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研究生： 吳昌穆
Wu, Chang-Mu
論文名稱： 運用超音波影像探討腕隧道解離與扳機指之共病性
Investigation of the Comorbidity of Carpal Tunnel Release and Trigger Finger with Ultrasonography
指導教授： 蘇芳慶
Su, Fong-Chin
學位類別： 碩士
Master
系所名稱： 工學院 - 生物醫學工程學系
Department of BioMedical Engineering
論文出版年： 2017
畢業學年度： 105
語文別： 英文
論文頁數： 76
中文關鍵詞： 腕隧道症候群 、腕隧道解離手術 、板機指 、手部大體
外文關鍵詞： carpal tunnel syndrome, carpal tunnel release, trigger finger, cadaver hand
相關次數： 點閱：106  下載：1 
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    • 腕隧道症候群是一種常見的手部疾病。一般用來治療腕隧道症候群的方式為橫腕韌帶解離手術。這種手術是藉由切開橫腕韌帶的手術方式以降低腕隧道內的壓力，來達到治療腕隧道症候群的目的。過去的研究指出病人在接受橫腕韌帶解離手術之後，容易導致板機指疾病的發生。而在橫腕韌帶解離手術之後，中指以及無名指相對容易發生板機指。此篇研究探討在橫腕韌帶解離手術前後，手指的屈指淺肌肌腱是否產生改變，屈指淺肌肌腱會分別觀察在腕隧道內與進入第一屈指腱鞘兩個位置的改變情形。食指、中指、無名指三指分別地改變情形也會在本研究中討論。而兩種不同的橫腕韌帶解離程度也將會被應用在本篇研究中，並且探討是否會有不同的改變情形發生。
    本篇研究使用八具手部大體來模擬病人手部的改變情形，手術方式是使用超音波輔助導影的橫腕韌帶解離手術。屈指淺肌肌腱在腕隧道以及掌指關節兩個地方的改變情形則是使用醫學用超音波影像來觀察。在量測的過程中，超音波探頭的下壓力量被規範在最小的力量值範圍，避免屈指淺肌肌腱在量測過程中被影響。於實驗過程，手指的各個關節動作會使用運動捕捉系統量測。
    藉由超音波影像發現，部分橫腕韌帶解離之後，屈指淺肌肌腱不會有顯著的改變發生。而在橫腕韌帶完全解離之後，屈指淺肌肌腱會往掌側方向移動，進入第一屈指腱鞘時的角度也會增加，而無名指的屈指淺肌肌腱同時也會往尺骨方向移動。
    本篇研究發現，當屈指淺肌肌腱的力量越大，會導致屈指淺肌肌腱往掌側方向移動更多，進入第一屈指腱鞘的角度也會更大。手腕角度彎曲時，屈指淺肌肌腱的改變才會發生。屈指淺肌肌腱往掌側方向的移動與進入第一屈指腱鞘的角度是有相關性的，我們認為進入第一屈指腱鞘的角度改變是因為屈指淺肌肌腱往掌側方向移動造成的。在本篇研究也發現超音波導影輔助的橫腕韌帶解離手術會導致無名指的屈指淺肌肌腱改變量最多。此篇研究的結果顯示在橫腕韌帶部分解離後，不容易造成板機指的發生，而在橫腕韌帶完全解離後，容易造成板機指的發生。同時，研究結果也顯示板機指較不容易發生在食指，無名指則是最有可能發生板機指的手指。

    Carpal tunnel syndrome (CTS) is a common neuropathic disease. The common surgical treatment for CTS is carpal tunnel release (CTR) by dividing the transverse carpal ligament. Previous studies demonstrated that the increased space in the carpal tunnel might increase the volar migration of the flexor tendons after CTR and possibly cause trigger finger. In addition, the most frequently affected trigger finger after CTR was the middle finger, followed by the ring finger. Thus, the purpose of this study was to investigate the changes of the volar-dorsal migration and the ulnar-radial of the flexor tendons in the carpal tunnel and the change of entrance angle of the flexor tendons through the A1 pulley among three release levels. The three release levels of TCL were that: the intact TCL, the partial release of TCL, and the complete release of TCL.
    Eight cadaver specimens were used in the study. The ultrasonographically-guided CTR was applied on each specimen to release the TCL in partial and complete levels. The migration and the entrance angle were captured by the ultrasound. The contact force between skin and the transducer of ultrasound was detected by the loadcell. The finger movements were captured by the motion capture system.
    No significant difference of the migrations and entrance angle of flexor tendons were found in the partial release level of TCL compared to the intact TCL. In the complete release level of TCL, the volar-dorsal migration and the entrance angle did not change at the wrist neutral posture; the increased volar-dorsal migration and the entrance angle were found at the wrist 30° flexion posture. Besides, the ulnar-radial migration was increased in the ring finger at the wrist 30° flexion posture.
    The greater loading applied on the FDS tendon lead to the increased change in both the volar migration and the entrance angle. However, the increased migration and entrance angle were only found with the wrist 30° flexion posture. The complete release level of TCL had the increased volar migration and the entrance angle in each finger. It proved that the risk of developing trigger finger was increased after CTR. The positive correlation between the volar migration and entrance angle indicated that the increased entrance angle might be caused by the increased volar migration after CTR. Besides, the index finger had fewer changes of gliding pattern of FDS tendon than the middle and ring finger. The ring finger had more influences than the index and middle finger because the incision of TCL was close to the ulnar side. Thus, patients undergoing the ultrasonographically-guided CTR should be tracked that whether the ring finger had higher risk of developing trigger finger.

    Abstract I 致謝 V Contents VI List of Table VIII List of Figure IX Chapter 1 Introduction 1 1-1 Background 1 1-2 Anatomy of carpal tunnel and finger flexor pulley system 2 1-3 Carpal tunnel syndrome 4 1-3-1 Carpal tunnel release 5 1-4 Trigger finger 9 1-5 Relationship between the CTR and trigger finger 10 1-6 Techniques for observing tendon migration patterns 11 1-7 Motivation 12 1-8 Purposes & Hypotheses 13 Chapter 2 Materials and Methods 14 2-1 Specimen preparation 14 2-2 Experimental Apparatuses 17 2-2-1 Three-dimensional motion capture system 17 2-2-2 Ultrasound 18 2-2-3 Loadcell 20 2-3 Experimental Setups 22 2-4 Experimental procedure 24 2-5 Data reduction 27 2-5-1 Migration of FDS tendon in carpal tunnel 27 2-5-2 Entrance angle of FDS tendon into A1 pulley 29 2-5-3 Finger movement 30 2-5-4 Compressive force measured by loadcells 32 2-6 Statistical analysis 33 Chapter 3 Results 34 3-1 Migration of FDS tendon in carpal tunnel 34 3-1-1 Volar-dorsal migration 34 3-1-2 Ulnar-radial migration 41 3-2 Entrance angle of FDS tendon into A1 pulley 47 3-3 Joint angle 50 3-4 Correlation between of volar-dorsal migration and entrance angle 54 3-4-1 Wrist neutral posture 54 3-4-2 Wrist 30° flexion posture 56 Chapter 4 Discussions 58 4-1 The gliding pattern of FDS tendon in the intact TCL 58 4-1-1 Migrations in volar-dorsal and ulnar-radial directions 58 4-1-2 Entrance angle 60 4-2 The gliding pattern of FDS tendon in partial release level of TCL 61 4-2-1 Migrations in volar-dorsal and ulnar-radial directions 61 4-2-2 Entrance angle 61 4-3 The gliding pattern of FDS tendon in complete release level of TCL 62 4-3-1 Migrations in volar-dorsal and ulnar-radial directions 62 4-3-2 Entrance angle 66 4-4 Effect of wrist postures on the migration of FDS tendon 67 4-5 Effect of loadings on the migration of FDS tendon 68 4-6 Difference of FDS tendon migration among index, middle, and ring fingers 69 4-7 Relationship between volar-dorsal migration and entrance angle 70 4-8 Limitations 71 Chapter 5 Conclusions 73 References 74

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