................VIII 第一章 緒論...............................................1 1.1截肢.............................................1 1.2義肢.............................................2 1.3研究動機與目的...................................5 1.4實驗假說.........................................8 第二章 文獻回顧...........................................9 2.1.1步態分析之簡介.................................9 2.1.2地面反作用力..................................16 2.1.3步態參數的定義................................18 2.1.4膝下截肢患者之步態分析........................19 2.2. 膝下截肢患者之承套與殘肢間的介面應力分析回顧..19 第三章 理論基礎..........................................24 3.1實驗假設........................................24 3.2動力學分析......................................24 3.2.1動力學計算流程................................25 3.2.2肢段作用力....................................26 3.2.3肢段作用力矩..................................28 3.3.1運動學分析....................................30 3.3.2關節中心的計算................................31 3.3.3座標系定義....................................35 3.3.4關節夾角-尤拉角的計算.........................37 3.3.5角速度和角加速度..............................40 3.3.6實驗室座標系和測力板座標系....................43 3.3.7實驗系統及原理................................48 3.4 Pedar 部分.....................................49 第四章 材料與方法........................................50 4.1實驗對象........................................50 4.2實驗設備........................................51 4.2.1硬體設備......................................51 4.2.2分析軟體......................................53 4.3實驗步驟........................................55 4.4 資料分析與處理.................................58 第五章 結果與討論........................................60 5.1.1時間與空間參數變化...........................60 5.1.2 運動學的特徵................................62 5.1.3動力學的特徵.................................65 5.2.1 三種不同走路速度下之最大力量(Max Force) 與最大壓力(Max Pressure).....................67 5.2.2 力量-時間積分...............................73 5.3 問卷結果......................................77 第六章 結論..............................................79 參考文獻.................................................82 附錄A 人體計測資料.......................................85 附錄B 實驗問卷...........................................86

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