- 學位論文
以肌電訊號探討針刺對退化性膝關節炎的影響
Effect of acupuncture on knee osteoarthritis using electromyography
摘要
臨床上對於針刺的療效評估主要都是使用問卷的方式來進行，由於問券是由病患主觀的回答，而在實際的臨床上需要將客觀參數結合主觀參數從兩個方面去探討治療行為對病患的影響，如此一來醫生才能夠針對每一位病患的情況去做治療行為的修正，而病患本身也能從不同的角度了解自己的治療狀況。 本研究的對象為罹患退化性膝關節炎患者，利用中醫針刺理論針刺，陽陵泉、犢鼻、委中三個穴位治療退化性膝關節炎，針刺深度為0.5吋、留針時間為15分鐘。量測股四頭肌、股二頭肌3、5公斤的負重下，進行膝關節踢伸動作3分鐘的sEMG。並利用遞歸定量分析(Recurrence Quantification Analysis, RQA)的結果以及肌電圖的均方根植(Root mean square, RMS)來探討退化性膝關節炎患者針刺治療前後的表面肌電訊號(Surface Electromyography, sEMG)的變化。並比較治療前後的膝關節活動角度(Range of motion, ROM)以及疼痛量表(Visual Analog Scale, VAS)來探討治療的影響。 本研究臨床收案有效樣本共11人，皆患有二級以上的退化性膝關節炎，經統計分析後發現治療前後的評估參數唯有左膝的VAS有顯著差異(P<0.05)，其他評估參數則無顯著差異(P>0.05)。可以得知本研究的針刺並無法達到改善肌肉活動與關節活動度的成效。
並列摘要
Therapeutic effects of acupuncture treatment are normally assessed by using questionnaires. However, the objectivity of results is often questionable because many surveys only consider subjective responses in patients. To avoid drawing biased survey conclusions, we proposed a new strategy in which, apart from the subjective questionnaires, objective clinical measurements are involved to assess the therapeutic effects. The strategy facilitates personalized medical practices, and it also encourages patients to participate in the decision-making process. The participants in this study are patients with knee osteoarthritis. We used acupuncture theory from Chinese medicine, performing acupuncture on three acupuncture points (Yanglingquan, Dubi, and Weizhong) to treat knee osteoarthritis. The acupuncture depth is 0.5 in. and the needle retention time is 15 min. We measured the quadriceps and the biceps femoris at loads of 3 kg and 5 kg, performing a 3-min surface electromyography (sEMG) for knee kicking extensor movement. We employ recurrence quantification analysis and root mean square values to investigate the changes in sEMG before and after acupuncture is conducted. We also compared knee motion angles and pain scales before and after therapy to investigate the influence of the therapy. A total of 11 valid clinical participants were enrolled. All had knee osteoarthritis at Stage 2 or later. Statistical analysis indicates that only the left knee VAS is significantly different (p < .05) among the assessment parameters before and after treatment. The other assessment parameters did not differ significantly (p > .05). This indicates that the acupuncture used in this study was unable to improve muscular activity and range of motion.