可動態改變外翻力矩的治療退化性膝關節炎輔具

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姓名

林家瑋(Chia-Wei Lin) 查詢紙本館藏

畢業系所

生物醫學工程研究所

論文名稱

可動態改變外翻力矩的治療退化性膝關節炎輔具
(The Innovative Knee Osteoarthritis Brace with Dynamic self-adjustability of valgus moment)

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摘要(中)

隨著生活型態的改變及醫學的進步，人類帄均壽命逐年延長，老年病患也隨之逐年增多，各種老人疾病漸趨增加，其中退化性膝關節炎就是明顯的例子，根據統計，帄均六十五歲以上的老人，每三人就有一人患有膝關節炎的疾病；在臨床治療方式有(1)退化性膝關節炎護膝輔具；(2)人工膝關節置換手術；而侵入式的外科手術會發生骨質溶解（osteolysis）和非細菌性引起的鬆脫（aseptic loosening）等併發症，而退化性膝關節炎護膝輔具好處在於不會有外科手術的併發症，且能改善退化性膝關節炎患者膝關節不正常的受力情形。
退化性膝關節炎護膝輔具目前主要的問題有(1)護膝輔具過於笨重；(2)護膝輔具矯正時的異物感；(3)病患的矯正程度需可調整。本研究針對目前退化性膝關節炎護膝輔具設計的缺點，設計單邊護膝輔具減輕重量、動態矯正角度機構移除步態擺盪期與坐姿時矯正的異物感、可調式矯正角度機構讓病患在站立期的矯正程度可調整，進一步改良退化性膝關節炎護膝輔具之設計。
依據動作模擬與有限元素分析、實際打樣成品的設計修改、實驗評估等，顯示本論文的設計是具可行性的。

摘要(英)

Due to the changes of living style and the progress of the medical science, human beings’ average life is more and more prolonged. It brings out that elder patients are getting much more year by year. Many kinds of disease, which easily occurs to elders, are also getting raising. The most obvious example is the Osteoarthritis. According to the statistics, there are almost 33% elders around the age of 65 suffer from the Osteoarthritis. There are two clinical therapies for this disease, one is Knee Brace, and the other is Total Knee Replacement. However, Osteolysis and Aseptic Loosening would happen due to the incursive surgery such as Total Knee Replacement. Knee Brace will not cause any complications, and it can improve abnormal force endured at Patients’ knees.
There are three main problems for the Knee Brace. First, Knee Brace is cumbersome. Second, Wearing Knee Brace is uncomfortable. Third, Knee Brace have to self-adjustability of valgus moment. In this study, the unilateral post Knee Brace, dynamic correction angle mechanism to reduce uncomfortable during swing phase and sit posture,adjustment correction angle mechanism to adjust valgus moment to solve the problems.
According to dynamic simulation, finite-element simlation, prototype, exprimental test demonstrated the design has feasibly in this study.

關鍵字(中)

★ 動作模擬
★ 護膝輔具
★ 退化性膝關節炎
★ 有限元素分析

關鍵字(英)

★ osteoarthritis
★ Knee Brace
★ dynamic simulation
★ finite-element simulation

論文目次

摘要 iv
Abstract v
致謝文 vi
目錄 vii
圖目錄 xi
表目錄 xvi
第一章、緒論 1
1-1 研究動機與目的 1
1-2 膝關節介紹 1
1-2-1 膝關節解剖學與生物力學介紹 1
1-2-2 膝關節正常步態 7
1-3 退化性膝關節炎（osteoarthritis knee） 11
1-3-1 退化性膝關節炎病理變化 11
1-3-2 退化性膝關節炎的成因 12
1-3-3 退化性膝關節炎的症狀 14
1-3-4 退化性膝關節炎患者之臨床處置方法 16
1-4 退化性膝關節炎護膝輔具介紹 17
1-4-1 退化性膝關節炎護膝輔具治療原則 17
1-4-2 退化性膝關節炎護膝輔具運動機構 18
1-5 文獻回顧 20
1-5-1 膝關節步態之運動學分析 20
1-5-2 退化性膝關節炎患者之生物力學分析 21
第二章、材料與方法 26
2-1 膝關節與護膝輔具運動參數定義 26
2-2 新型退化性膝關節炎護膝輔具機構設計 30
2-2-1 動態矯正角度機構設計 30
2-2-2 可調式矯正角度機構設計 31
2-3 新型退化性膝關節炎護膝輔具動作模擬 33
2-3-1 模型實體建立 33
2-3-2 模型動力來源、邊界受力、介面碰撞條件 35
2-3-3 動作分析參數選用 40
2-4 新型退化性膝關節炎護膝輔具靜態有限元素分析 41
2-4-1 模型實體建立 41
2-4-2 模型材料性質 44
2-4-3 模型負載、邊界及介面條件 45
2-4-4 有限元素模型網格化 52
2-4-5 有限元素分析後處理探討參數介紹 53
2-5 新型退化性膝關節炎輔具模型打樣 54
2-6 新型退化性膝關節炎輔具臨床實驗評估 57
2-6-1 實驗目的 57
2-6-2 實驗方法及流程 57
第三章、結果 58
3-1 新型退化性膝關節炎輔具動作模擬結果 58
3-1-1 動態矯正角度機構動作模擬結果 58
3-1-2 可調式矯正角度機構動作模擬結果 59
3-2 新型退化性膝關節炎輔具靜態有限元素分析結果 60
3-2-1 大腿支架組合件模型應力色階分佈情形 61
3-2-2 大腿支架組合件模型位移色階分佈情形 64
3-2-3 小腿支架組合件簡化模型應力色階分佈情形 66
3-3 新型退化性膝關節炎輔具打樣結果 67
3-4 新型退化性膝關節炎輔具實驗結果 69
第四章、討論 72
4-1 新型退化性膝關節炎輔具動態模擬結果討論 72
4-1-1 動態矯正角度機構動態模擬結果討論 72
4-1-2 可調式矯正角度機構態模擬結果討論 74
4-2 新型退化性膝關節炎輔具靜態有限元素分析結果討論 76
4-2-1 大腿支架組合件模型應力色階分佈結果討論 77
4-2-2 大腿支架組合件模型位移色階分佈結果討論 78
4-2-3 小腿支架組合件簡化模型應力色階分佈結果討論 78
4-3 新型退化性膝關節炎輔具模型打樣結果討論 79
4-4 新型退化性膝關節炎輔具臨床實驗結果討論 81
第五章、結論與未來展望: 83
5-1 結論 83
5-2 未來展望 83
參考文獻 84
附錄一 88

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指導教授

林上智、李宇翔
(shang-chih Lin、yu-hsiang Li)

審核日期

2010-10-28

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