| 研究生: |
吳國禎 Wu, Kuo-Chen |
|---|---|
| 論文名稱: |
腕隧道症候群患者開關罐動作之手指協調模式 The Digits Coordinated Pattern of the Patient with Carpal Tunnel Syndrome during Jar Opening and Closing |
| 指導教授: |
蘇芳慶
Su, Fong-Chin |
| 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: | 2009 |
| 畢業學年度: | 97 |
| 語文別: | 中文 |
| 論文頁數: | 87 |
| 中文關鍵詞: | 開罐 、腕隧道症候群 、關罐 、手指協調模式 |
| 外文關鍵詞: | carpal tunnel syndrome, jar opening, jar closing, coordinated pattern |
| 相關次數: | 點閱:71 下載:2 |
| 分享至: |
| 查詢本校圖書館目錄 查詢臺灣博碩士論文知識加值系統 勘誤回報 |
腕隧道症候群為正中神經於手腕受到壓迫,就會表現出手部(拇指、食指、中指及橈側之無名指)會有疼痛、灼熱、刺痛或麻木感,嚴重者可看到手掌拇指球肌萎縮及手腕無力,因而影響到手部功能。本研究的主要目地在於研究腕隧道症候群女性患者,右手開、關罐時,各手指力量協調和扭矩貢獻值。此外與常人進行差異分析。
本研究利用自行設計的罐子模擬器(罐子直徑8.0cm,內含有三顆六軸荷重元及一顆扭力計),本實驗分成兩組受測者,腕隧道症候群與正常受測者,各三十六位女性;皆收測右手於開罐和關罐動作時,手指所施的力量和總扭矩,分析出手指的拇指、食指和其他三指,施力點、力量和協調模式。
腕隧道症候群於摩擦係數、抓握力、指捏力、側捏力和總扭力矩均小於正常受測者,在統計上皆有顯著差異,且開關罐總扭力矩比值變小。拇指、食指和其他三指施力點相距角度與正常人相似,食指則具靈活調控地位。
腕隧道症候群受測者於開關罐動作手指力量上,與正常人相比均下降,但其他三指於開關罐動作的差異不大,足顯其他三指於開關罐動作中扮演穩定協助角色。由貢獻度來看,大拇指為主要貢獻者。與正常人相比,腕隧道症候群受測者,主要是正向力貢獻度下降,應與正中神經於手腕受到壓迫有關。而切線力貢獻度未變,應與其主要貢獻者為外部肌群有關。
利用此開關罐模擬器,可以快速、客觀與數位化顯示測量數據,且可以一台測量儀收測多樣數據,確可較全面性手部功能客觀性、快速性評估右手開關罐方式。
Carpal tunnel syndrome is caused by increased pressure on median nerve entering the hand through the confined space of the carpal tunnel at wrist. The most common symptoms are tingling, numbness, weakness, or pain felt in the radial three and one-second fingers. With long-lasting carpal tunnel syndrome (CTS), the thenar muscles can get atrophy and loss some hand strength. The purpose of this study was to investigate the coordination of applied force and the contribution ratio of twisting torque of the right digits in jar opening and closing in female patient with carpal tunnel syndrome. In addition, the difference between patients and normal subjects was analyzed.
There were two female groups, one was CTS group and another was normal group. Each group had thirty-six subjects. Right hand was divided to three parts, thumb & thenar, index finger and others three finger for analysis. Using the simulated jar apparatus (diameter 8.0 cm, equipped with three six-axis load cells and one torque cell) to measure the maximal strength of the thumb at lateral pinch, tip pinch and power grip. All subjects were recruited to measure the total twisting torque. The force amount, coordination and contribution were respectively analyzed.
CTS group was small than normal group in the items of lateral pinch, tip pinch, power grip. The maximal torque generated by CTS group was smaller than normal group in jar opening and closing. But the amount of decrease between CTS and normal group, closing jar was larger than opening jar. The angle between the point of combined force application of the three parts of hand were different between opening jar and closing jar no matter CTS or normal group. But comparing CTS and normal group, only the angle between thumb and index finger had difference no matter opening jar or closing jar. Comparing total force between opening jar and closing jar, only the three fingers part hadn’t difference no matter CTS or normal group. Dividing the total force of thumb to normal, tangential and axial force, only tangential force had difference between opening jar and closing jar. Analyzing the contribution at CTS group, thumb plays the most important role no matter opening jar or closing jar. Comparing with normal group, the contribution of normal force decreased at the three parts of CTS hand. But the contribution of tangential and axial force, only index finger had difference.
CTS patient is difficult to tighten jar than normal subject. From the analysis of the contribution of normal, tangential and axial force, it seems to prove median nerve compressed affects jar opening and closing. Thumb plays the most important role no matter opening jar or closing jar. Index finger plays the important role in finger coordination. The other three fingers part plays the steady role when opening jar or closing jar.
1.Atroshi I, Gummesson C, Johnsson R, Ornstein E, Ranstam J, Rosen I. Prevalence of carpal tunnel syndrome in a general population. JAMA 282 (2): 153-8, 1999.
2.Carus DA, Grant C, Wattie R, Pridham MS. Development and validation of a technique to measure and compare the opening characteristics of tamper-evident bottle closures. Packaging Technology and Science 19 (2): 105-118, 2006.
3.Chang JH, Ho KY, Su FC. Kinetic analysis of the thumb in jar-opening activity among female adults. Ergonomics 51 (6): 843-857, 2008.
4.Crawford JO, Wanibe E, Nayak L. The interaction between lid diameter, height and shape on wrist torque exertion in younger and older adults. Ergonomics 45 (13): 922-933, 2002.
5.de Krom MC, Knipschild PG, Kester AD, Thijs CT, Boekkooi PF, Spaans F. Carpal tunnel syndrome: prevalence in the general population. J Clin Epidemiol 45 (4): 373-6, 1992.
6.Dumont CE, Popovic MR, Keller T, Sheikh R. Dynamic force-sharing in multi-digit task. Clinical Biomechanics 21 (2): 138-146, 2006.
7.Flanagan JR, Burstedt MKO, Johansson RS. Control of fingertip forces in multidigit manipulation. Journal of Neurophysiology 81 (4): 1706-1717, 1999.
8.Fowler NK, Nicol AC. A force transducer to measure individual finger loads during activities of daily living. Journal of Biomechanics 32 (7): 721-725, 1999.
9.Fowler NK, Nicol AC. Functional and biomechanical assessment of the normal and rheumatoid hand. Clinical Biomechanics 16 (8): 660-666, 2001.
10.Fowler NK, Nicol AC. Measurement of external three-dimensional interphalangeal loads applied during activities of daily living. Clinical Biomechanics 14 (9): 646-652, 1999.
11.Geere J, Chester R, Kale S, Jerosch-Herold C. Power grip, pinch grip, manual muscle testing or thenar atrophy - Which should be assessed as a motor outcome after carpal tunnel decompression? A systematic review. Bmc Musculoskeletal Disorders 8: -, 2007.
12.Hsiu-Yun Hsu L-CK, Haw-Yen Chiu, I-Ming Jou, Fong-Chin Su,. Functional sensibility assessment. part II: Effects of sensory improvement on precise pinch force modulation after transverse carpal tunnel release. Journal of Orthopaedic Research , 28 Apr 2009.
13.Kuo LC, Chang JH, Lin CF, Hsu HY, Ho KY, Su FC. Jar-opening challenges. Part 2: estimating the force-generating capacity of thumb muscles in healthy young adults during jar-opening tasks. Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine.Vol. 223, 121-129
14.Landsmeer JM. Power grip and precision handling. Ann Rheum Dis 21: 164-70, 1962.
15.Li ZM. Inter-digit co-ordination and object-digit interaction when holding an object with five digits. Ergonomics 45 (6): 425-440, 2002.
16.Mondelli M, Giannini F, Giacchi M. Carpal tunnel syndrome incidence in a general population. Neurology 58 (2): 289-94, 2002.
17.Murgia A, Kyberd PJ, Chappell PH, Light CM. Marker placement to describe the wrist movements during activities of daily living in cyclical tasks. Clinical Biomechanics 19 (3): 248-254, 2004.
18.Napier JR. The prehensile movements of the human hand. J Bone Joint Surg Br 38-B (4): 902-13, 1956.
19.Nordstrom DL, DeStefano F, Vierkant RA, Layde PM. Incidence of diagnosed carpal tunnel syndrome in a general population. Epidemiology 9 (3): 342-5, 1998.
20.Olafsdottir H, Zatsiorsky VM, Latash ML. Is the thumb a fifth finger? A study of digit interaction during force production tasks. Experimental Brain Research 160 (2): 203-213, 2005.
21.Olafsdottir H, Zhang W, Zatsiorsky VM, Latash ML. Age-related changes in multifinger synergies in accurate moment of force production tasks. Journal of Applied Physiology 102 (4): 1490-1501, 2007.
22.Radhakrishnan S, Nagaravindra M. Analysis of Hand Forces in Health and Disease during Maximum Isometric Grasping of Cylinders. Medical & Biological Engineering & Computing 31 (4): 372-376, 1993.
23.Reale F, Ginanneschi F, Sicurelli F, Mondelli M. Protocol of outcome evaluation for surgical release of carpal tunnel syndrome. Neurosurgery 53 (2): 343-50; discussion 350-1, 2003.
24.Shim JK, Huang JF, Hooke AW, Latsh ML, Zatsiorsky VM. Multi-digit maximum voluntary torque production on a circular object. Ergonomics 50 (5): 660-675, 2007.
25.Shinohara M, Scholz JP, Zatsiorsky VM, Latash ML. Finger interaction during accurate multi-finger force production tasks in young and elderly persons. Experimental Brain Research 156 (3): 282-292, 2004.
26.Su FC, Chiu HY, Chang JH, Lin CF, Hong RF, Kuo LC. Jar-opening challenges. Part 1: an apparatus for assessing hand and finger torques and forces in a jar-opening activity. Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine 223 (1): 121-130, 2009.
27.Yoxall A, Janson R, Bradbury SR, Langley J, Wearn J, Hayes S. Openability: Producing design limits for consumer packaging. Packaging Technology and Science 19 (4): 219-225, 2006.
28.Yoxall A, Luxmoore J, Austin M, Canty L, Margrave KJ, Richardson CJ, Wearn J, Howard IC, Lewis R. Getting to grips with packaging: Using ethnography and computer simulation to understand hand-pack interaction. Packaging Technology and Science 20 (3): 217-229, 2007.
29.Zatsiorsky VM, Gao F, Latash ML. Finger force vectors in multi-finger prehension. Journal of Biomechanics 36 (11): 1745-1749, 2003.
30.何岳昆. 開罐動作之拇指生物力學分析, 國立成功大學, 2004.
31.張勝焜. 開關罐動作之手指協調模式, 國立成功大學, 2008.