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研究生： 李濬宇
Li, Chun-Yu
論文名稱： 硫酸鈣植入大鼠脛骨平台軟骨/骨軟骨缺損後之步態分析
Gait analysis of rats implanted with calcium sulfate in tibial plateau cartilage/osteochondral defects
指導教授： 朱建平
Ju, Chien-Ping
陳瑾惠
Chern Lin, Jiin-Huey
學位類別： 碩士
Master
系所名稱： 工學院 - 材料科學及工程學系
Department of Materials Science and Engineering
論文出版年： 2021
畢業學年度： 109
語文別： 中文
論文頁數： 84
中文關鍵詞： 硫酸鈣 、步態分析 、軟骨修復 、功能性評估
外文關鍵詞： calcium sulfate, gait analysis, cartilage repair , functional evaluation
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    • 現行軟骨的修復評估方式中大多數缺乏功能性的評估。即便在組織病理學上得到了良好的軟骨修復效果，實際生成的軟骨也沒辦法像天然形成的軟骨一樣具有降低關節磨損、提供緩衝的效果，導致後續出現功能性喪失的問題出現。有鑑於此，軟骨修復後的功能性評估顯得相當重要，然而目前軟骨修復的相關研究中幾乎沒有有效的模型可以判斷功能性的修復效果，也沒有完善的動物模型研究用於軟骨修復狀態的評估。因此本實驗的重點即為建立大鼠的軟骨/骨軟骨修復模型，並以動態負重(dynamic weight bearing)這項力學參數作為修復效果的判斷依據。本實驗的材料是由喜樂醫材提供的新型硫酸鈣，步態分析系統則是由成大職能治療系提供，是成大職能治療系教授郭立杰老師的團隊所開發，透過該系統搭載的測力板清楚地紀錄大鼠移動時的動態負重，能有效反映軟骨修復過程中的行走功能恢復狀況。軟骨受損模式暨新型硫酸鈣植入的部位為脛骨平台，因為此區域的軟骨在臨床骨科學退化性關節炎中是最常見的受損區域之一。
    經由植入後持續15周的步態分析結果發現，植入材料的實驗組在功能性的恢復上明顯優於純鑽孔的對照組。可見硫酸鈣的確具備優良的功能性修復效果，步態分析的動態負重結果也能很明確的反映功能性的變化，在軟骨修復的領域中以步態模型作為功能性評估的方式是極具潛力的，待日後將大鼠模型樣本數擴大可望建立較為完整的大鼠軟骨/骨軟骨功能性修復評估模型。

    關鍵字:硫酸鈣、步態分析、軟骨修復、功能性評估

    Most of the current cartilage repair evaluation methods lack functional evaluation. Even in some cases, where new cartilage was successfully generated, they can't reduce cartilage wear and provide as good cushion as naturally formed cartilage. In view of this, the functional evaluation after cartilage repair is an integral part. However, there are few effective animal models of gait analysis in the current researches that discussed about functional evaluation after cartilage repair. Therefore, the focus of this research is to establish a rat cartilage/osteochondral repair model for dynamic gait analysis.
    The material for this research is a new type of calcium sulfate provided by Joy Medical Devices Co.,and the gait analysis system is provided by department of Occupational Therapy, National Cheng Kung University. Customized gait analysis system can precisely record dynamic weight bearing of the rat while walking through the force pates. The surgical implantation site is at the medial tibial plateau, where cartilage in area bears the main vertical force during walking. Therefore, it’s the most suitable for functional evaluation to drill holes, which can reflect the rat gait accurately.
    According to the rats in results of continuous gait analysis within 15 weeks after implantation, rats in the implant group performs significantly better than those in the control group with pure drilling. Calcium sulfate does have an excellent functional recovery effect. The results of the gait continuous mechanical analysis can also clearly reflect functional changes of rats, proving that gait analysis has great potential for functional evaluation of cartilage repair.

    Key words: calcium sulfate,gait analysis,cartilage repair,functional evaluation

    中文摘要 I 誌謝 VI 目錄 VIII 圖目錄 XII 第一章 緒論 1 1-1 研究動機 1 1-2 軟骨修復功能性評估的重要性 2 第二章 理論基礎及文獻回顧 4 2-1 步態分析 4 2-1-1 步態分析簡介 4 2-1-2 步態分析中的大鼠模型 8 2-1-3 步態分析的動力學參數 10 2-1-4 步態分析的時、空間參數 12 2-1-5 步態分析的運動學參數 14 2-2 軟骨修復 18 2-2-1 軟骨修復的發展 18 2-2-2 軟骨修復材料 20 2-2-3 軟骨組織中的必要成分 22 2-3 硫酸鈣材料 23 2-3-1 硫酸鈣在骨修復領域的應用 23 2-3-2 硫酸鈣在軟骨修復上的潛力 24 2-4動物模型 25 2-4-1 步態實驗的動物模型 25 2-4-2 脛骨平台 26 2-4-3 臨界缺損 27 2-5研究目的 30 第三章 實驗原理及步驟 31 3-1 動物實驗及手術流程 31 3-1-1 實驗動物及照護 31 3-1-2 實驗設計 31 3-1-3 手術流程 32 3-2 步態分析 33 3-2-1 步態分析儀器 33 3-2-2 影像輔助步態分析 36 3-2-3 步態分析的數據及有效性判讀 38 第四章 結果與討論 44 4-1 實驗組數據分析 44 4-1-1 實驗組個別動態負重 44 4-1-2 實驗組15周標準化動態負重 49 4-1-3 實驗組15周標準化動態負重統計分析 51 4-2 對照組數據分析 52 4-2-1 對照組個別動態負重 52 4-2-2 對照組15周標準化動態負重 57 4-2-3 對照組15周標準化動態負重統計分析 58 4-3 新實驗組數據分析 59 4-3-1 新實驗組個別動態負重 59 4-3-2 新實驗組6周標準化動態負重 63 4-4 不同組之間比較 65 4-4-1 實驗組以及對照組代償程度比較 65 4-4-2 新實驗組、實驗組以及對照組代償程度比較 67 4-5 各組別之間體重變化趨勢 69 第五章 結論 71 第六章 附錄 73 中英對照表 73 參考文獻 77 統計結果 83   圖目錄 圖 2-1-1 步寬、步長以及步幅示意圖 12 圖 2-1-2 步行時的階段變化 13 圖 2-1-3 大鼠在步行過程中的關節角度變化 15 (Eftaxiopoulou et al., 2014) 15 圖 2-2-1 骨軟骨缺損(Madry, van Dijk, & Mueller-Gerbl, 2010) 21 圖 2-2-2 硫酸軟骨素結構 23 圖 2-4-1 脛骨平台 27 圖 2-4-2 鑽孔大小及手術位置示意圖 30 圖 3-2-1 步態分析儀器示意圖(Wu et al., 2017) 34 圖 3-2-2 TBS傳感器以及透明測力板示意圖(Wu et al., 2017) 35 圖 3-2-3 高速攝影機 36 圖 3-2-4 高速攝影機回傳影像 37 圖 3-2-5 動態負重折線圖 38 圖 3-2-6 大鼠行走位置偏移示意圖 40 圖 3-2-7 大鼠行走時出現站立以及洗臉等行為 41 圖 3-2-8 大鼠洗臉以及站立產生的力讀值 41 圖 3-2-9 大鼠在行走過程中突然抬頭 42 圖3-2-10 大鼠行走中突然抬頭所記錄下的力讀值 43 圖 4-1-2 IG12-2術後12周動態負重 45 圖 4-1-3 IG12-3術後12周動態負重 46 圖 4-1-4 IG15-1術後15周動態負重 47 圖 4-1-6 IG15-3術後15周動態負重 48 圖 4-1-7 植入組15周標準化動態負重結果 49 圖 4-1-8 植入組15周統計分析 51 圖 4-2-1 CG12-1術後12周動態負重 53 圖 4-2-2 CG12-2術後12周動態負重 53 圖 4-2-3 CG12-3術後12周動態負重 54 圖 4-2-4 CG15-1術後15周動態負重 54 圖 4-2-5 CG15-2術後15周動態負重 55 圖 4-2-6 CG15-3術後15周動態負重 55 圖 4-2-7 對照組15周標準化動態負重結果 57 圖 4-2-8 對照組15周統計分析 58 圖 4-3-1 nIG-1術後4周動態負重 60 圖 4-3-2 nIG-2術後4周動態負重 60 圖 4-3-3 nIG-3術後4周動態負重 61 圖 4-3-4 nIG-4術後4周動態負重 61 圖 4-3-5 nIG-5術後4周動態負重 62 圖 4-3-6 nIG-6術後4周動態負重 62 圖 4-3-7 新實驗組6周標準化動態負重結果 63 圖 4-4-1 大鼠代償情形比對圖 66 圖 4-4-2 大鼠代償情形比對圖 67 圖 4-5-1 大鼠體重變化趨勢圖 69 圖 4-5-2 大鼠體重變化量趨勢圖 70 圖 6-1-1 對照組15周統計結果 84 圖 6-1-2植入組15周統計結果 84

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