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研究生： 嗗吉哈
Ahmad, Wajiha
論文名稱： 雙項多孔彈性模型於腕隧道症候群：進階診斷、治療與預防的有限元素框架
Biphasic Poroelastic Modeling of Carpal Tunnel Syndrome: A Finite Element Framework for Advancing Diagnosis, Treatment and Prevention
指導教授： 楊岱樺
Yang, Tai-Hua
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： 2025
畢業學年度： 113
語文別： 英文
論文頁數： 170
中文關鍵詞： 雙相材料 、多孔彈性 、腕管綜合症 、腕管 、有限元素分析 、生物力學
外文關鍵詞： Biphasic Materials, Poroelasticity, Carpal Tunnel Syndrome, Carpal Tunnel, Finite element analysis, Biomechanics
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    • 腕隧道症候群（Carpal Tunnel Syndrome, CTS）是最常見的周邊神經病變形式，其特徵是正中神經（Median Nerve, MN）在腕隧道（Carpal Tunnel, CT）內受到壓迫。病理生理學證據表明，腕隧道內壓（Intracarpal Tunnel Pressure, ICTP）的增加是其發展的關鍵驅動因素，而這與手指和手腕姿勢等生物力學因素密切相關。儘管已有廣泛的研究，但現有的生物力學模型——包括彈性、超彈性和粘彈性模型——未能準確描述腕隧道組織中固體與液體的交互作用。
    本研究首次採用準靜態瞬態雙相多孔彈性框架來建模腕隧道，解決了以往方法中的關鍵局限性，並推進了對CTS病理生理學的理解。通過有限元素分析（Finite Element Analysis, FEA），本研究檢視了手腕屈曲（10°）、手腕伸展（10°）及單獨手指屈曲（10°、15°、20°）對CTS發展的影響。雙相多孔彈性模型將屈肌腱（Flexor Tendons, FT）、正中神經（MN）和下滑膜結締組織（Subsynovial Connective Tissues, SSCT）的固體基質假定為完全被液體飽和，從而能模擬腕隧道內的液體交換與形變。
    結果顯示，手腕屈曲誘發了最高的正中神經應變，這與臨床診斷方法如Phalen測試一致。然而，腕隧道內壓在手腕伸展時達到峰值，這與以往的實驗結果一致。此外，隨著手指屈曲角度的增加，腕隧道內壓和正中神經壓迫也隨之增強，突顯了極端屈曲姿勢的生物力學重要性。此前研究表明，手腕屈曲與手指屈曲的結合會加劇正中神經的壓迫，本研究基於觀察到的機制對此結果進行了近似估算。本研究強調了採用雙相多孔彈性框架研究CTS的創新性，首次在計算上捕捉了腕隧道內間質液行為與固體形變的交互作用。通過整合機械負荷、組織形變和液體傳輸現象，該研究提供了關於非中立姿勢如何促進CTS的關鍵見解。研究結果對提高診斷準確性、設計減壓手術、優化康復方案以及開發預防CTS的符合人體工學的干預措施具有重要意義。
    本研究不僅將理論建模與臨床相關性相結合，還為周邊神經病變的生物力學研究樹立了新的標杆。通過探討腕隧道組織的複雜雙相多孔彈性行為，該研究為未來雙相生物力學研究奠定了堅實的基礎，並深化了對CTS發病機制、預防、診斷及管理的科學認識。

    Carpal Tunnel Syndrome (CTS) is the most prevalent form of peripheral neuropathy, characterized by compression of median nerve (MN) within the carpal tunnel (CT). Pathophysiological evidence highlights that increased intracarpal tunnel pressure (ICTP), influenced by biomechanical factors such as fingers and wrist posture, is a key driver in its development. Despite extensive research, existing biomechanical models—elastic, hyperelastic, and viscoelastic—fail to accurately account for the solid-fluid interactions inherent in the CT tissues.
    This study pioneered the application of a quasi-static transient biphasic poroelastic framework to model the CT, addressing critical limitations in prior approaches and advancing the understanding of CTS pathophysiology. Using finite element analysis (FEA), the study examined the effects of wrist flexion (10°), wrist extension (10°), and isolated fingers flexion (10°, 15°, 20°) on CTS development. The biphasic poroelastic model considered the solid matrix of the flexor tendons(FT), median nerve (MN) and subsynovial connective tissues(SSCT) to be completely saturated with fluid, enabling the simulation of fluid exchange and deformation within the CT.
    Results demonstrate that wrist flexion induced the highest MN strain, aligning with clinical diagnostics such as Phalen's test. However, ICTP was found to peak during wrist extension, consistent with previous experimental findings. Additionally, increasing the angle of finger flexion amplifies the ICTP and compression of the MN, highlighting the biomechanical significance of extreme flexion. Previous studies suggest that combining wrist flexion with fingers flexion would exacerbate MN compression, and this study approximated such outcomes, based on the observed mechanics.
    This study highlighted the novelty of employing a biphasic poroelastic framework for CTS, making it the first to computationally capture interstitial fluid behavior and solid deformation interactions within the CT. By integrating mechanical loading, tissue deformation, and fluid transport phenomena, this research provided critical insights into how non-neutral postures contribute to CTS. The findings hold significant implications for enhancing diagnostic precision, designing pressure-relieving surgical procedures, optimizing rehabilitation protocols, and developing ergonomic interventions to mitigate CTS risk.
    This work not only bridged theoretical modeling with clinical relevance but also set a new benchmark for biomechanical studies of peripheral neuropathies. By addressing the intricate biphasic poroelastic behavior of CT tissues, this study established a robust foundation for future research in biphasic biomechanics and enhances the scientific understanding of CTS pathogenesis, prevention, diagnosis and management.

    DEDICATION II 摘要 III ABSTRACT V ACKNOWLEDGEMENTS VII CONTENT X LIST OF TABLES XIII TABLE OF FIGURES XIV ABBREVIATION XVI CHAPTER 1 INTRODUCTION 1 1.1 RESEARCH BACKGROUND 1 1.2 POROELASTICITY 8 1.2.1 Porous Materials 8 1.2.2 Theory of Linear Poroelasticity 10 1.3 APPLICATION TO CARPAL TUNNEL SYNDROME 14 1.3.1 Anatomy of Carpal Tunnel (CT) 14 1.3.2 Incidence of CTS 23 1.3.3 Pathophysiology and Etiology of CTS 25 1.3.4 Clinical Diagnosis of CTS 28 1.3.5 Treatment of CTS 38 1.3.6 Current Limitations in the Diagnosis of CTS 48 1.3.7 Current Limitations in Treatment of CTS 50 1.3.8 Current Limitations in Prevention of CTS 51 1.3.9 Research Purpose 52 CHAPTER 2 RESEARCH MATERIALS AND METHODS 55 2.1 OVERVIEW 55 2.2 MODEL DEVELOPMENT 56 2.1.1 Geometry Construction 57 2.1.2 Importing Model into FEBio Studio 59 2.3 MATERIAL MODELS AND PROPERTIES 59 2.3.1 Assigned Materials 59 2.3.2 Specification of Material Models 60 2.3.3 Material Properties of the CT Components 61 2.3.4 Physiological Relevance and Model Accuracy 65 2.4 MESH GENERATION 65 2.4.1 Initial Mesh Generation 65 2.5 BOUNDARY CONDITIONS 67 2.5.1 General Boundary Conditions (Dirichlet BCs / Essential BCs) 67 2.5.2 Natural Boundary Conditions (Neumann BCs) 73 2.5.3 Physiological Relevance 74 2.6 ANALYSIS STEPS 75 2.6.1 Analysis Type 75 2.6.2 Time Stepping 75 2.6.3 Auto-Time Stepper Configuration: 76 2.6.4 Solver Settings for Nonlinear Equations 77 2.6.5 Physiological Relevance 77 2.7 SIMULATION EXECUTION AND OBSERVATIONS 78 2.7.1 Running the Analysis 78 2.7.2 Observations 78 2.8 TRANSITION TO SIMPLIFIED MODEL 79 2.8.1 Development of Simplified Model 79 2.8.2 Reassignment of Material Properties, Boundary Conditions, and Solver Settings 81 2.8.3 Execution of Simulation and Observations 84 2.9 MESH CONVERGENCE ANALYSIS 84 2.9.1 Mesh Refinement 85 2.9.2 Convergence Testing 86 2.9.3 Significance of Mesh Convergence Analysis 87 2.10 TIME CONVERGENCE ANALYSIS 87 2.10.1 Purpose of Time Convergence Analysis 88 2.10.2 Methodology 88 2.11 CONCLUSION FOR CHAPTER 2 89 CHAPTER 3 RESULTS 91 3.1 MESH CONVERGENCE ANALYSIS 91 3.2 TIME CONVERGENCE ANALYSIS 92 3.3 FLUID PRESSURE DISTRIBUTION, SOLID MATRIX DISPLACEMENT, AND EFFECTIVE STRESS 93 3.3.1 Fluid Pressure Distribution (Table 5) 93 3.3.2 Solid Matrix Displacement Magnitude (Table 6) 100 3.3.3 Effective Stress (Table 7) 102 3.4 VISUAL REPRESENTATION OF RESULTS 103 3.4.1 Case 1: Wrist Flexion (10°) 104 3.4.2 Case 2: Wrist Extension (10°) 106 3.4.3 Case3: Fingers Flexion (10°) 108 3.4.4 Case 4: Fingers Flexion (15°) 110 3.4.5 Case 5: Fingers Flexion (20°) 112 CHAPTER 4 DISCUSSION 115 4.1 DISCUSSION OF RESULTS 115 4.1.1 Overview of the Cases 115 4.2 NOVELTY OF THE STUDY 119 4.3 LIMITATIONS: 121 4.3.1 Geometrical Simplifications 121 4.3.2 Material Properties and Assumptions in Boundary Conditions 122 4.3.3 Simplified Representation of the Median Nerve 123 4.3.4 Neglected Effects of Carpal Bone Movement 123 4.3.5 Absence of Frictional Interactions 123 CHAPTER 5 CONCLUSION AND FUTURE WORK 124 5.1 CONCLUSION 124 5.2 FUTURE WORK 125 5.2.1 Incorporation of Dynamic and Repetitive Motions 126 5.2.2 Development of Patient-Specific Models 127 5.2.3 Advancing Computational Modeling Techniques 127 5.2.4 Broader Applications of Poroelastic Modeling 127 REFERENCES 129

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