前十字韌帶損傷及重建後膝關節之生物力學與神經肌肉適應之分析

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Title:	前十字韌帶損傷及重建後膝關節之生物力學與神經肌肉適應之分析 Biomechanics and Neuromuscular Adaptation in ACL Patients
Authors:	許弘昌
Contributors:	中國醫藥大學物理治療學系
Keywords:	前十字韌帶;生物力學;電腦模型;動作分析;運動功能;肌力;自主徵召;動作控制;ACL;Biomechanics;Computer model;Motion analysis;Motor ability;Muscle strength;Self recruitment;Motor Control
Date:	2002-12
Issue Date:	2010-06-30 13:22:05 (UTC+8)
Abstract:	脛骨與股骨以及周圍的支持組織如韌帶構成膝關節，並決定其被動活動度，加上神經系統支配的周圍肌肉與被動支持組織共同控制膝關節的動作，在這些組織當中任何一向受到損傷都會導致膝關節功能變差。在這些重要的支持組織當中，前十字韌帶不僅在維持被動的膝關節穩定度扮演相當重要的角色，在前十字韌帶當中富含的本體感覺接受器也傳回關節的受力及動作訊息，以提供肌肉作為動態控制膝關節的依據。本研究包含了三個部分針對前十字韌帶受損與重建之後的病患，研究其生物力學上與神經肌肉控制的短期與長期的變化與因應的適應情形。第一個子計劃主要針對前十字韌帶的生物力學特徵深入研究探討，在第一年希望藉由研發新的電腦輔助設計的膝關節模型去計算並量化出動態活動當中膝關節的位移與穩定度，以及前十字韌帶的受力與應變；第二年將設計發展膝關節的體外測試儀，利用實體的測試以驗證電腦輔助模型的效度；第三年的重點便是希望利用光學攝影動作分析系統結合測力板與肌電圖系統的測量，將驗證過的膝關節模型應用在人體正常功能活動的分析中，以量化活動當中的膝關節動態穩定度。第二個子計劃主要針對前十字韌帶受損及重建後病人做詳細的三度空間動作分析，第一年目標在整合光學攝影動作分析儀與測力板以及動態肌電圖系統，先收集正常人的資料作為比對，再透過轉介陸續收集前十字韌帶受傷的病患在從事功能性活動時的三度空間動作資料；第二年陸續累積收集前十字韌帶受傷的病患，並追蹤前一年之病患在前十字韌帶受損後，及接受重建術後的恢復過程，動作型態與肌肉神經控制的變化與長期的適應；第三年應用子計劃一當中新發展的膝關節模型用以分析前十字韌帶受傷後的病患，在從事功能活動時的膝關節動態穩定度與動力學，以更深入了解膝關節在動態活動時的生物力學。第三個子計劃重點在針對前十字韌帶受損後肌肉的神經支配與因應而產生的適應變化，第一年利用等速肌力測試儀建立在單側前十字韌帶受損後的病患，分析其兩側控制膝關節主要的肌群，在所產生力矩與膝關節角度之間的關係，產生力矩與速度之間的關係，以及探討等速運動後肌肉疲勞的情況，並了解肌肉活化的徵召是否與正常人有所不同；第二年主要在探討這些患者在H-反射以及的髕骨韌帶反射的變化，並追蹤了解受傷後短期與長期的變化，另外應用平衡測試儀測試膝關節受損後的平衡功能表現；第三年除持續追蹤前兩年的個案，也將對這些病患在神經肌肉上的變化結果，應用以了解並解釋在這些患者在從事功能性活動時所表現出的變化。這些子計劃深入探討並了解前十字韌帶受損後的病患，其膝關節以及整個下肢在從事日常活動功能表現的生物力學分析以及神經肌肉的控制，以求能提供未來這些病患恢復計劃的指標，讓這些患者都能及早恢復受傷前的運動程度，能發揮其最佳的表現，並希望能有效的避免後續的關節炎等問題的發生。 Both tibia and femur and their surrounding ligaments determine the passive motion of the knee joint. Under the action of the nervous system muscles together with the passive elements control the dynamics of the joint. Any injury of these elements will result in degradation of the function of the joint. Anterior cruciate ligament (ACL) is one of the important elements that contribute to the stability of the knee, not only through passive restraint of tibia anterior translation but also the proprioception feedback of dynamic control of muscles. This research contains three projects to investigate the biomechanics and neuromuscular control and adaptation of the knee joint after ACL injuries or reconstruction. The first project will develop a computer-graphics-based mathematical model of the knee joint suitable for the inclusion into a complete locomotor system model which will be useful for the calculation of the mechanical variables of the joint with special emphasis on the ACL forces and the quantification of dynamic knee stability during functional activities. The second project will analyze the gait characteristics of ACL injured and ACL reconstructed patients using the model with optoelectronic and dynamic electromyographic systems. In the first year, the main objective is to investigate the differences of gait variables and muscle activation pattern in ACL deficient and reconstructed patients during functional activities. The second year, the effects of functional knee bracing in three anatomic planes with three-dimensional motion analysis will be exam to study the long-term neuromuscular adaptations in ACL reconstructed patients. With the model developed in project 1 and neuromuscular profile found in project 3, to study the muscle-ligament interaction, adaptations and knee dynamic stability during functional activities. And the third project will examine the neuromuscular adaptation of knee muscles in these specific subjects. It aims to establish the length-tension and force-velocity relationships of quadriceps and hamstrings in ACL-D and ACL-R in the short and long term and investigate whether the voluntary activation failure is responsible for the weakness observed and the corresponding changes in the long term. The second year, we will examine the short and long term modification in reflex activity in terms of H-reflex and tendon jerk response in ACL-D and their restoration in ACL-R, and explore the possible adaptive changes in balance strategy as well as the muscle activation patterns while maintaining balance. And then hope to incorporated the results with the changes in functional performance concerning lower extremities and general mobility in final year. Results of these projects will help us understand the recovery and neuromuscular adaptation after ACL injuries. It will contribute to guide the future rehabilitation program in this particular group of patients.
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