2012-08-012024-05-14https://scholars.lib.ntu.edu.tw/handle/123456789/659096摘要：重複性動作與高施力是腕隧道症候群重要的人因危險因子，其致病原因可能來自於 腕道壓力上升或者直接壓迫神經。過去的人因暴露評估著重在外在暴露的測量，比如測 量姿勢、重複次數或者用力的大小，但對於内部暴露的量化，研究有限。過去有部分研 究，以侵入性方法測量手腕壓力，而對於正中神經在不同的姿勢/施力暴露下，是否有可 測量的形變或壓迫，仍然缺乏足夠研究。高解像力超音波為軟組織或神經組織影像提供 了一個快速、可靠的方法，可以提供正中神經的靜態與動態影像，且較核磁共振造影取 得方便、價格便宜。依據過去文獻，已有越來越多的研究，使用高解像力超音波影像， 測量正中神經於不同姿勢下的影像(位置、直徑、截面積)變化、評估特定腕道症候群高 危險族群(洗腎患者、類風濕性關節炎)的正中神經影像變化、以及追蹤手術後的變化情 形。常用的超音波參數包括:不同手腕位置的截面積、flattening ratio、正中神經的活動度 等等。然而，上述的研究個案數不多，大多以探討姿勢的影響為主，少數幾篇探討手部 施力對正中神經影像的研究，多使用大體研究，結果也仍有分歧。因此，本研究將以正 常人以及腕道症候群個案為對象，以高解像力超音波測量其手腕部正中神經在不同手部 /手腕姿勢下，重複測量的參數變化，並比較手部使力時，影像之變化，本研究並將探討 個人因子(年齡、性別、身體質量指數、慣用手)對上述參數的影響，並與問卷及神經電 學檢查所收集之臨床資料進行相關性分析，找尋臨床意義較佳之參數，再應用於追蹤治 療。藉由研究結果，提供不同工作下手部施力或姿勢所造成的内部暴露，提供人因介入 的評估方法。<br> Abstract: Repetitive motion and high force of hand/wrist are important ergonomic risk factors forcarpal tunnel syndrome. The pathogensis is contributed to increased intracarpal tunnelpressure or direct compression. The quantification of exposure of these ergonomic exposuresrelies on measurement of external exposure, for example, posture, repetitiveness or force. Asfor internal exposure, there are very limited studies. Past researchers used pressure gauge tomeasure intracarpal tunnel pressure, but the availability was limited due to highly-invasiveapproach. Another alternative is to measure the deformity caused by increased pressure ordirect compression. Magnetic resonance image or ultrasound both can provide validmeasurement, but the later is superior for its low-cost, readily accessibility and even dynamicimages. High-resolution ultrasound has been documented to be a valid and reliablemeasurement for median nerve. Several studies applied it to study the influence ofmorphological of median nerve in different posture, among specific population at risk ofcarpal tunnel syndrome (i.e. uremic and rheumatoid arthritis patients), after operation. Thefrequently used ultrasonographic parameters included: cross-sectional area (CSA) at differentlevels, flattening ratio and excursion, etc. Nevertheless, most of these studies recruited limitednumber of subjects and the results were controversial. Besides, the impact of forceful motion,a major risk factor for work-related CTS, on the morphological change of median nerve wasnot well explored yet. In current study, we will recruit carpal tunnel syndrome and healthycontrols and evaluate the risk factors and symptoms of carpal tunnel syndrome byquestionnaires and nerve conduction studies. By using high-resolution ultrasonography, wewill measure and analyze the morphology parameters of median nerves at wrist, includingCSA, flattening ratio, perimeter and position change at different finger/wrist postures andfinger exertion. The influence of personal characteristics (age, BMI, handedness) on theseparameters will be explored and the correlation with other clinical data obtained byquestionnaires and electrodiagnosis will be analyzed. The results would help to explore thepathophysiology of carpal tunnel syndrome and provide evidence-based recommendation fortreatment. The results will help to find clinically meaningful parameters, which can be used asguide of treatment and follow up. We will also be able provide a quantitative data for internalexposure during different hand/wrist tasks and design ergonomic intervention.腕道症候群超音波職業暴露神經傳導檢查人因工程carpal tunnel syndromeultrasonographyoccupational exposurenerve conduction studiesergonomics