建立量化真空拔罐系統及評估在骨科物理治療應用

Evaluation and development of Quantitative dry cupping in physiotherapy of orthopedics and sports medicine

邱彥鈞(Yen-Chun Chiu)

指導教授 ： 郭士民

共同指導教授 ： 陳建良 ； 黃蓮池(Lain-Chyr Hwang)

義守大學/電機資訊學院/電機工程學系/博士(2020年)

摘要

背景:
拔罐治療是現今在世界各地都極為盛行的一種民俗療法，雖然有不少文獻證實其對人體是有其療效，而且也被廣泛的運用在治療各種肌筋膜疼痛及運動傷害，但是目前的研究仍有許多爭議存在，其中最為人所批評的地方是在於拔罐的操作大都依循傳統的方式，對於拔罐的劑量並未有明確的科學定量(位置、負壓值、時間、頻率…)，尤其是在負壓值的部分，傳統是依照經驗感受或僅僅只敘述在拔罐中將軟組織吸起約2公分，然而由於不同個體軟組織順應性並不相同，拔罐的負壓便無法定量，此類不定量的操作方式，非但會造成實驗誤差，也使研究失去可信度，本研究之目的在於改進上述不科學定量的缺點，建置拔罐負壓定量化設備，並且將其使用於棒球隊員身上，測試拔罐治療是否可以有效減少運動員的疲勞、改善肌筋膜炎、增進肩膀功能、與增加軟組織的順應性。
實驗方法:
為有效定量拔罐負壓，避免因缺乏定量化而導致的實驗誤差，我們將壓克力材質拔罐器、可調強度抽痰機和偵測壓力裝置組裝成一可調整負壓大小以及即時監控壓力改變之拔罐定量裝置，並將其用於受試者身上，受試者為十八位義守大學棒球校隊之隊員，所有受試者皆接受為期四週，每週二次的拔罐治療，拔罐的的劑量為負壓400毫米汞柱持續15分鐘,所有受試者在治療前後皆接受專業骨科醫師評估是否有肌筋膜炎問題，並且使用「上肢功能受損程度問卷」與「肩關節功能性指數量表」評估肩關節功能變化，並使用儀器偵測拔罐前後軟組順應性之變化。
結果:
在實驗開始前，經骨科醫師診斷，其中九位運動員有肌筋膜疼痛問題被歸為肌筋膜疼痛組，另外九位無肌筋膜疼痛症狀者則被歸類為正常組，經過四週的拔罐治療後，肌筋膜組中有四位受試者肌筋膜疼痛消失，然後正常組中卻有一位受試者出現肌筋膜疼痛的症狀，在「上肢功能受損程度問卷」部分，正常組與肌筋膜疼痛組分別由2.50和6.11分顯著降低至1.31和2.87分，在「肩關節功能性指數量表」方面，正常組與肌筋膜疼痛組分別由35.89和36.11分顯著改善至38.67和36.56分, 至於在皮膚順應性的檢測結果，在拔罐治療後，兩組的順應性雖皆有增加但是並未達到顯著差異性。
結論:
由本實驗結果可得知，無論受試者本身有無筋肌膜疼痛，拔罐治療可以顯著增進棒球選手在功能性評估的表現，雖然在本實驗中尚未達到顯著的差異，該治療可以改善皮膚與軟組織的順應性。

關鍵字

肌筋膜疼痛症 ； 真空拔罐 ； 定量化 ； 物理治療

並列摘要

Background:
Cupping therapy is one of the popular traditional therapy in the world. Althouth the effectiveness had been proved by many academic articles, and it had been widely used in management of myofascial pain and sports injury. There are still debates exist in current literature. The most common criticized issue is that the operation of cupping therapy is performed through traditional method. The dose of cupping, included location, negative pressure value, time, and frequency, can not be quantitative. Among these, negative pressure value is most difficult to be defined. In tradition, it only depends on operator’s experience or socks the soft tissue about 2 cm in the cup. However, we could not quantitate the value of negative pressure because the soft tissue compliance is not the same in diffenent individuals. The unquantified operation not only causes the experimental error but also makes the study unreliable. The purpose of our study is to improve the defects of traditional methods. We developed a quantitative dry cupping equipment and applied it to baseball players to evaluate the effectiveness.
Materials and Methods:
We used acryl cupping cup, adjustable pumping machine, and detecting pressure device assembled into a adjustable and real-time pressure monitoring cupping equipment. Then, eighteen volunteers were collected from the baseball team of I-Shou University. We used the assembled cupping equipment for the volunteers. All subjects who included in this study received four weeks cupping therapy with the frequency of twice a week. The dose of cupping therapy is 400 mmHg in negative pressure and fifteen minutes in length of time. The conditions of myofasciitis, functional outcome, and soft tissue compliance were collected before and after intenventions.
Results:
In the fourty volunteers, nine baseball players who was diagnosed with a back or shoulder myofasciits by an orthopedic doctor were classified as myofasciitis group and the other 9 were classified as normal group. After four-week cupping treatment, 5 players in myofasciitis group recovered but 1 player in normal group was disgnosed as back myofasciitis. In DASH (Disabilities of the Arm, Shoulder, and Hand) score, the normal and myofasciitis group were improved significantly from 2.50 and 6.11 to 1.31 and 2.87 after treatment. In FLEX-SF ( Flexilevel scale of shoulder function) score, the control and experimental group were improved significantly from 35.89 and 36.11 to 38.67 and 36.56 after treatment. In the results of soft tissue compliance, the cupping therapy could increase the compliance but the difference could not achieve significant level.
Conclusion:
Cupping therapy could significantly improve the functional outcomes of baseball players no matter myofasciitis exists or not. It seems that the soft tissue compliance could be increased but larger sample size may be needed to achieve significant difference.

並列關鍵字

myofascial pain ； vacuum cupping ； quantitative ； physiotherapy

參考文獻

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