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研究生：	董玟伶 Tung, Wen-Lin
論文名稱：	扳機指及介入影響之生物力學研究 Biomechanical Analysis of Trigger Digits and the Effects of Intervention
指導教授：	蘇芳慶 Su, Fong-Chin
學位類別：	博士 Doctor
系所名稱：	工學院 - 醫學工程研究所 Institute of Biomedical Engineering
論文出版年：	2010
畢業學年度：	98
語文別：	英文
論文頁數：	90
中文關鍵詞：	扳機指、生物力學、手部、運動學、功能評估、動作分析
外文關鍵詞：	Trigger Digits, Biomechanics, Hand, Kinematics, Functional Outcome, Motion Analysis
相關次數：	點閱：155 下載：4
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隨著現代科技之進步，電腦、手機、攜帶式媒體播放器之使用頻繁，扳機指在臨床上的診斷日益增多。目前並無文獻以生物力學的方法探討扳機指之發生原因、運動學及功能表現、與手術介入前後的評估。本研究目的包括1)以正常手指屍體研究比較大拇指、食指、中指、無名指與小指之第一環狀帶容忍性、2)了解不同損傷等級之扳機指的運動學及功能表現差異、3)以動作分析方法評估超音波影像協助扳機指手術前後的表現。
首先，研究分別針對八個大拇指、食指、中指、無名指與小指正常屍體為樣本，第一環狀帶容忍性以金屬圓椎桿通過第一環狀帶並量測其阻力變化，研究結果發現第一環狀帶容忍性與扳機指好發於無名指並無顯著的關聯性，研究結果不支持假設第一環狀帶之剛性與扳機指的好發有相關性。進一步，針對四十七位扳機指病人，以中文簡易版上肢功能評估問卷以及動作分析方法量測扳機指嚴重程度與其功能表現，研究結果表示扳機指嚴重程度與其功能表現、工作空間、近端手指關節活動度及近端及遠端手指關節之角加速度指數有顯著相關性 (P < 0.05)；最後，再針對二十二位病人以握力器、捏力器、上肢功能評估問卷及動作分析方法評估接受手術介入前後的表現，研究結果表示其工作空間、關節活動度、手部力量和扳機現象，手術後追縱皆有顯著改善的情形 (P < 0.05)。
此研究提供關於扳機指的實證性知識，並使用生物力學方法在臨床應用可以提供對於扳機指之疾病診斷、評估手術治療以及治療活動的成效。

Modern technological devices, such as personal computers, cellular phones and portable media players like iPod have become most popular nowadays. Trigger digits is an increasing disorder seen in clinical practice. To the author’s knowledge, no biomechanical analysis has been performed to study the causes, kinematics and functional performance, and intervention outcomes on trigger digits. The objectives of this study are (1) to compare the A1 pulley compliance among thumbs, index, middle, ring and little fingers by a cadaver study; (2) to investigate the kinematics and functional performance in different graded trigger fingers; and (3) to examine the kinematical and functional outcomes of treated trigger digits after sonographically-assisted percutaneous release using quantitative motion analysis.
First, eight normal thumbs, index, middle, ring and little fingers from eight fresh frozen human hand cadavers were used in this experiment. The compliance of the A1 pulley was measured by the resistance when passing a tapered metal rod through the A1 pulley. The results show that there is no significant relationship between the A1 pulley compliance and the common frequency of trigger fingers on the ring fingers. The findings did not support our clinical hypothesis that A1 pulley stiffness would parallel the relative frequency of trigger finger by digit. Next, the kinematics and functional differences in forty-seven patients with different graded trigger fingers were evaluated by the QuickDASH questionnaire and motion analysis. The results show that the QuickDASH score, workspace, range of motion of proximal interphalangeal joint and an angular acceleration factor of proximal interphalangeal and distal interphalangeal joint of trigger fingers have significant differences among different grades (P < 0.05). These findings quantitatively show that trigger fingers in different impairment levels have different kinematics and functional performances. Finally, twenty-two patients with idiopathic trigger digits who received the surgery were recruited. A dynamometer, a pinch meter, self-report questionnaire assessments, and a motion tracking system were used to measure the kinematical and functional performances before and after surgery. The results show that the workspace, joint range of motion, hand strength, and triggering effect of the involved hand had significant improvement in the follow-up examinations after the surgical intervention (P < 0.05).
The results serve as evidence-based knowledge trigger digits for clinics and the use of the biomechanical approaches to analyze the mechanism of injury would be to facilitate the diagnosis, assessment of the intervention or treatment outcomes for patients with trigger fingers.

中文摘要...............................................	I
Abstract..............................................  III
致謝...................................................	V
Contents...............................................	VI
List of Tables.........................................	IX
List of Figures........................................	X
Chapter 1 Introduction................................. 1
    1.1 Research Background............................	1
    1.2 Significance...................................	5
    1.3 Specific Aims..................................	6
    1.4 Hypothesis.....................................	7
Chapter 2 Literature Review............................	8
    2.1 Roles of Thumb and Fingers in Human Hand 
        Function....................................... 8
    2.2 Trigger Digits.................................	9
        2.2.1 What is Trigger Digit....................	9
        2.2.2 Etiology of Trigger Digits...............	10
        2.2.3 Incidence of Trigger Digits.............. 12
        2.2.4 Signs and Symptoms of Trigger Digits.....	12
        2.2.5 Clinical Approaches for Trigger Digits...	16
    2.3 Applications of Motion Analysis Techniques in Hand  
        Evaluations....................................	20
    2.4 Summary........................................	22
Chapter 3 Methodology..................................	24
    3.1 A1 Pulley Compliance in Thumbs, Index, Middle, 
        Ring and Little Fingers........................	24
        3.1.1 Specimen Preparation.....................	24
        3.1.2 Mechanical Evaluation of A1 Pulley      
              Compliance...............................	25
        3.1.3 Data Analysis............................	29
        3.1.4 Statistical Analysis.....................	30
    3.2 Kinematics and Functional Performance in   
        Different Graded Trigger Fingers...............	31
        3.2.1 Subjects.................................	31
        3.2.2 Instrumentation..........................	33
        3.2.3 Procedure................................	34
        3.2.4 Data Analysis............................	36
        3.2.5 Statistical Analysis.....................	38
    3.3 Kinematical and Functional Improvements of Trigger  
        Digits After Sonographically-Assisted Percutaneous  
        Release of the A1 Pulley.......................	39
        3.3.1 Subjects.................................	39
        3.3.2 Instrumentation..........................	40
        3.3.3 Procedure and Data Analysis..............	41
        3.3.4 Statistical Analysis.....................	45
Chapter 4 Results and Discussion.......................	46
    4.1 A1 Pulley Compliance in Thumbs, Index, Middle, Ring 
        and Little Fingers.............................	46
        4.1.1 Repeated Tapered Rod Tests...............	46
        4.1.2 A1 Pulley Description....................	47
        4.1.3 A1 Pulley Compliance.....................	48
        4.1.4 Discussion...............................	50
    4.2 Kinematics and Functional Performance in Different 
        Graded Trigger Fingers.........................	53
        4.2.1 Kinematics and Functional Performance....	53
        4.2.2 Discussion...............................	56
    4.3 Kinematical and Functional Improvements of Trigger 
        Digits after Sonographically-Assisted Percutaneous  
        Release of the A1 Pulley.......................	60
        4.3.1 Clinical Examinations.................... 60
        4.3.2 Kinematical and Functional Improvements.. 60
        4.3.3 Discussion............................... 65
Chapter 5 Conclusions..................................	69
    5.1 Major Contributions............................	69
    5.2 Future Work....................................	71
References.............................................	73
Appendix A. QuickDASH..................................	84
Brief Personal Introduction............................	86
Publications...........................................	87





                                    

Akalin, E., El, O., Peker, O., Senocak, O., Tamci, S., Gulbahar, S., Cakmur, R., Oncel, S. 2002. Treatment of carpal tunnel syndrome with nerve and tendon gliding exercises. Am. J. Phys. Med. Rehabil. 81, 108-113.
Al-Qattan, M.M. 2007. Trigger fingers requiring simultaneous division of the A1 pulley and the proximal part of the A2 pulley. J. Hand Surg. Eur. Vol. 32, 521-523.
Amadio, P.C. 1997. Outcomes assessment in hand surgery. What's new? Clin. Plast. Surg. 24, 191-194.
Amadio, P.C. 2001. Outcome assessment in hand surgery and hand therapy: an update. J. Hand Ther. 14, 63-67.
Amadio, P.C., Frasca, P., Hunter, J.M. 1982. Histology and scanning electron microscopy of flexor tendons in trigger fingers. Trans. Orthop. Res. Soc. 7, 345.
Bain, G.I., Turnbull, J., Charles, M.N., Roth, J.H., Richards, R.S. 1995. Percutaneous A1 pulley release: a cadaveric study. J. Hand Surg. Am. 20, 781-784; discussion 785-786.
Benson, L.S., Ptaszek, A.J. 1997. Injection versus surgery in the treatment of trigger finger. J. Hand Surg. Am. 22, 138-144.
Blumberg, N., Arbel, R., Dekel, S. 2001. Percutaneous release of trigger digits. J. Hand Surg. Br. 26, 256-257.
Bonnici, A.V., Spencer, J.D. 1988. A survey of 'trigger finger' in adults. J. Hand Surg. Br. 13, 202-203.
Chammas, M., Bousquet, P., Renard, E., Poirier, J.L., Jaffiol, C., Allieu, Y. 1995. Dupuytren's disease, carpal tunnel syndrome, trigger finger, and diabetes mellitus. J. Hand Surg. Am. 20, 109-114.
Chern, T.C., Jou, I.M., Yen, S.H., Lai, K.A., Shao, C.J. 2005. Cadaveric study of sonographically assisted percutaneous release of the A1 pulley. Plast. Reconstr. Surg. 115, 811-822.
Chin, D.H., Jones, N.F. 2002. Repetitive motion hand disorders. J. Calif. Dent. Assoc. 30, 149-160.
Chiu, H.Y. 1995. A method of two-dimensional measurement for evaluating finger motion impairment. A description of the method and comparison with angular measurement. J. Hand Surg. Br. 20, 691-695.
Chiu, H.Y., Lin, S.C., Su, F.C., Wang, S.T., Hsu, H.Y. 2000. The use of the motion analysis system for evaluation of loss of movement in the finger. J. Hand Surg. Br. 25, 195-199.
Chiu, H.Y., Su, F.C. 1996. The motion analysis system and the maximal area of fingertip motion. A preliminary report. J. Hand Surg. Br. 21, 604-608.
Chiu, H.Y., Su, F.C., Wang, S.T. 1998a. The motion analysis system and the fingertip motion area. Normal values in young adults. J. Hand Surg. Br. 23, 53-56.
Chiu, H.Y., Su, F.C., Wang, S.T., Hsu, H.Y. 1998b. The motion analysis system and goniometry of the finger joints. J. Hand Surg. Br. 23, 788-791.
Drossos, K., Remmelink, M., Nagy, N., de Maertelaer, V., Pasteels, J.L., Schuind, F. 2009. Correlations between clinical presentations of adult trigger digits and histologic aspects of the A1 pulley. J. Hand Surg. Am. 34, 1429-1435.
Eastwood, D.M., Gupta, K.J., Johnson, D.P. 1992. Percutaneous release of the trigger finger: an office procedure. J. Hand Surg. Am. 17, 114-117.
Fahey, J.J., Bollinger, J.A. 1954. Trigger-finger in adults and children. J. Bone Joint Surg. Am. 36-A, 1200-1218.
Fess, E.E., Moran, C.A. 1981. Clinical Assessment Recommendations. In: American Society of Hand Therapists.
Finsen, V., Hagen, S. 2003. Surgery for trigger finger. Hand Surg. 8, 201-203.
Freiberg, A., Mulholland, R.S., Levine, R. 1989. Nonoperative treatment of trigger fingers and thumbs. J. Hand Surg. Am. 14, 553-558.
Froimson, A.I. 1999. Tenosynovitis and tennis elbow, in: Green, D.P., Hotchkiss R.N., Pederson W.C., (Eds.), Green's operative hand surgery, Elsevier/Churchill Livingstone, Philadelphia, pp. 1989-1991.
Fu, Y.C., Huang, P.J., Tien, Y.C., Lu, Y.M., Fu, H.H., Lin, G.T. 2006. Revision of incompletely released trigger fingers by percutaneous release: results and complications. J. Hand Surg. Am. 31, 1288-1291.
Gilberts, E.C., Beekman, W.H., Stevens, H.J., Wereldsma, J.C. 2001. Prospective randomized trial of open versus percutaneous surgery for trigger digits. J. Hand Surg. Am. 26, 497-500.
Gilberts, E.C., Wereldsma, J.C. 2002. Long-term results of percutaneous and open surgery for trigger fingers and thumbs. Int. Surg. 87, 48-52.
Griggs, S.M., Weiss, A.P., Lane, L.B., Schwenker, C., Akelman, E., Sachar, K. 1995. Treatment of trigger finger in patients with diabetes mellitus. J. Hand Surg. Am. 20, 787-789.
Guerini, H., Pessis, E., Theumann, N., Le Quintrec, J.S., Campagna, R., Chevrot, A., Feydy, A., Drape, J.L. 2008. Sonographic appearance of trigger fingers. J. Ultrasound Med. 27, 1407-1413.
Ha, K.I., Park, M.J., Ha, C.W. 2001. Percutaneous release of trigger digits: A Technique and Results Using a Specially Designed Knife. J. Bone Joint Surg. Br. 83, 75-77.
Hauger, O., Chung, C.B., Lektrakul, N., Botte, M.J., Trudell, D., Boutin, R.D., Resnick, D. 2000. Pulley system in the fingers: normal anatomy and simulated lesions in cadavers at MR imaging, CT, and US with and without contrast material distention of the tendon sheath. Radiology 217, 201-212.
Heithoff, S.J., Millender, L.H., Helman, J. 1988. Bowstringing as a complication of trigger finger release. J. Hand Surg. Am. 13, 567-570.
Hudak, P.L., Amadio, P.C., Bombardier, C. 1996. Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand) [corrected]. The Upper Extremity Collaborative Group (UECG). Am. J. Ind. Med. 29, 602-608.
Jongjirasiri, Y. 2009. Length and landmark of A1 pulley in hand: an anatomical study. J. Med. Assoc. Thai. 92, 41-46.
Jou, I.M., Chern, T.C. 2006. Sonographically assisted percutaneous release of the a1 pulley: a new surgical technique for treating trigger digit. J. Hand Surg. Br. 31, 191-199.
Kazuki, K., Egi, T., Okada, M., Takaoka, K. 2006. Clinical outcome of extrasynovial steroid injection for trigger finger. Hand Surg. 11, 1-4.
Kumar, P., Chakrabarti, I. 2009. Idiopathic carpal tunnel syndrome and trigger finger: is there an association? J. Hand Surg. Eur. Vol. 34, 58-59.
Kuo, L.C., Cooney, W.P., 3rd, Kaufman, K.R., Chen, Q.S., Su, F.C., An, K.N. 2004. A quantitative method to measure maximal workspace of the trapeziometacarpal joint--normal model development. J. Orthop. Res. 22, 600-606.
Kuo, L.C., Su, F.C., Chiu, H.Y., Yu, C.Y. 2002. Feasibility of using a video-based motion analysis system for measuring thumb kinematics. J. Biomech. 35, 1499-1506.
Lapidus, P.W., Guidotti, F.P. 1972. Stenosing tenovaginitis of the wrist and fingers. Clin. Orthop. Relat. Res. 83, 87-90.
Li, Z.M., Tang, J. 2007. Coordination of thumb joints during opposition. J. Biomech. 40, 502-510.
Liang, H.W., Wang, H.K., Yao, G., Horng, Y.S., Hou, S.M. 2004. Psychometric Evaluation of the Taiwan Version of the Disability of the Arm, Shoulder, and Hand (Dash) Questionnaire. J. Formos. Med. Assoc. 103, 773-779.
Lifchez, S.D., Marchant-Hanson, J., Matloub, H.S., Sanger, J.R., Dzwierzynski, W.W., Nguyen, H.H. 2005. Functional improvement with digital prosthesis use after multiple digit amputations. J. Hand Surg. Am. 30, 790-794.
Lim, M.H., Lim, K.K., Rasheed, M.Z., Narayanan, S., Beng-Hoi Tan, A. 2007. Outcome of open trigger digit release. J. Hand Surg. Br. 32, 457-459.
Lin, G.T., Cooney, W.P., Amadio, P.C., An, K.N., Lin, G.T., Cooney, W.P., Amadio, P.C., An, K.N. 1990. Mechanical properties of human pulleys. J. Hand Surg. Br. 15, 429-434.
Lorthioir, J., Jr. 1958. Surgical treatment of trigger-finger by a subcutaneous method. J. Bone Joint Surg. Am. 40-A, 793-795.
Makkouk, A.H., Oetgen, M.E., Swigart, C.R., Dodds, S.D. 2008. Trigger finger: etiology, evaluation, and treatment. Curr. Rev. Musculoskelet. Med. 1, 92-96.
Maneerit, J., Sriworakun, C., Budhraja, N., Nagavajara, P. 2003. Trigger thumb: results of a prospective randomised study of percutaneous release with steroid injection versus steroid injection alone. J. Hand Surg. Br. 28, 586-589.
Moore, J.S. 2000. Flexor tendon entrapment of the digits (trigger finger and trigger thumb). J. Occup. Environ. Med. 42, 526-545.
Moore, J.S., Garg, A. 1994. Upper extremity disorders in a pork processing plant: relationships between job risk factors and morbidity. Am. Ind. Hyg. Assoc. J. 55, 703-715.
Moriya, K., Uchiyama, T., Kawaji, Y. 2005. Comparison of the surgical outcomes for trigger finger and trigger thumb: preliminary results. Hand Surg. 10, 83-86.
Murphy, D., Failla, J.M., Koniuch, M.P. 1995. Steroid versus placebo injection for trigger finger. J. Hand Surg. Am. 20, 628-631.
Newport, M.L., Lane, L.B., Stuchin, S.A. 1990. Treatment of trigger finger by steroid injection. J. Hand Surg. Am. 15, 748-750.
Nimigan, A.S., Ross, D.C., Gan, B.S. 2006. Steroid injections in the management of trigger fingers. Am. J. Phys. Med. Rehabil. 85, 36-43.
Park, M.J., Oh, I., Ha, K.I. 2004. A1 pulley release of locked trigger digit by percutaneous technique. J. Hand Surg. Br. 29, 502-505.
Patel, M.R., Bassini, L. 1992. Trigger fingers and thumb: when to splint, inject, or operate. J. Hand Surg. Am. 17, 110-113.
Patel, M.R., Moradia, V.J. 1997. Percutaneous release of trigger digit with and without cortisone injection. J. Hand Surg. Am. 22, 150-155.
Pope, D.F., Wolfe, S.W. 1995. Safety and efficacy of percutaneous trigger finger release. J. Hand Surg. Am. 20, 280-283.
Quinnell, R.C. 1980. Conservative management of trigger finger. Practitioner 224, 187-190.
Ryzewicz, M., Wolf, J.M. 2006. Trigger digits: principles, management, and complications. J. Hand Surg. Am. 31, 135-146.
Saldana, M.J. 2001. Trigger digits: diagnosis and treatment. J. Am. Acad. Orthop. Surg. 9, 246-252.
Sampson, S.P., Badalamente, M.A., Hurst, L.C., Seidman, J. 1991. Pathobiology of the human A1 pulley in trigger finger. J. Hand Surg. Am. 16, 714-721.
Sbernardori, M.C., Bandiera, P. 2007. Histopathology of the A1 pulley in adult trigger fingers. J. Hand Surg. Eur. Vol. 32, 556-559.
Sbernardori, M.C., Mazzarello, V., Tranquilli-Leali, P. 2007. Scanning electron microscopic findings of the gliding surface of the A1 pulley in trigger fingers and thumbs. J. Hand Surg. Eur. Vol. 32, 384-387.
Serafini, G., Derchi, L.E., Quadri, P., Martinoli, C., Orio, O., Cavallo, A., Gandolfo, N. 1996. High resolution sonography of the flexor tendons in trigger fingers. J. Ultrasound Med. 15, 213-219.
Sha, C.J., Jou, I. M. 2004. Percutaneous A1 pulley release for trigger digit: two year's experience with the sonographically assisted percutaneous release technique. J. Orthop. Surg. Taiwan 21, 112-118.
Stahl, S., Kanter, Y., Karnielli, E. 1997. Outcome of trigger finger treatment in diabetes. J. Diabetes Complicat. 11, 287-290.
Strom, L. 1977. Trigger finger in diabetes. J. Med. Soc. N. J. 74, 951-954.
Su, F.C., Kuo, L.C., Chiu, H.Y., Chen-Sea, M.J. 2003. Video-computer quantitative evaluation of thumb function using workspace of the thumb. J. Biomech. 36, 937-942.
Su, F.C., Kuo, L.C., Chiu, H.Y., Hsu, H.Y. 2002. The validity of using a video-based motion analysis system for measuring maximal area of fingertip motion and angular variation. Proc. Inst. Mech. Eng. H. 216, 257-263.
Tallia, A.F., Cardone, D.A. 2003. Diagnostic and therapeutic injection of the wrist and hand region. Am. Fam. Physician 67, 745-750.
Tanaka, T., Amadio, P.C., Zhao, C., Zobitz, M.E., An, K.N. 2003. Gliding resistance versus work of flexion--two methods to assess flexor tendon repair. J. Orthop. Res. 21, 813-818.
Taras, J.S., Raphael, J.S., Pan, W.T., Movagharnia, F., Sotereanos, D.G. 1998. Corticosteroid injections for trigger digits: is intrasheath injection necessary? J. Hand Surg. Am. 23, 717-722.
Thorpe, A.P. 1988. Results of surgery for trigger finger. J. Hand Surg. Br. 13, 199-201.
Turowski, G.A., Zdankiewicz, P.D., Thomson, J.G. 1997. The results of surgical treatment of trigger finger. J. Hand Surg. Am. 22, 145-149.
Verdon, M.E. 1996. Overuse syndromes of the hand and wrist. Prim. Care 23, 305-319.
Wehbe, M.A., Hunter, J.M. 1985a. Flexor tendon gliding in the hand. Part I. In vivo excursions. J. Hand Surg. Am. 10, 570-574.
Wehbe, M.A., Hunter, J.M. 1985b. Flexor tendon gliding in the hand. Part II. Differential gliding. J. Hand Surg. Am. 10, 575-579.
Weilby, A. 1970. Trigger finger. Incidence in children and adults and the possibility of a predisposition in certain age groups. Acta. Orthop. Scand. 41, 419-427.
Wilhelmi, B.J., Mowlavi, A., Neumeister, M.W., Bueno, R., Lee, W.P. 2003. Safe treatment of trigger finger with longitudinal and transverse landmarks: an anatomic study of the border fingers for percutaneous release. Plast. Reconstr. Surg. 112, 993-999.
Wilhelmi, B.J., Snyder, N.t., Verbesey, J.E., Ganchi, P.A., Lee, W.P. 2001. Trigger finger release with hand surface landmark ratios: an anatomic and clinical study. Plast. Reconstr. Surg. 108, 908-915.
Zhao, C., Amadio, P.C., Zobitz, M.E., An, K.N. 2001. Gliding characteristics of tendon repair in canine flexor digitorum profundus tendons. J. Orthop. Res. 19, 580-586.

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