皮下疤痕的形成往往對手部創傷後患者的手功能和日常生活活動造成負面影響，因此，針對疤痕的復健是手部創傷後復健療程的核心之一。深入了解疤痕的內在狀態和變化過程可以協助臨床相關人員做出適當的介入決策。但截至目前為止，尚無適用於手部創傷後疤痕的評估工具，且過去研究較少探討疤痕特徵於復健期間的變化以及疤痕的嚴重程度如何影響手功能。超音波檢查可藉由不具侵入性的方式檢測肌肉骨骼組織的狀態，並為臨床人員提供更客觀、直接的證據，但現有超音波儀器在評估手部區域時仍有限制需要克服。因此，本研究的主要目的在於建立一套以超音波為基礎之疤痕評估工具，以了解手部創傷後疤痕的形態及力學特性，並探討疤痕特徵與手功能之間的相關性。本研究分為兩部份。於第一部份的研究中建立一套超音波疤痕評估導引系統（Ultrasonographical scar assessment guiding system, USAGS），系統之效標關聯效度使用包埋塑膠模型之吉利丁仿體，並以塑膠模型深度之量測正確性來檢驗；系統之再測信度則以重複測量30名健康成人的手部軟組織厚度之結果來檢驗。皮爾森相關係數和組內相關係數分別用於檢驗效標關聯效度和再測信度。第二部分將超音波疤痕評估導引系統應用於五位診斷為手部肌腱損傷或骨折之受試者，用以評估其疤痕特徵。本研究所定義之三種疤痕特徵包含壓縮性、血管性及肌腱滑動距離，患側手及健側手皆會評估，並將健側手的數值作為標準化疤痕特徵的依據。此外，受測者之手功能表現使用量角器、握力器、捏力器、力量感測器、普渡插板測驗和上肢功能評估問卷（DASH）來評估。第二部份研究為縱貫性設計，每位受測者於一個月內完成三次評估。弗里德曼檢驗用於檢驗疤痕特徵和手功能表現於三次評估之間是否有所差異。斯皮爾曼等級相關係數用於檢驗疤痕特徵與手功能表現之間的相關性。本研究第一部分的結果顯示新建立之超音波疤痕評估導引系統具有良好效標關聯效度及再測信度。除此之外，亦發現隨著人口學資料如性別及BMI數值的不同，手部軟組織的厚度也會有所不同，指出進行超音波檢查時應同時考慮個體差異對手部軟組織厚度的影響。根據本研究第二部分的結果，發現壓縮性和血管性數值於患側手疤痕及健側手相應區域有所差異，這些結果顯示，相較於未受影響的組織，疤痕呈現較僵硬且有較多血管分布之趨勢。在三次評估中，僅疤痕區域的標準化壓縮性出現增加的趨勢，此一現象可能與恢復過程中疤痕硬度降低有關。此外，在疤痕特徵與手功能的相關性中，僅在疤痕區域之標準化壓縮性和關節活動度中發現顯著的正相關，推測較柔軟的疤痕可能與關節活動度的改善有關。本研究所建立之超音波疤痕評估導引系統具有良好信效度，未來可將此工具擴大應用於量測其他手部相關疾患的組織特性。本研究亦探討手部創傷後疤痕特徵、其變化量與部分手功能表現的相關性，本研究之初步結果將可協助臨床人員以客觀角度了解此族群之疤痕特徵，但未來仍需較大樣本數之相關研究。

Scars in hand injury always interrupt the patient's hand function and their daily activities, and make scar management central to the concept of recovery following hand injury. Knowing the inner status and the evolution of scars can help clinicians to improve their decision making which is relevant to the rehabilitation or intervention. Unfortunately, there is still no appropriate scar assessment for hand injury so far. Ultrasonography can provide clinicians more objective and direct evidence based on non-invasive techniques. Therefore, this study aims to establish an ultrasonography-based scar assessment for comprehending the morphological and mechanical properties of scars in hand injuries, and to explore the correlation between the scar characteristics and hand function. This study is divided into two parts. In the first part, an ultrasonographical scar assessment guiding system (USAGS) was established. The criterion validity was tested by measuring the depths of the targets embedded in a gelatin-based phantom. The test-retest reliability was examined by repeatedly measuring the soft tissue thickness in hands from 30 healthy adults. The Pearson correlation coefficient and intraclass correlation coefficient (ICC) were used to test the criterion validity and test-retest reliability, respectively. In the second part, the USAGS was applied to five traumatic hand injured participants to assess the scar characteristics including compressibility, vascularity, and tendon gliding distance. Clinical hand function measurements were conducted for knowing the functional performance. Each participant received three evaluations within one month due to the longitudinal study design. The Friedman test was used to test the differences of all results at three time-points. The Spearman's rank correlation coefficient was used to test the correlation between scar characteristics and results of hand function measurements. In the first part, the USAGS was found to have good criterion-related validity (> 0.9) and test-retest reliability (ICC > 0.75). Moreover, differences in the soft tissue thickness in hand were found related to gender and body-mass index (BMI). These results indicated that the individual differences of the soft tissue thickness in hand should be considered when conducting ultrasonographic examinations. In the second part, both compressibility and vascularity showed differences between affected and unaffected hands. These results implied that the scar characteristics were different from those unaffected areas. Only the normalized compressibility of the scars showed the increasing tendency among the three evaluations. The increase of the normalized compressibility might attribute to the stiffness of scars decreased during the recovery process. Furthermore, the positive correlation was only found in the normalized compressibility of scars and ranges of motion (ROM) which indicated the softer scars might be related to the improvement of the ROM. The USAGS with good reliability and validity was presumed to have the good stability when doing the ultrasonography examinations at hand regions. This study also explored the changes in the scar characteristics as well as the correlation between scar characteristics and hand function performance. Although future works with larger sample size are still needed, the preliminary findings of this study are supposed to assist clinicians to understand the scar characteristics of this population from an objective perspective.

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