肌電訊號分析與輔助控制機械結構於整形手術之臨床轉譯開發

Clinical translational development of electromyography signal analysis and adjunctive mechanical devices in plastic surgery

杜隆成(Lung-Chen Tu)

指導教授 ： 張家靖

國立交通大學/生物科技學院/生物科技學系暨研究所/博士(2016年)

摘要

整形外科主要是藉著手術的方法來修補先天或後天上形體的缺失，或是改變形體的外觀。它主要包含兩方面：一，是軟組織。軟組織的範圍很廣，像肌肉，神經，血管，皮膚，甚至脂肪，組織細胞等等都屬於這類的範儔。二，是骨骼。舉凡顏面骨的骨折，移位，切除矯正，移植皆包含在內。另外手部指骨，掌骨，腕骨的骨折，移位，切除矯正，顯微移植等等，腿骨的移位，切除矯正，顯微移植，也同樣包含在整形手術的範圍內。
一般而言，整形外科手術後，都是藉著臨床觀察來判定結果成效，對於組織手術後的變化，比較少有客觀的分析。因此我們選擇對眼瞼下垂手術病人，以及具正常眼瞼功能者，使用表面肌電圖進行術前術後的量測。同時藉由波形的分析，客觀的比較眼瞼開闔肌肉之間肌電訊號的性質變化。另一方面，由於組織工程的進步，許多器官已經可在實驗室造出完成。儘管如此，漸進式的骨骼延展，仍然延用幾十年前使用的骨骼外固定器延展方式。這不但造成生活上的不方便，也容易產生感染的問題。我們提議發展全植入式自動延展之機器，以期減少術後的併發症並達成骨骼，組織延伸的目的。
經由表面肌電圖進行術前術後的量測，應用時間上的相關性之分析，眼輪匝肌和提眼肌皆未改變，因此這證明了沒有去切除或傷到眼輪匝肌可以避免術後的眼閉鎖不全。手術後的兩隻眼睛，其表面肌電圖的測量，肌肉的複雜度都增加了甚至沒有手術的眼睛它肌肉的複雜度也都增加更顯示了經由結膜切口的手術方式，增加了肌肉的調控能力。對於全植入式自動延展骨骼或神經之機器，在體外實驗已成功的隔著障礙物使用外控制器延伸或縮短內延展器。然而在植入動物的實驗發現無法精確的移動機構，可能在這些電訊號的傳輸過程，遮避了一些特定物質而無法傳達。因此未來對於傳送和接收訊號的改良將是未來研究的重點。

關鍵字

肌電圖訊號 ； 提眼肌 ； 眼輪匝肌 ； 去趨勢波動之分析 ； 全部體內植入式牽引延長器

並列摘要

It is the plastic surgeons that change the outlook of the body whatever congenital or acquired defect by surgery. Two aspects are concerned: one is the soft tissue, another is the bone. The skin, muscle, tendon and fat belong to soft tissues of the body. For fixation of fracture bone, correction and microsurgery transfer belong to the scope of plastic surgery.
Conventionally, prognosis evaluation mostly depends on clinical observations and lacks quantitative analysis tool for assessment of eyelid muscle controlling. We examined the potential of using assessments of temporal correlation and complexity in surface electromyography (SEMG) as a quantitative description for the change of muscle controlling after operation.
Accordingly, we designed a comprehensive clinical study to evaluate a new method for correcting poor levator function with severe blepharoptosis. On the other hand, external destractor for bone lengthening had been developed for long time and there are also drawbacks of the design. We have designed a totally internal implanted device with outer control for the preparing of automotive lengthening in the body.
The temporal correlation of the SEMG signal of the levator aponeurosis and the orbicularis oculi muscle remains unchanged and confirms that non-dissection of the orbicularis oculi muscle prevents post-operative lagophthalmos. There is a net effect of increased post-operative SEMG complexity for both eyes implying the improvement of muscle control. For the totally internal implantable machine, we still need further modify of the sensor design.

並列關鍵字

electromyography signal ； levator aponeurosis ； orbicularis oculi muscle ； detrended fluctuation analysis ； totally internal distracter device

參考文獻

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