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研究生：	陳怡靜 Chen, Yi-Ching
論文名稱：	探討在腕隧道施加外部下壓力對於屈指肌腱之拉弓效應的影響 Effects of External Compressive Force at the Carpal Tunnel on the Bowstringing Effect of the Flexor Tendon
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：	2019
畢業學年度：	107
語文別：	中文
論文頁數：	69
中文關鍵詞：	腕隧道症候群、板機指、拉弓效應、外部下壓力
外文關鍵詞：	carpal tunnel syndrome, trigger finger, bowstringing effect, external compressive force
相關次數：	點閱：108 下載：0
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患有腕隧道症候群之病人會施行腕隧道解離手術將橫腕韌帶切開，以此降低正中神經在腕隧道內所受到的壓迫。然而先前有研究指出橫腕韌帶的解離會使得屈指肌腱產生拉弓(bowstringing)現象，並會導致板機指症狀的發生率增加。為了降低這個現象的發生，本研究希望能藉由在腕隧道上施加外部壓力來抑制屈指肌腱的拉弓效應，並探討不同的外部下壓力對於屈指肌腱的影響。另外，本研究也希望能夠找出能夠有效消除肌腱在解離手術後產生的拉弓效應的外部下壓力，並且此外部下壓力不會對腕隧道內的結構造成二次傷害。
本研究以十五位健康成人以及十三位進行腕隧道解離手術之腕隧道症候群患者為研究對象。健康成人以慣用手之中指作為施測手指，患者則以患側手之中指來進行施測。在施測過程中會在受試者的腕隧道上施加不同的外部下壓力，健康成人分別施加輕觸力(just contact force)、2牛頓、4牛頓、6牛頓和8牛頓力，腕隧道症候群患者的外部下壓力則為輕觸力、4牛頓及8牛頓力。施加外部下壓力的同時也記錄在腕隧道以及掌指關節處屈指肌腱的超音波影像，並利用荷重元調整腕隧道上的外部下壓力及紀錄施測過程中的力值變化。
研究結果顯示屈指肌腱在腕隧道內的位置以及在掌指關節處的進入角度會隨著外部下壓力的增加而減小。這個結果可能代表外部下壓力能夠有效抑制致屈指肌腱在橫腕韌帶解離後的過度位移。比較腕隧道症候群患者在解離手術前及手術後的結果，可以推測出4牛頓和8牛頓的外部下壓力雖然可以有效抑制肌腱的位移，但是可能會導致屈指肌腱和橫腕韌帶之間過多的摩擦力以及腕隧道內壓力的提高，可能會造成二次腕隧道症候群。

Patients with carpal tunnel syndrome (CTS) undergo carpal tunnel release (CTR) surgery to decompress the carpal tunnel pressure in the carpal tunnel by transecting the transverse carpal ligament (TCL). However, previous studies reported that the lack of the TCL causes the bowstringing phenomenon of the flexor tendon and increases the incidence of trigger finger. In the current study, it is considered that applying external compressive force on the carpal tunnel may be able to restrict the bowstringing phenomenon. The purpose of the study is to investigate the effect of different compressive force on the flexor tendon and find out the effective and appropriate force for eliminating the bowstringing effect after CTR surgery.
There were fifteen healthy subjects and ten CTS subjects who underwent ultrasonographically guided percutaneous CTR surgery in the study. Subjects were asked to flex the middle finger while applying different external compressive force on the top of the carpal tunnel. Compressive forces in healthy subjects were just contact, 2N, 4N, 6N, 8N force. CTS subjects were compressed just contact, 4N, and 8N force on the carpal tunnel. Images of the flexor tendon within the carpal tunnel and at the MCP joint were recorded by the ultrasound. Compressive force on the carpal tunnel was detected by the loadcell.
The flexor tendon positions and angles between the flexor tendon and metacarpal bone decrease as external compressive force increases. It may suggest that applying compressive force on the carpal tunnel can restrict excessive movement of the flexor tendon resulting from CTS patients cutting the TCL. Compressing just contact force on healthy and CTS subjects in the pre-surgery has significant differences compared with 4N and 8N in the post-surgery. It may represent that 4N and 8N force results in more normal force on the surface between the flexor tendon and the TCL and will cause greater frictional force and carpal tunnel pressure, which may result in the recurrence of CTS.

中文摘要	I
Abstract	II
致謝	IV
Contents	V
List of Figure	VIII
Chapter 1 Introduction	1
1.	Background	1
1.1.	Anatomy of carpal tunnel	1
1.2.	Anatomy of hand digit	2
1.3.	Carpal tunnel syndrome	4
1.4.	Trigger finger	4
1.5.	Carpal tunnel release	5
1.6.	Relation of trigger finger and carpal tunnel release	7
1.7.	Effect of external force on the carpal tunnel	8
2.	Motivation	8
3.	Hypotheses and purposes	9
Chapter 2 Materials and Methods	10
1.	Subjects	10
2.	Experimental apparatuses	11
2.1.	Ultrasound	11
2.2.	Loadcell	11
2.3.	Custom-designed dynamometer	12
3.	Experimental procedure	13
4.	Parameters	17
4.1.	Part one: The effect on the flexor tendon migration	17
4.1.1.	Tendon position	17
4.1.2.	The height of the carpal tunnel	18
4.1.3.	The normalized tendon position	18
4.1.4.	Volar-dorsal migration	19
4.1.5.	The normalized volar-dorsal migration	19
4.2.	Part two: The effect on the entrance angle of the flexor tendon	19
4.2.1.	Angle between the flexor tendon and metacarpal bone	19
4.2.2.	Change in the entrance angle	21
4.3.	Loadcell force on the carpal tunnel	21
5.	Statistical analysis	22
Chapter 3 Results	23
1.	Healthy subjects with different compressive force on the carpal tunnel	23
1.1.	Tendon position	23
1.2.	Angle between the FDS tendon and metacarpal bone	24
1.3.	Angle between the FDP tendon and metacarpal bone	26
2.	CTS subjects in the pre- and post-surgery with different compressive force on the carpal tunnel	28
2.1.	Tendon position and volar-dorsal migration	28
2.2.	The height of the carpal tunnel	30
2.3.	The normalized tendon position and volar-dorsal migration	30
2.4.	Angle between the FDS tendon and metacarpal bone and change in the entrance angle of FDS tendon	32
2.5.	Angle between the FDP tendon and metacarpal bone and hange in the entrance angle of FDP tendon	34
2.6.	Force measured on the carpal tunnel	36
3.	Healthy subjects and CTS subjects in the post-surgery with different compressive force on the carpal tunnel	38
3.1.	Tendon position and volar-dorsal migration	38
3.2.	The height of the carpal tunnel	40
3.3.	The normalized tendon position and volar-dorsal migration	40
3.4.	Angle between the FDS tendon and metacarpal bone and change in the entrance angle of FDS tendon	42
3.5.	Angle between the FDP tendon and metacarpal bone and change in the entrance angle of FDP tendon	44
3.6.	Force measured on the carpal tunnel	46
Chapter 4 Discussions	48
1.	Healthy subjects with different compressive force	48
1.1.	The effect within the carpal tunnel	48
1.2.	The effect at MCP joint	49
1.3.	The force on the carpal tunnel	49
2.	Comparison of the effect of different compressive force	50
2.1.	Tendon position	51
2.2.	Volar-dorsal migration	52
2.3.	The height of the carpal tunnel	53
2.4.	The normalized tendon position	53
2.5.	The normalized volar-dorsal migration	54
2.6.	Angle between the flexor tendon and metacarpal bone	55
2.7.	Change in the entrance angle of the flexor tendon	56
2.8.	The force on the carpal tunnel	57
3.	Limitations	59
Chapter 5 Conclusion	60
References	61
Appendix I	64
1.	CTS subjects in the pre-surgery with different compressive force on the carpal tunnel	64
1.1.	Tendon position and volar-dorsal migration	64
1.2.	The height of the carpal tunnel	65
1.3.	The normalized tendon position and volar-dorsal migration	66
1.4.	Angle between the FDS tendon and metacarpal bone and change in the entrance angle of FDS tendon	67
1.5.	Angle between the FDP tendon and metacarpal bone and change in the entrance angle of FDP tendon	68
1.6.	Force measured on the carpal tunnel	69
                                    

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校外：2024-09-01公開

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