• 期刊

Forced Vital Capacity and Chest Excursion in Children with Duchenne Muscular Dystrophy

The purpose of this study was to investigate the involvement of respiratory muscle and lung volume in children with Duchenne muscular dystrophy. The index of respiratory muscle weakness and lung volume included forced vital capacity, the ratio of forced expiratory volume in 1 second and forced vital capacity, and chest excursion. Sixteen boys with Duchenne muscular dystrophy (age ranged from 6 to 13 years old) and thirty-three healthy school boys with matched age, body height and weight were included in this study. All subjects were asked to take their maximal inspiration and then exhale fully in the tests. Forced vital capacity and forced expiratory volume in 1 second were measured with spirometer in supine and sitting position. The chest excursion was measured the changes of rib circumference with a plastic centimeter tape at the level of xiphoid process. Our findings confirmed that children with Duchenne muscular dystrophy had lower forced vital capacity (l.4±0.3ℓ), % predicted forced vital capacity (78.4±16.8%) than normal controls. However, the ratio of forced expiratory volume in 1 second and forced vital capacity in children with Duchenne muscular dystrophy (93.5±7.3%) were similar to normal controls. Therefore, there was lung volume restriction in children with Duchenne muscular dystrophy. The chest excursion at the level of xiphoid process was significantly smaller in children with Duchenne muscular dystrophy (2.5+1.6cm). This might be the effects of alternation in the elastic properties of the lungs and chest wall due to respiratory muscles weakness. Differences in vital capacity between the upright and supine postures were small, it represented the relative preservation of diaphragm function in DMD.

• 期刊

手掌多汗症之電離子透入療法

多汗症往往造成患者莫大的困擾，治療上，可採用多種方法來控制或降低汗液分泌。交感神經切除或汗腺切除術，其效果雖佳，但免不了有合併症及復發現象。藥物治療，除少部份患者外，效果皆不甚理想。根據以往文獻報告，利用電離子透入法，可使汗腺口角質阻塞，對治療手掌及腳掌多汗症之效果極為良好。因此本科與皮膚科合作，從事手掌多汗症之電離子透入法研究。自民國76年3月起至10月止，對14位手掌多汗症患者作雙掌治療。方法是採直流電機器，以自來水當介質，電流量為15mA到20mA，治療時間廿分鐘，每周三次，共做兩周六次治療。並利用特殊製作之手印記錄，評估治療前，治療中及追蹤治療後手掌汗液分泌改善情形及維持期限。結果發現，一星期後約有50%的患者有改善，兩星期後約有71.5%患者有改善，但停止治療後效果能維持兩周者約57.1%，維持六周者，則有42.9%。由此研究證實，物理治療領域中之電離予透入法對治療手掌多汗症確實具有功效，方法簡單，無副作用，應視為安全可行之治療法。

• 期刊

小兒麻痺患者骨盆傾斜與脊椎側彎之關聯性

自民國七十一年八月至七十二年十二月私立振興復健醫學中心小兒麻痺症患者有骨盆傾斜者203人，弱側下肢骨盆上傾者103人，骨盆下斜者100人，經分析發現骨盆上傾者驅幹肌肉衰弱(70% fair、30% trace/poor、0% good)與脊椎側彎(77%)的比例甚高，而且兩者在程度上互有關聯性，與上傾角度也有正相關，強側下肢肌力也頗衰弱，95%坐姿重心落在強側臀部。骨盆下斜者軀幹肌力較為強壯，只有6%有輕微的脊椎側彎，強側下肢肌力強壯者多，82%坐姿重心落在弱側下肢的臀部，因而判斷骨盆上傾者主因脊髓灰白質炎波及軀幹肌肉，而骨盆下斜者主因下肢麻痺所帶來的繼發性畸型。

• 期刊

狄魁文氏狹窄性腱鞘炎

手、腕部是全身最容易發生腱鞘炎之處，其中又以狄魁文氏狹窄性腱鞘炎最常見。此病乃是在橈骨莖突處，包圍在伸拇指短肌和外展拇長肌肌腱外的滑膜發炎所致。臨床徵狀常見橈骨莖突處有微腫、觸痛；尤其是在作阻抗性拇指伸直、外展時，或作芬克司汀測試時會更痛。中年婦女為最常見的受害者。病因至今未明，但咸信以累積的微細傷害最為可能。其治療方式雖以手術將腱鞘切開的效果最為徹底，但考慮其諸多併發症的可能性，所以包括物理治療的保守性療法應為優先的選擇。

• 期刊

斜方一掌骨間關節在姆指一手指對向運動中的角色

對向動作是大姆指的一個重要動作，它幫助大姆指完成多數的握執動作。大姆指能做出對向動作，是因為它有一個特殊的腕－掌骨間關節。本篇復習了有關這個關節解剖、力學的研究，以期了解它在對向動作中的運作。

• 期刊

腕隧道症候羣的電學診斷

腕隧道症候群是一般電學診斷檢查室最常見的一種壓迫性神經病變，由於電學診斷可提供對神經生理變化上的了解，對此病的診斷有很大幫助，另外在治療上也可提供一個重要的指標，並可作為其預後的評估方法。 電學診斷應用於腕隧道症候群的方法很多，大多以神經傳導檢查正中感覺神經手指至腕部及手掌至腕部的傳導時間與傳導速度，及運動神經傳導時間等；另外以針肌電圖也可測其病變引起的神經與肌肉變化，本文例舉各種電學診斷方法，並以台大醫院復健科124位腕隧道症候群患者所得結果及參考國外學者的研究結果來探討其在臨床上的應用。

• 期刊

功能性電刺激治療中風踝關節背屈肌肉羣之效應

Functional Electrical Stimulation (F.E.S.) for spasticity Control in Clinical Studies are numerous. The purposes of this study were to examine the effectiveness of F.E.S for initiating and normalizing the ankle dorsiflexors muscle tone in stroke patients during the first 6 months post onset and for evaluating the correlation between F.E.S and proprioceptive sensation improvement. Ninety stroke patients were randomly divided into three groups. Group A was the control group receiving the regular physical therapy. In group B, F.E.S was applied on dorsiflexors of the affected side only while the patient was supine, first for 15 minutes with hip at 30º flexion, knee extension and then 15 minutes in neutral position. In group C, F.E.S was applied similarly but on both sides reciprocally. Each patient's dorsiflexor muscle conditions were evaluated at the beginning and at the end of the course of treatment. Some patients experienced rather sudden return of voluntary ankle movements after only a few F.E.S applications. The results showed that the ankle motion scores of group C were significantly higher than those of group A (p＜0.05 using BMDP 3S Kruskal-Wallis test). No significant differences in proprioceptive improvement were noted among three groups. It is suggested that the reciprocal stimulation application of F.E.S be considered for inclusion as a regular part of treatment for stroke patients in the initial stage, to stimulate ankle motion, to maintain walking pattern while the patient is bed ridden and to counter synergy.

• 期刊

骨性關節炎病因之探討

From 1985 July to 1988 Feb., 83 patients of osteoarthritis knee were studied in the Dept of Orthopaedic Surgery. There were 19 males and 64 females. Among them, 23 patients (21 ♀) involved both knees. In term of age, there were only 5 patients under 30 years old (6.02%). In contrary, there were 58 patients who were more than 45 of age (69.88%). It is obvious that the degenerated osteoarthritis is more common in the aged. Fifity-two patients were obese in this series (62.65%), and there were 44 females (84.62%) and 8 males. There is no statistically significant differnece (P＜0.05). Therefore, we can make a conclusion that the obese females are easier to get the osteoarthritic knee. The pattern of daily activity living also affected the formation of degenerated arthritis. 74.7% of the total subjects were laborers or hyperactive career. 25.3% of them did light work. In those labor workers, the higher incidence to get injury of soft tissue or joint, the more popularity to get degenerated arthritis. Many ahtuors concerned that the history of trauma was a major facotr to cause degenerated arthritis, but we couldn't demonstrate the relationship between the trauma factor and the incidence of osteoarthritis from this study.

• 期刊

膝關節屈曲性攣縮之牽引治療

關節固定(immobilization)長久時間後，引起的攣縮(contracture)是一般骨科病人常見後遺症。低重量及長時間伸長(low-load prolonged stretch)已多次被證實比短時間及高重量伸展(high-load brief stretch)效果好。長時間伸展可改變組識黏性，使組識產生最大殘餘伸長(residual elongation)和最小傷害。熱與伸展合併產生的永久性伸長比熱或伸展單獨使用好得多。本文報告利用Light，K.E等人所改良之Buck's skin traction，並合併水療、肌力訓練、行走訓練和關節調整術(Joint Mobilization)，治療因韌帶傷害或骨折後手術治療後仍合併有膝關節屈曲性攣縮(Flexion contracure)之7位病患，所得之結果。膝伸長角度對步態影響頗巨，即使在些微的伸直角度限制，仍會影響行走姿勢，所以儘可能達到正常值，本文所報告為沿著脛骨方向之牽引方式，不但使結締組織拉長外，尚包括膝關節之關展(distraction)，因而增加了股一經關節面活動(femorotibial joint play)，是一種操作簡單，病患不感覺疼痛，且效果相當良好之方法。

• 期刊

前十字韌帶受傷及其處理

前十字韌帶的主要功龍是阻擋脛骨向前脫位和限制脛骨的轉動。急性前十字韌帶受傷的診斷，包括病史的詢問、前拉測試、拉曼測試、樞軸移動測試和關節鏡檢查；慢性前十字韌帶功能不足者，除以上檢查外，還可測出功能方面的不穩與大腿的萎縮。受傷後的處理方法有保守療法和開刀治療；保守療法包含有復健運動和活動的改變，手術治療方法很多，大致可分為關節內修補卡關節外修補二類，無論傷者接受那種治療，復健計劃都佔有舉足輕重的地位；復健的目的在籍由漸進式訓練方法，讓病人能再達到受傷前的活動程度。