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標題: | 不同髖關節角度對於各層髕骨肌腱的偏移和滑行特徵之影響 Effects of different hip flexion angles on the excursion and gliding of the layers of patellar tendon |
作者: | 施品竹 Pin-Chu Shih |
指導教授: | 王興國 Hsing-Kuo Wang |
關鍵字: | 髕骨肌腱,超音波斑點追蹤技術,離心收縮,機械特徵,生物力學, patellar tendon,ultrasonic speckle tracking technique,eccentric contraction,mechanical properties,biomechanics, |
出版年 : | 2023 |
學位: | 碩士 |
摘要: | 研究背景:髕骨肌腱病變在跳躍運動員中發生率與再發生率極高,往往伴隨著疼痛和功能上的限制,過去認為和髕骨肌腱深淺層過大且反覆的受力以及偏移與滑行特徵不同相關,造成病變位置好發於髕骨肌腱近端深層位置,髕骨肌腱淺層為雙關節肌肉──股直肌之延伸,理論上控制髖關節角度,應能影響髕骨肌腱深淺層的偏移與滑行特徵,然而目前仍無研究探討不同動力鏈以及髖關節角度下執行膝伸肌離心收縮時,對於髕骨肌腱近端深淺層的偏於與滑行特徵之影響,超音波斑點追蹤技術能非侵入式的方法,在人體活動時即時收集軟組織的影像變化,透過該技術能量測肌腱偏移與滑行的能力。
研究目的:本研究之目的為比較健康髕骨肌腱在不同髖關節角度下執行開放鏈及閉鎖鏈之膝伸肌離心收縮時,髕骨肌腱近端深淺層偏移與滑行特徵、股四頭肌誘發、生物力學特徵變化以及靜態機械特徵,並利用上述結果,進一步了解髕骨肌腱病變之病因學,並作為將來臨床評估與治療的依據。 研究設計: 本研究為橫斷式研究設計。 研究對象:本研究收取符合本研究條件之健康族群共30人。 研究方法:受試者將於等速肌力儀上分別於坐姿與躺姿兩種不同髖關節角度下進行膝伸肌離心收縮(開放鏈動作);於動作分析系統搭配測力板中分別於伸直和彎曲髖關節姿勢下進行下蹲(閉鎖鏈動作);於靜態躺姿量測髕骨肌腱超音波彈性成像,比較以下參數:(1)髕骨肌腱近端淺層與深層長軸方向之偏移與滑行量 (2)膝伸直力矩 (3)髕骨肌腱受力 (4)股四頭肌均方根肌電振訊號大小 (5) 髕骨肌腱機械特徵 統計分析: 使用Shapiro-Wilk test測試檢定所有數據是否符合常態分布,若符合常態分布,將使用二變數重複測量變異數分析雙變數重複測量變異數分析(two-way repeated-measure ANOVA)檢定一般健康族群於兩種髖關節角度是否於深淺層偏移與滑行量有統計差異;使用成對樣本t檢定(Paired Sample t-test)來比較於兩種髖關節角度之膝關節伸直力矩、髕骨肌腱受力、肌電訊號、機械特徵是否有差異。 結果:在這項研究中,髕骨肌腱深淺層偏移與滑行量的再測信度在十名受試者中表現為中等至佳。開放鏈和閉鎖鏈動作中,髕骨肌腱深淺層有顯著的交互作用(開放鏈 p = 0.006;閉鎖鏈 p = 0.002)。在後續分析中,淺層皆顯著比深層有更多像遠端的偏移和滑行。動力學方面,開放鏈和閉鎖鏈動作的膝關節力矩和髕骨肌腱受力呈現出顯著差異。肌電圖結果顯示,股直肌、股外側肌和股內側肌在開放鏈動作的坐姿下,均方根肌電振幅訊號顯著大於躺姿(股直肌 p = 0.013;股外側肌:p<0.001;股內側肌 p = 0.003)。而在閉鎖鏈動作中,股直肌在髖關節伸直下蹲的均方根肌電振幅訊號顯著大於屈曲下蹲(p = 0.014)。剪力超音波彈性成像參數顯示髕骨肌腱近端淺層的剪力模數顯著高於深層(p = 0.003)。 結論:本研究以超音波斑點追蹤技術觀察髕骨肌腱深淺層在股四頭肌離心收縮過程中的偏移和滑行行為,並探討髖關節角度的影響。研究發現髖關節角度會對膝關節力矩和股四頭肌的肌肉活化造成影響,且髕骨肌腱淺層比深層更具剛性。此項發現將有助於理解髕骨肌腱病變背後的機制,並對未來設計有效的治療策略提供重要參考。 Background: Patellar tendinopathy has a high incidence and recurrence rate in jumping athletes, often accompanied by pain and functional limitations. It was believed that patellar tendinopathy was related to the excessive and repeated stress as well as the relative excursion and gliding of the layers of patellar tendon. The superficial layer of the patellar tendon is the extension of the double-joint muscle, which is the rectus femoris. Controlling the hip joint angle flexion angle should be able to affect the excursion and gliding characteristics of the deep and superficial layers of the patellar tendon. However, there is still no research to investigate the influence of the excursion and gliding characteristics of the proximal patellar tendon when performing eccentric contraction of the knee extensors under different kinetic chains and hip joint angles. Ultrasonic speckle tracking can provide a non-invasive and real-time image of soft tissue during dynamic motion, and thus can measure tendon excursion and gliding through this technique. Purpose: The purpose is to compare the excursion and gliding characteristics of the layers of the proximal patellar tendon, quadriceps activation, and biomechanical characteristics when subjects perform eccentric contraction of the knee extensors in open and closed chains at the different hip joint flexion angles. Using the results to further understand the etiology of patellar tendinopathy, and serve as the recommendation for future clinical evaluation and treatment. Design: Cross-sectional research design. Participants: A total of 30 healthy subjects who met the recruitment criteria were enrolled in this study. Method: The subjects will perform eccentric contraction of the knee extensors in a sitting and a lying position on an isokinetic muscle dynamometer(open chain), perform the eccentric squat in hip flexion and extension posture on a force plate with motion analysis system (closed chain), and shear-wave elastography in a static supine position. The following parameters were compared: (1) the excursion and gliding of the proximal superficial and deep layers of the patellar tendon in the lateral direction (2) Knee extension moment (3) Patellar tendon force (4) EMG signal of the quadriceps (5) Mechanical property of the patellar tendon Statistical analysis: The Shapiro-Wilk test was used to assess whether all the data followed a normal distribution. If the data met the criteria for normal distribution, a two-way repeated-measure analysis of variance (ANOVA) would be employed to examine the statistical differences in excursion and gliding between two hip joint angles in the general healthy population. Paired sample t-tests would be conducted to compare differences in knee joint extension torque, patellar tendon force, electromyographic signals, and mechanical characteristics between the two hip joint angles. Results: This study investigated the excursion and gliding behavior of the patellar tendon during eccentric quadriceps contraction using ultrasound speckle tracking. Significant interactions were found between hip joint angles and superficial patellar tendon excursion in both open chain (p = 0.006) and closed chain (p = 0.002) movements. The superficial layer exhibited greater distal excursion and gliding compared to the deep layer. Kinetic analysis revealed differences in knee joint torque and patellar tendon force between open chain and closed chain movements. Electromyographic signals indicated higher muscle activation of all quadriceps in the seated position during open chain movements, and higher muscle activation of rectus femoris in the hip flexion position during closed chain movements(p = 0.014). Shear wave elastography demonstrated higher stiffness in the superficial layer of the patellar tendon compared to the deep layer (p = 0.003). Conclusion: Our study provides insights into the excursion and gliding behavior of the patellar tendon during eccentric quadriceps contraction and its relationship with hip joint angles. The findings highlight the impact of hip joint angles on patellar tendon excursion, knee joint torque, and muscle activation of the quadriceps. Moreover, the study reveals that the superficial layer of the patellar tendon exhibits greater stiffness than the deep layer. These findings contribute to our understanding of patellar tendon pathology and have implications for the development of effective therapeutic strategies. |
URI: | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/89808 |
DOI: | 10.6342/NTU202304074 |
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顯示於系所單位: | 物理治療學系所 |
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