本研究為到院前救護人員之脊椎固定術中，使用脊椎固定器材中之頸圈(collar)的研究。

　　脊椎固定器材包括頸圈、長短背板、頭部固定器。而此研究範圍由大而小，先研究頸椎固定術的整個流程，再針對頸圈來作使用方面之實驗，試圖結合流程動作觀察結果發現之問題，再加以重新設計，最後以實驗來評估新產品的優良程度，以完成此研究。

研究方法採三階段進行。
　第一階段為頸椎固定術與頸圈使用分析：
　　結合文獻探討、專家訪談及脊椎固定術救護動作觀察著手，釐清頸圈在頸椎固定器材中的定位與找出脊椎固定產品之問題。

　第二階段為建立頸圈的設計目標與進行新設計：
　　並與專業人員多次討論與修正，選定最佳之構想方案，完成新概念頸圈設計。
　
　第三階段為評估驗證：
　　採實驗方式評估新型態設計頸圈之效果，及問卷方式取得受測者主觀感受，分析結果，以完成此研究。

　　經由前置研究階段，整理出一套頸椎固定器設計要素。而此套設計要素能提供給頸椎固定器設計者有效之設計建議。

　　設計製作出的新式頸圈有兩式，一是A式的頸顴骨固定式；另一個是B式的肩頸固定式。
　　
　　A式與B式頸圈比起現有頸圈在各方向角度限制方面，除了前屈(Flexion)動作外，其他動作皆能達成顯著的限制度效果。
　　
　　B式頸圈在右彎和左彎(R-lateral bending and L-lateral bending)之固定效度上，明顯提供了比現有頸圈最大之改善量(P=0.004，P<0.05)。

　　在不舒適度上，A式頸圈採顴骨固定但伴隨著顴骨不舒適感與B式頸圈採肩頸固定但伴隨著肩頸不適感，此仍須再改進。

　　未來頸圈若能做到完全的固定，則頭部固定器可能無存在之需要，此優點為節省急救步驟與時間，此為未來一值得繼續研究之方向。

　　This study aimed at improving current collar design when enforcing the pre-hospital spine immobilization.

　　Spine immobilization equipments include collar, backboard and cervical head immobilizer. The research range is from large to small. We research the procedures of the spine immobilization, and then we do the user experiment. We combine the problem we find from the result of the observation, then to redesign. Finally, we conduct the experiment to evaluate the efficiency of the new concept design.

　　Research includes three stages. First, user analysis when using collar is taken. We search the studies in concerning references, professional interview and the observation. Try to find out the problem of the collar product. Second, we set up the design factor of collar and enforce new design. We discuss and correct our design with professional, then choose the best design project and finished new concept design. Third, evaluation of new our collar design is taken. We conduct experiment to evaluate the effect of new collar design and to obtain the subjective opinion of the pain scales. From the aforesaid, we made up a convention of collar design. The convention of collar design provides good advice for the designer.

　　Based the research results, we have developed two brand new collar design. A-type immobilizes the cheekbone while B-type immobilizes the shoulder. Compared to current product, both collar have better immobilization in restricting the R-lateral bending and L-lateral bending. However, the effect of immobilization in restricting the flexion is quite the same with the current collar. In uncomfortable scale, A-style collar bring uncomfortable on cheekbone; B-style collar bring uncomfortable on shoulder.

　　In future, if collar design could immobilize completely, than the Cervical Head Immobilizer will be leave out. The advantage is we can save the emergency time and steps.

英文部分
1.American College of Surgeons (1991).. Advanced Trauma Life Support Manual, ACS.
2.Nation Association of Emergency Medical Technicians (1994). Prehospital Trauma Life Support Manual, NAEMT.
3.Barnsley, L.,S.Lord, et al. (1994) " Whiplash injury." Pain 58:283-307.
4.Barkana, Y., M. Stein, et al. (2000). "Prehospital stabilization of the cervical spine for penetrating injuries of the neck - is it necessary?" Int. J. Care Injured 31: 305-309.
5.Bennett, S.E.,R.J. Schenk, et al. (2000) " Active range of motion utilized in the cervical spine to perform daily functional tasks(Astract)." Association of Bone and Joint Surgeons 52nd Annual Meeting .San Antonio.
6.Bostrom, O., M. Y. Svennson, et al. (1996). A new neck injury criterion candidate - based on injury findings in the cervical spine ganglia after experimental neck extension trauma. Proceedings of the International Conference on the Biomechanics of Impact, Dublin, Ireland.
7.Break, L. W. and R. M. Van Norman (1971). "Medicolegal aspects of cervical spine sprains." Clin Orthop 74: 124-8.
8.Butman, A. M. and R. W. Vomacka (1991). "Spinal immobilization:part I." Emergency 23: 48-51.
9.Carducci, B., R. A. Lowe, et al. (1986). "Penetrating neck trauma: consensus and controversies." Annals of Emergency Medicine 15(2): 208-214.
10.Chandler, D. R., C. Nemejc, et al. (1992). "Emergency cervical spine immobilization." Ann Emerg Med 21: 1185.
11.Chiarella, S., G. GianPiero, et al. (2002). " Three-dimension analysis of active and cervical spine range of motion : effect of age in healthy male subject." Clinical Biomechanics 17: 611–614.
12.Craig, G. R. and M. S. Nielsen (1991). "Rigid cervical collars and intracranial pressure." Intensive Care Med 17: 504.
13.Croft, A. C., P. Herring, et al. (2002). "The neck injury criterion: future considerations." Accident Analysis and Prevention 34: 247-255.
14.Davies, G., C. Deakin, et al. (1996). "The effect of a rigid collar on intracranial pressure." Injury 27(9): 647-649.
15.Dick, T. and R. Land (1983). "Cervical extrication devices." Journal of Emergency Medicine Service 8: 23-26.
16.Feipel, V.,B. Rondelet , et al. (1999) " Normal global motion of the cervical spine:An electrogoniometric study." Clin Biomech 14:462-470.
17.Garfin, S. R., M. M.Katz, et al. (1987). "Prehospital care of spine cord injuries." Topics Emerg Med 9: 37-49.
18.Graziano, A., E. A. Scheidel, et al. (1987). "A radiographic comparison of prehospital cervical immobilization methods." Ann Emerg Med 16: 1127.
19.Hamilton, R. S. and P. T. Pons (1996). "The efficacy and comfort of full-body vacuum splints for cervical-spine immobilization." The Journal of Emergency Medicine 14(5): 553-559.
20.Hewitt, S. (1994). "Skin necrosis caused by a semi rigid cervical collar in a ventilated patient with multiple injuries." Injury 64: 139.
21.Ivaturi, R. R. and G. C. Cayten (1996). The Textbook of penetrating trauma, Williams and Wilkins.
22Jakob Nielsen.(1993) Usability Engineering ,p26.
23.Jeanneret, B., F. Magerl, et al. (1991). "A hazard of skull traction in the management of acute injuries of the cervical spine." Arch Orthop Trauma Surg 110(24): 2-5.
24.Jeanneret, B., F. Magerl, et al. (1991). "Overdistraction: A hazard of skull traction in the management of acute injuries of the cervical spine." Arch Orthop Trauma Surg 110: 242-245.
25.Lorenzo, R. A. D. (1996). "A review of spinal immobilization techniques." The Journal of Emergency Medicine 14(5): 603-613.
26.Marion, D. and G. Clifton (1991). Injury to the vertebrae and spinal cord. M. EE, M. KL and e. Feliciano DV. Norwalk, Trauma: 61-75.
27.Podolsky, S. M., J. R. Hoffman, et al. (1983). "Neurologic complications following immobilization of cervical spine fracture in a patient with ankylosing spondylitis." Ann Emerg Med 12: 578-580.
28.Rosen, P. B., N. E. McSwain, et al. (1992). "Comparison of two new immobilization collars." Ann Emerg MED 21: 1189.
29.Roye, W. J., E. Dunn, et al. (1988). "Cervical spine and injury-a public catastrophe." J Trauma 28: 1260.
30.Stephen , D. P. (1999) . " The efficacy of head immobilization techniques During Simulated Vehicle Motion." SPINE Volume 24:1839-1844.
31.Teschen, J. (1988). "Prevention of neurological deterioration before admission to spinal cord injury unit." Paraplegia 26: 143-150.
32.Thal, E. R. and D. M. Meyer (1992). "Penetrating neck trauma." Current
33.Problems in Surgery 29(1): 1-56.
34.Wagner, F. C. and R. M. Johnson (1982). "Cervical bracing after trauma." Medical Instrument 16: 287-288.
35.Wargareta, N. and H. F. Victor (2001). Basic Biomechanics of the Musculoskeletal system. Lippincott Williams &Wilkins , New Yark.
36.Wolf, J. W. and R. M. Johnson (1989). Cervical orthoses. The cervical spine. Philadelphia, JB Lippencott: 97-105.

中文部分
1.胡勝川 編著。民國89年。實用到院前緊急救護。金名圖書。台北。
2.劉耀宗。民國83年。低溫成型頸支架對頸椎固定。國立成功大學醫學工程研究所。碩士論文。
3.胡明一等 著。民國91年。人體解剖學。藝軒圖書出版社，中華民國。
4.行政院衛生署。民國84年。中級救護技術員訓練教材。行政院衛生署。
5.楊斯嵐。民國92年。學童專用指向設備之人因設計與評價。國立成功大學工業設計研究所。碩士論文。