tag:blogger.com,1999:blog-13502683008348302532024-03-12T20:15:45.432-07:00李文吉醫師 骨科專欄「....只是把自己的所學與心得寫下,算是對自己的人生作部分交代。」baba.wg58@gmail.comhttp://www.blogger.com/profile/03790611799966344101noreply@blogger.comBlogger110125tag:blogger.com,1999:blog-1350268300834830253.post-86232250672532201472020-11-19T16:59:00.008-08:002021-08-27T18:16:07.451-07:00五十肩 關節沾黏的治療 <p><b style="font-family: Verdana, Arial, Helvetica, sans-serif;"> </b><span face="Verdana, Arial, Helvetica, sans-serif"><b><span style="font-size: medium;">--</span></b></span><span face="Verdana, Arial, Helvetica, sans-serif"> </span><b style="font-family: Verdana, Arial, Helvetica, sans-serif;"><span style="font-size: large;">閉鎖式肩關節沾黏分離 加 關節活動拓展術</span></b><span style="font-size: medium;"><span face="Verdana, Arial, Helvetica, sans-serif"> </span><b style="font-family: Verdana, Arial, Helvetica, sans-serif;">--</b></span></p><p style="font-family: Verdana, Arial, Helvetica, sans-serif;"><span data-mce-style="font-size: medium;"><span style="font-size: large;"><br /></span></span></p><p style="font-family: Verdana, Arial, Helvetica, sans-serif;"><span data-mce-style="font-size: medium;"><span style="font-size: medium;">有「五十肩」的人,大多在一段時間後,會發覺肩膀的活動變得不方便,卡卡的,有些動作做不出來,這十之八、九是肩關節產生了<strong>沾黏</strong>。</span></span></p><p style="font-family: Verdana, Arial, Helvetica, sans-serif;"><span data-mce-style="font-size: medium;"><span style="font-size: medium;">肩關節為什麼會沾黏 ?</span></span></p><p style="font-family: Verdana, Arial, Helvetica, sans-serif;"><span data-mce-style="font-size: medium;"><span style="font-size: medium;">肩關節會沾黏,是身體自主性保護措施的副作用。 保護措施是<strong>自體免疫反應</strong>,是要讓發了炎的肩關節 (主要是肩旋轉肌袖 ),不要動,得到休息,傷害不擴大;用意雖佳,卻造成人們生活起居的不便。</span></span></p><p style="font-family: Verdana, Arial, Helvetica, sans-serif;"><span data-mce-style="font-size: medium;"><span style="font-size: medium;">那 肩旋轉肌袖是怎麼會發炎呢? 肩旋轉肌袖是肩關節上端的特殊結構,它由 四條肩肌的混合腱 與 關節囊合成(complex) ;是上臂啟動 動作的「<b>指揮官</b>」,位高權重,但 卻棲身在<strong>肩峰下</strong>(肩胛-鎖骨關節下) 一個類同<strong>雪山隧道</strong>似的狹小空間。它 須機動、不停的、在「隧道」裡進進出出(伸縮);隧道空間若有問題,造成擠壓、進出磨損(請</span></span><span style="font-size: medium;"> 參閱前文https://docwglee.blogspot.com/2020/07/biomechenics.html )</span><span style="font-size: large;">,</span><span style="font-size: medium;">長期下來 就造成它的受傷與發炎。</span></p><p style="font-family: Verdana, Arial, Helvetica, sans-serif;"><span style="font-size: medium;"><span data-mce-style="font-size: medium;">關節受傷 發炎 沾黏了,通常會越沾越緊,變成 <strong>凍肩</strong>。強忍疼痛勞動,可能會造成旋轉肌袖破裂;不當的推拿強喬,甚至會造成嚴重的肱骨<strong>骨折</strong>。此時若能</span><span data-mce-style="font-size: medium;">及時 做關節鬆動術 (簡稱) (正確術式: <strong>閉鎖式肩關節沾黏分離 加 關節活動拓展術 ) ,</strong> 會有很好的療效。閉鎖式肩關節沾黏分離 加 關節活動拓展術 並不是動刀手術;而是 用</span><strong data-mce-style="font-size: medium;">全身麻醉</strong><span data-mce-style="font-size: medium;">(短時 靜脈注射),在病人完全睡著, 放鬆, 無痛下,</span><span data-mce-style="font-size: medium;">運用 <b>技巧與手法</b>,</span><span data-mce-style="font-size: medium;">緩和但連貫的、順著沾黏部位、一個接一個分離開,</span></span><span style="font-size: large;"> 施術</span><span style="font-size: large;">醫師必須對肩關節的<b> 解剖、生理、人體工學 …, </b></span><span style="font-size: large;">有相當的</span><b style="font-size: large;">熟稔,</b><span style="font-size: large;">操作手法要拿捏分寸</span><b style="font-size: large;">,</b><span style="font-size: large;">切忌蠻力硬幹。</span></p><p style="font-family: Verdana, Arial, Helvetica, sans-serif;"><span data-mce-style="font-size: medium;"><span style="font-size: medium;">術前的診間理學檢查,及<strong>多面相X光</strong>的拍攝,有助於正確的診斷,且可預估空間的大小 及 沾黏的部位,這對術中手法的操作, 是重要的指引。筆者運用這樣的方式 , 成功的鬆解了近兩千多沾黏甚至凍肩的個案。</span></span></p><p style="font-family: Verdana, Arial, Helvetica, sans-serif;"><span style="font-size: medium;"><span data-mce-style="font-size: medium;">值得強調的是:<strong>病人術後的配合</strong>。術後應盡早 認真、 積極 、正確的在醫師指導下,做肩關節的 <strong>運動治療</strong> (HESP Home Exercise Stretching Program) 。HESP是 幫病人打造一個無形的 <strong>關節軌道</strong> ( Trajectory), 然後 靠持續 正確 重覆地練習,讓 關節的動作</span></span><span style="font-size: large;">,變成慣性,</span><span data-mce-style="font-size: medium;" style="font-size: large;">運行在軌道上,</span><span style="font-size: large;">回歸正常</span><span data-mce-style="font-size: medium;" style="font-size: large;"> 。</span><span data-mce-style="font-size: medium;" style="font-size: large;">HESP 也能避免術後的<b>再沾黏</b></span><span style="font-size: large;">(Residual post-lysis adhesion)</span><span data-mce-style="font-size: medium;" style="font-size: large;">,因此 越早做越好;怕痛不做,則可能在 2~3週左右,產生</span><span data-mce-style="font-size: medium;" style="font-size: large;">再沾黏</span><span data-mce-style="font-size: medium;" style="font-size: large;">,要重來.。</span></p><p style="font-family: Verdana, Arial, Helvetica, sans-serif;"><span style="font-size: medium;"><span data-mce-style="font-size: medium;">HESP是居家 DIY 分次做、困難度不高、有輔具幫忙、做完冰敷。運動治療期間,病人須配合</span><strong data-mce-style="font-size: medium;">門診追蹤</strong><span data-mce-style="font-size: medium;">,</span></span><span data-mce-style="font-size: medium;" style="font-size: large;">追蹤</span><span style="font-size: large;">旨在 驗收動作做得對不對?是否正確?進步如何?如此 醫 病一齊 同心協力,則通常在4~6 週內 , 肩關節即可回復到正常的活動,也不再疼痛。</span></p><p style="font-family: Verdana, Arial, Helvetica, sans-serif;"><span data-mce-style="font-size: medium;"><span style="font-size: medium;">並不是所有的五十肩都會沾黏;有的五十肩 是 旋轉肌袖破裂,有的是產生鈣化性肌腱炎 ..., 不一而論,各有各不同的治療方法,就不在本文論述範圍之內了。</span></span></p>baba.wg58@gmail.comhttp://www.blogger.com/profile/03790611799966344101noreply@blogger.com1tag:blogger.com,1999:blog-1350268300834830253.post-1764765052144953302020-07-11T01:34:00.000-07:002020-07-20T15:31:09.092-07:00以生物力學 (Biomechenics) 的觀點 看肩人工關節的發展<br />
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<span style="background-color: black;"><span style="color: #cccccc;"><b><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 11.5pt; line-height: 115%;">生物力學</span></b><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 11.5pt; line-height: 115%;">是用</span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 11.5pt; line-height: 115%;">力學觀點</span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif";">,探討人</span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 11.5pt; line-height: 115%;">體之</span><span lang="ZH-TW" style="font-family: "arial" , "sans-serif"; font-size: 11.5pt; line-height: 115%;"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 11.5pt; line-height: 115%;">結構、</span><span style="font-family: "pmingliu" , serif; font-size: 15.3333px;">動作</span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 11.5pt; line-height: 115%;">、和相關</span><span style="font-family: "pmingliu" , serif; font-size: 15.3333px;">功能</span><span lang="ZH-TW" style="font-family: "arial" , "sans-serif"; font-size: 11.5pt; line-height: 115%;"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 11.5pt; line-height: 115%;">的醫學,是運動醫學的內容。骨科是骨骼肌肉系統的醫學,是即身體「<b style="mso-bidi-font-weight: normal;">動</b></span><span lang="ZH-TW" style="font-family: "arial" , "sans-serif"; font-size: 11.5pt; line-height: 115%;"> </span><span style="font-family: "arial" , "sans-serif"; font-size: 11.5pt; line-height: 115%;">(locomotion) </span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 11.5pt; line-height: 115%;">」</span><span lang="ZH-TW" style="font-family: "arial" , "sans-serif"; font-size: 11.5pt; line-height: 115%;"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 11.5pt; line-height: 115%;">的醫學,自然是生物力學關注與研究之範疇。</span></span><span style="color: #cccccc; font-family: "arial" , "sans-serif"; font-size: 11.5pt; line-height: 115%;">1970</span><span style="color: #cccccc;"><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 11.5pt; line-height: 115%;">年代起,生物力學篷勃發展,帶動了<b>人工關節</b>的快速興起;有一段時間,人工關節置換手術,甚至被認為是退化性關節炎的</span><span lang="ZH-TW" style="font-family: "arial" , "sans-serif"; font-size: 11.5pt; line-height: 115%;"> </span><b style="mso-bidi-font-weight: normal;"><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 11.5pt; line-height: 115%;">最後解決方案</span></b><span lang="ZH-TW" style="font-family: "arial" , "sans-serif"; font-size: 11.5pt; line-height: 115%;"> </span><span style="font-family: "arial" , "sans-serif"; font-size: 11.5pt; line-height: 115%;">(Final solution)</span></span><span lang="ZH-TW" style="color: #cccccc; font-family: "pmingliu" , "serif"; font-size: 11.5pt; line-height: 115%;">。</span></span><br />
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<span lang="ZH-TW" style="color: #cccccc; font-family: "pmingliu" , "serif"; font-size: 11.5pt; line-height: 115%;">人工關節的置換,髖關節發展最早,滿意度不錯;膝關節置換 則最為成功,幾可回復正常的膝關節功能,唯獨</span><span style="color: #cccccc; font-family: "pmingliu" , serif; font-size: 15.3333px;">美中不足,</span><span style="color: #cccccc; font-family: "pmingliu" , serif; font-size: 11.5pt;">肩關節的置換,術後卻有一些問題</span><span style="color: #cccccc; font-family: "pmingliu" , serif; font-size: 15.3333px;">,迄今猶待克服</span><span style="color: #cccccc; font-family: "pmingliu" , serif; font-size: 15.3333px;">。</span><span style="color: #cccccc; font-family: "pmingliu" , serif; font-size: 11.5pt;">之所以會如此,關鍵是在肩關節解剖學的結構 與 肩關節生理上須擔負大</span><span style="color: #cccccc; font-family: "pmingliu" , serif; font-size: 15.3333px;">幅度</span><span style="color: #cccccc; font-family: "pmingliu" , serif; font-size: 11.5pt;">的活動需求(ROM)所致。</span></span></div>
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<span style="background-color: black;"><span style="color: #cccccc;"><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 11.5pt; line-height: 115%;">肩關節是人體活動度最大的關節,若不挑剔活動全程需在同一平面,則肩關節幾可有</span><span style="font-family: "arial" , "sans-serif"; font-size: 11.5pt; line-height: 115%;">360</span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 11.5pt; line-height: 115%;">度迴轉</span><span style="font-family: "arial" , "sans-serif"; font-size: 11.5pt; line-height: 115%;">(Rotation)</span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 11.5pt; line-height: 115%;">,這是其它關節所辦不到的!關節</span><span style="font-family: "pmingliu" , serif; font-size: 15.3333px;">,</span><span style="font-family: "pmingliu" , serif; font-size: 15.3333px;">生理上的基本要求一是</span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 11.5pt; line-height: 115%;"> : </span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 11.5pt; line-height: 115%;">結構要穩;二是:範圍內活動要無所障礙。這兩個要求,立場是矛盾與對立的,但也是所有關節的圭臬。人工關節的設計</span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 11.5pt; line-height: 115%;">,自然也是朝此兩項宗旨, 做為設計的目標</span></span><span style="color: #cccccc; font-family: "pmingliu" , serif; font-size: 15.3333px;">。</span></span><br />
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<span style="background-color: black;"><span style="color: #cccccc; font-family: "pmingliu" , serif; font-size: 15.3333px;">肩關節的<b>硬體</b>結構,包括鎖骨、肩胛骨、肱骨。結構裡的 </span><span lang="ZH-TW" style="color: #cccccc; font-family: "pmingliu" , "serif"; font-size: 11.5pt; line-height: 17.6333px;"><b>肱骨</b></span><b style="color: #cccccc;"><span style="font-family: "arial" , "sans-serif"; font-size: 11.5pt; line-height: 17.6333px;">-</span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 11.5pt; line-height: 17.6333px;">肩胛盂關節(Humeroglenoid joint)</span></b></span><span style="font-family: "arial" , "sans-serif"; font-size: 11.5pt; line-height: 17.6333px;"><span style="background-color: black;"> </span><span style="background-color: black; color: #f3f3f3;">(</span></span><span style="background-color: black; color: #f3f3f3;"><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 11.5pt; line-height: 17.6333px;">圖</span><span style="font-family: "arial" , "sans-serif"; font-size: 11.5pt; line-height: 17.6333px;">1)</span><span style="color: #cccccc;"><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 11.5pt; line-height: 115%;">, 就是 把像高爾夫開球(開球)</span><b style="mso-bidi-font-weight: normal;"><span style="font-family: "arial" , "sans-serif"; font-size: 11.5pt; line-height: 115%;">Tee</span></b><b style="mso-bidi-font-weight: normal;"><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 11.5pt; line-height: 115%;">座</span><span lang="ZH-TW" style="font-family: "arial" , sans-serif; font-size: 11.5pt; line-height: 115%;">的</span></b><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 11.5pt; line-height: 115%;">肩胛盂</span></span><span style="font-family: "pmingliu" , serif; font-size: 15.3333px;">,</span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 11.5pt; line-height: 115%;">結合肱骨</span><span style="font-family: "arial" , "sans-serif"; font-size: 11.5pt; line-height: 115%;">( </span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 11.5pt; line-height: 115%;">此處的高爾夫球</span><span style="font-family: "arial" , "sans-serif"; font-size: 11.5pt; line-height: 115%;">) </span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 11.5pt; line-height: 115%;">組合而成</span><span style="font-family: "pmingliu" , serif; font-size: 15.3333px;">。</span></span><br />
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<tr><td class="tr-caption" style="text-align: center;"><span style="color: black; font-size: x-small;"><b style="background-color: white;">圖 1. 如 Tee 座的<span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; line-height: 17.6333px;">肱骨</span><span style="font-family: "times new roman";"><span style="font-family: "arial" , "sans-serif"; line-height: 17.6333px;">-</span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; line-height: 17.6333px;">肩胛盂結構</span></span></b></span><br />
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<span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 11.5pt; line-height: 115%;"><span style="background-color: black; color: #cccccc;">這組合是沒得選擇的組合,卻也是關鍵性的組合</span></span><span style="background-color: black;"><span style="color: #cccccc; font-family: "pmingliu" , serif; font-size: 15.3333px;">,但Tee座置球體</span><span style="color: #cccccc; font-family: "pmingliu" , serif; font-size: 15.3333px;">,力學上 自然是不穩的 ! 可也就靠這「<b>不穩」</b>的 組合</span><span style="color: #cccccc; font-family: "pmingliu" , serif; font-size: 15.3333px;">,</span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 11.5pt; line-height: 115%;"><span style="color: #cccccc;">達到活動最大的目的</span></span><span style="color: #cccccc; font-family: "pmingliu" , serif; font-size: 15.3333px;">。</span><span style="color: #cccccc; font-family: "pmingliu" , serif; font-size: 11.5pt;"> </span></span></div>
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<a href="https://1.bp.blogspot.com/-3h9qXEF-3io/XfSkv12UPLI/AAAAAAAAI7U/kGGkXuPbDSkHKyrTggA-47MKbASkUMsSACLcBGAsYHQ/s1600/191124-2.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="264" data-original-width="268" src="https://1.bp.blogspot.com/-3h9qXEF-3io/XfSkv12UPLI/AAAAAAAAI7U/kGGkXuPbDSkHKyrTggA-47MKbASkUMsSACLcBGAsYHQ/s1600/191124-2.jpg" /></a><span style="background-color: black;"><span style="color: #cccccc;"><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 11.5pt; line-height: 115%;">而穩定的要求,則以關節囊</span><span lang="ZH-TW" style="font-family: "arial" , "sans-serif"; font-size: 11.5pt; line-height: 115%;"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 11.5pt; line-height: 115%;">與旋轉肌袖的合成體 <b>--</b></span><span lang="ZH-TW" style="font-family: "arial" , "sans-serif"; font-size: 11.5pt; line-height: 115%;"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 11.5pt; line-height: 115%;"><b>旋轉肌袖 </b></span></span><span style="color: #cccccc; font-family: "arial" , "sans-serif"; font-size: 11.5pt; line-height: 17.6333px;">(</span><span lang="ZH-TW" style="color: #cccccc; font-family: "pmingliu" , "serif"; font-size: 11.5pt; line-height: 17.6333px;">圖</span><span style="color: #cccccc; font-family: "arial" , "sans-serif"; font-size: 11.5pt; line-height: 17.6333px;">2)</span><span lang="ZH-TW" style="color: #cccccc; font-family: "pmingliu" , "serif"; font-size: 11.5pt; line-height: 115%;">,以 像櫬衫袖口,包住</span><span style="color: #cccccc; font-family: "arial" , "sans-serif"; font-size: 11.5pt; line-height: 115%;">3/4 </span><span lang="ZH-TW" style="color: #cccccc; font-family: "pmingliu" , "serif"; font-size: 11.5pt; line-height: 115%;">的肱骨</span><span style="color: #cccccc; font-family: "arial" , "sans-serif"; font-size: 11.5pt; line-height: 115%;">-</span><span lang="ZH-TW" style="color: #cccccc; font-family: "pmingliu" , "serif"; font-size: 11.5pt; line-height: 115%;">肩盂關節</span><span lang="ZH-TW" style="color: #cccccc; font-family: "pmingliu" , "serif"; font-size: 11.5pt; line-height: 115%;">,建構肩關節穏定的<b>第一道穩定</b></span><span style="color: #cccccc; font-family: "pmingliu" , serif; font-size: 15.3333px;">,</span></span><br />
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<span style="background-color: black;"><span style="color: #eeeeee;"><b><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 10pt; line-height: 115%;"> 圖</span></b><b><span style="font-family: "arial" , "sans-serif"; font-size: 10pt; line-height: 115%;">2. </span></b><b><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 10pt; line-height: 115%;">旋轉肌袖</span></b><b><span lang="ZH-TW" style="font-family: "arial" , "sans-serif"; font-size: 10pt; line-height: 115%;"> </span></b><b><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 10pt; line-height: 115%;">是棘上肌</span></b><b><span style="font-family: "arial" , "sans-serif"; font-size: 10pt; line-height: 115%;">(Supraspinatus)</span></b><b><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 10pt; line-height: 115%;">、棘下肌</span></b><b><span style="font-family: "arial" , "sans-serif"; font-size: 10pt; line-height: 115%;">(Infraspinatus)</span></b><b><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 10pt; line-height: 115%;">、肩胛下肌</span></b><b><span style="font-family: "arial" , "sans-serif"; font-size: 10pt; line-height: 115%;">(Subscapularis) </span></b><b><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 10pt; line-height: 115%;">及小圓肌</span></b><b><span style="font-family: "arial" , "sans-serif"; font-size: 10pt; line-height: 115%;">(Teres mnor) </span></b><b><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 10pt; line-height: 115%;">組成,</span></b><b><span style="font-family: "arial" , "sans-serif"; font-size: 10pt; line-height: 115%;">4</span></b><b><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 10pt; line-height: 115%;">肌肌腱遠端</span></b><b><span lang="ZH-TW" style="font-family: "arial" , "sans-serif"; font-size: 10pt; line-height: 115%;"> </span></b><b><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 10pt; line-height: 115%;">集合成袖,附著及固定於肱骨粗隆</span></b><b><span style="font-family: "arial" , "sans-serif"; font-size: 10pt; line-height: 115%;">(</span></b><b><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 10pt; line-height: 115%;">接骨點</span></b><b><span style="font-family: "arial" , "sans-serif"; font-size: 10pt; line-height: 115%;">)</span></b><b><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 10pt; line-height: 115%;">。</span></b></span><b><span style="color: #eeeeee;"><span style="font-family: "arial" , "sans-serif"; font-size: 10pt; line-height: 115%;"> </span></span><span style="color: #222222; font-family: "arial" , "sans-serif"; font-size: 10pt; line-height: 115%;"> <o:p></o:p></span></b></span></div>
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<span style="background-color: black;"><span lang="ZH-TW" style="color: #222222; font-family: "pmingliu" , serif; font-size: 11.5pt; line-height: 115%;"></span><br /></span><span style="background-color: black;"><span style="color: #eeeeee;"><span lang="ZH-TW" style="font-family: "pmingliu" , serif; font-size: 11.5pt; line-height: 115%;">再以壯碩的三角肌環圍在外,建構其<b>第二道穩定</b></span></span><span style="color: #eeeeee; font-family: "pmingliu" , serif; font-size: 15.3333px;">,</span><span style="color: #eeeeee; font-family: "pmingliu" , serif; font-size: 15.3333px;"> 這是既精簡又智慧的的設計</span><span style="color: #eeeeee; font-family: "pmingliu" , serif; font-size: 15.3333px;">。</span><span lang="ZH-TW" style="color: #eeeeee; font-family: "pmingliu" , serif; font-size: 11.5pt; line-height: 115%;">靠三角肌來穩住肩關節</span><span style="color: #eeeeee; font-family: "pmingliu" , serif; font-size: 15.3333px;">,</span><span lang="ZH-TW" style="color: #eeeeee; font-family: "pmingliu" , serif; font-size: 11.5pt; line-height: 115%;"> 同時也靠三角肌擔負上臂動作的動力。這樣的安排,滿足了肩關節360度迴旋的完美</span><span style="color: #eeeeee; font-family: "pmingliu" , serif; font-size: 15.3333px;">,</span><span lang="ZH-TW" style="font-family: "pmingliu" , serif; font-size: 11.5pt; line-height: 115%;"><span style="color: #eeeeee;"> </span><span style="color: #f3f3f3;">但</span></span><span style="color: #f3f3f3;"><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 11.5pt; line-height: 17.6333px;">肱骨</span><span style="font-family: "arial" , "sans-serif"; font-size: 11.5pt; line-height: 17.6333px;">-</span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 11.5pt; line-height: 17.6333px;">肩盂關節不穩的本質</span><span lang="ZH-TW" style="font-family: "pmingliu" , serif; font-size: 11.5pt; line-height: 115%;">,也說明了</span></span><span lang="ZH-TW" style="color: #eeeeee; font-family: "pmingliu" , serif; font-size: 11.5pt; line-height: 115%;">肩關節為什麼容易脫臼的原因。</span></span><br />
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<span style="background-color: black;"><span style="color: #eeeeee;"><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 11.5pt; line-height: 115%;">肩關節有另一瑕庛就是: 供應肱骨頭<b>-</b>頸端的血液並不旺盛,這與它担綱的功能十分不相配,既缺大血管</span></span><span style="color: #eeeeee; font-family: "arial" , sans-serif; font-size: 15.3333px;">,</span><span style="font-family: "arial" , sans-serif; font-size: 15.3333px;"><span style="color: #f3f3f3;">而血管的分佈與量也</span></span><span style="color: #eeeeee;"><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 11.5pt; line-height: 115%;"><span style="color: #f3f3f3;">不多</span></span><span lang="ZH-TW" style="color: #eeeeee; font-family: "arial" , "sans-serif"; font-size: 11.5pt; line-height: 115%;"> </span><span style="color: #eeeeee; font-family: "arial" , "sans-serif"; font-size: 11.5pt; line-height: 115%;">(</span><span lang="ZH-TW" style="color: #eeeeee; font-family: "pmingliu" , "serif"; font-size: 11.5pt; line-height: 115%;">圖</span><span style="color: #eeeeee; font-family: "arial" , "sans-serif"; font-size: 11.5pt; line-height: 115%;">3) ,這樣血循不旺的結果是</span><span lang="ZH-TW" style="color: #eeeeee; font-family: "pmingliu" , serif; font-size: 11.5pt; line-height: 17.6333px; text-align: center;"> </span></span><span style="color: #f3f3f3;"><span lang="ZH-TW" style="font-family: "pmingliu" , serif; font-size: 11.5pt; line-height: 115%;">肱骨粗隆
</span><span style="font-family: "pmingliu" , serif; font-size: 11.5pt; line-height: 115%;">(Tuberosity)</span></span><span style="color: #f3f3f3;"><span lang="ZH-TW" style="font-family: "pmingliu" , serif; font-size: 11.5pt; line-height: 17.6333px; text-align: center;">的骨質是稀疏的,致使容易發生骨折,而骨折 </span><span style="font-family: "arial" , sans-serif; font-size: 11.5pt; line-height: 17.6333px; text-align: center;">(</span><span lang="ZH-TW" style="font-family: "pmingliu" , serif; font-size: 11.5pt; line-height: 17.6333px; text-align: center;">通常是骨</span><span lang="ZH-TW" style="font-family: "pmingliu" , serif; font-size: 11.5pt; line-height: 17.6333px; text-align: center;">碎裂</span><span style="font-family: "arial" , sans-serif; font-size: 11.5pt; line-height: 17.6333px; text-align: center;">) </span><span lang="ZH-TW" style="font-family: "pmingliu" , serif; font-size: 11.5pt; line-height: 17.6333px; text-align: center;">後,</span><span style="font-family: "pmingliu" , serif; font-size: 11.5pt;">也因血循不豐富,</span><span style="font-family: "pmingliu" , serif; font-size: 11.5pt; text-align: center;">骨的癒合慢或不佳</span></span></span><span style="background-color: black; color: #eeeeee; font-family: "pmingliu" , serif; font-size: 15.3333px;">。</span></div>
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<b style="font-family: PMingLiU, serif; font-size: 11.5pt;"><span lang="ZH-TW" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; font-size: 10pt; line-height: 115%;">圖 </span><span style="font-family: "arial" , sans-serif; font-size: 10pt; line-height: 115%;">3. </span><span lang="ZH-TW" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; font-size: 10pt; line-height: 115%;">肱骨頭</span><span style="font-family: "arial" , sans-serif; font-size: 10pt; line-height: 115%;"> </span><span lang="ZH-TW" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; font-size: 10pt; line-height: 115%;">頸部,</span><span lang="ZH-TW" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; font-size: 10pt; line-height: 115%;">僅有腋下動脈之</span><span lang="ZH-TW" style="font-family: "arial" , sans-serif; font-size: 10pt; line-height: 115%;"> </span><span lang="ZH-TW" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; font-size: 10pt; line-height: 115%;">前迴轉分枝</span><span lang="ZH-TW" style="font-family: "arial" , sans-serif; font-size: 10pt; line-height: 115%;"> </span><span lang="ZH-TW" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; font-size: 10pt; line-height: 115%;">與 </span><span lang="ZH-TW" style="font-family: "arial" , sans-serif; font-size: 10pt; line-height: 115%;"> </span><span lang="ZH-TW" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; font-size: 10pt; line-height: 115%;">後迴轉分枝,供給的血循並不旺盛。</span><span style="font-family: "arial" , sans-serif; font-size: 10pt; line-height: 115%;"> </span></b><span style="font-family: "pmingliu" , serif; font-size: 11.5pt;"> </span></div>
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<span style="background-color: black; color: #f3f3f3;"><span lang="ZH-TW" style="font-family: "pmingliu" , serif; font-size: 11.5pt; line-height: 115%;">而肩關節的硬體範疇</span><span style="font-family: "arial" , sans-serif; font-size: 11.5pt; line-height: 115%;"> (boundary)</span><span lang="ZH-TW" style="font-family: "pmingliu" , serif; font-size: 11.5pt; line-height: 115%;">,包括肩峰、鎖骨外端、肱骨</span><span style="font-family: "arial" , sans-serif; font-size: 11.5pt; line-height: 115%;">-肩盂關節</span></span><span style="background-color: black; color: #f3f3f3; font-family: "pmingliu" , serif; font-size: 15.3333px;">、</span><span style="background-color: black; color: #f3f3f3;"><span style="font-family: "arial" , sans-serif; font-size: 11.5pt; line-height: 115%;">肩盂<b>...</b>等</span></span><span style="background-color: black; color: #f3f3f3; font-family: "pmingliu" , serif; font-size: 15.3333px;">,對活動度大的肩,顯然是一個<b>有限空間</b>的箍筐(圖 4-1, 4-2, 4-3, 4-4, 4-5. )˙</span></div>
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<tr><td class="tr-caption" style="text-align: center;"><b>圖 4-2</b></td></tr>
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<tr><td class="tr-caption" style="text-align: center;"><b><span style="background-color: black; color: #f3f3f3;">圖 4-1</span></b></td></tr>
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<tr><td class="tr-caption" style="text-align: center;"><b>圖 4-3 </b></td></tr>
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<tr><td class="tr-caption" style="text-align: center;"><b>圖 4-4</b></td></tr>
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<span style="background-color: black; color: #f3f3f3;"><span lang="ZH-TW" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; line-height: 115%; text-align: center;">只要結構上</span><span style="font-family: "arial" , "sans-serif"; font-size: 11.5pt; line-height: 115%; text-align: center;">(</span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 11.5pt; line-height: 115%; text-align: center;">解剖學</span><span style="font-family: "arial" , "sans-serif"; font-size: 11.5pt; line-height: 115%; text-align: center;">)</span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 11.5pt; line-height: 115%; text-align: center;">有稍許角度的瑕疵,就會有空間不足的問題,產生肩關節內部的擠壓與摩擦 </span></span><br />
<span style="background-color: black; color: #f3f3f3;"><b style="text-align: center;"><span style="font-family: "arial" , "sans-serif"; font-size: 11.5pt; line-height: 115%;">-- </span></b><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 11.5pt; line-height: 115%; text-align: center;">此即</span><span lang="ZH-TW" style="font-family: "arial" , "sans-serif"; font-size: 11.5pt; line-height: 115%; text-align: center;"> </span><b style="text-align: center;"><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 11.5pt; line-height: 115%;">肩峰下夾擊</span></b><b style="text-align: center;"><span lang="ZH-TW" style="font-family: "arial" , "sans-serif"; font-size: 11.5pt; line-height: 115%;"> </span></b><b style="text-align: center;"><span style="font-family: "arial" , "sans-serif"; font-size: 11.5pt; line-height: 115%;">(Impingement)</span></b><span lang="ZH-TW" style="font-family: "arial" , "sans-serif"; font-size: 11.5pt; line-height: 17.6333px; text-align: center;"> </span><span style="font-family: "arial" , "sans-serif"; font-size: 11.5pt; line-height: 17.6333px; text-align: center;">(</span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 11.5pt; line-height: 17.6333px; text-align: center;">圖</span><span style="font-family: "arial" , "sans-serif"; font-size: 11.5pt; line-height: 17.6333px; text-align: center;">5)</span><span style="text-align: center;"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 11.5pt; line-height: 115%; text-align: center;">。</span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 11.5pt; line-height: 115%; text-align: center;"> </span></span><br />
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<tr><td class="tr-caption" style="text-align: center;"><b>圖 4-5</b></td></tr>
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<b style="font-family: pmingliu, serif; font-size: 11.5pt; text-align: center;"><span lang="ZH-TW" style="color: #222222; font-family: "pmingliu" , "serif"; font-size: 10pt; line-height: 15.3333px;"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 10pt; line-height: 15.3333px;">註: </span></b><span lang="ZH-TW" style="font-family: "pmingliu" , serif; font-size: 11.5pt; line-height: 17.6333px; text-align: center;"><b style="font-size: medium; text-align: left;"><span lang="ZH-TW" style="font-family: "pmingliu" , serif; font-size: 10pt; line-height: 15.3333px;">圖</span></b><b style="font-size: medium; text-align: left;"><span style="font-size: 10pt; line-height: 15.3333px;">4-1~4-2 </span></b><b style="font-size: medium; text-align: left;"><span lang="ZH-TW" style="font-family: "pmingliu" , serif; font-size: 10pt; line-height: 15.3333px;">圖示:肩峰下空間</span></b><b style="font-size: medium; text-align: left;"><span style="font-size: 10pt; line-height: 15.3333px;"> (</span></b><b style="font-size: medium; text-align: left;"><span lang="ZH-TW" style="font-family: "pmingliu" , serif; font-size: 10pt; line-height: 15.3333px;">點示</span></b><b style="font-size: medium; text-align: left;"><span style="font-family: "arial" , sans-serif; font-size: 10pt; line-height: 15.3333px;">)</span></b><b style="font-size: medium; text-align: left;"><span lang="ZH-TW" style="font-family: "pmingliu" , serif; font-size: 10pt; line-height: 15.3333px;">。</span></b><b style="font-size: medium; text-align: left;"><span lang="ZH-TW" style="font-size: 10pt; line-height: 15.3333px;"> </span></b><b style="font-size: medium; text-align: left;"><span lang="ZH-TW" style="font-family: "pmingliu" , serif; font-size: 10pt; line-height: 15.3333px;">圖</span></b><b style="font-size: medium; text-align: left;"><span lang="ZH-TW" style="font-size: 10pt; line-height: 15.3333px;"> </span></b><b style="font-size: medium; text-align: left;"><span style="font-size: 10pt; line-height: 15.3333px;">4-3~4-5 </span></b><b style="font-size: medium; text-align: left;"><span lang="ZH-TW" style="font-family: "pmingliu" , serif; font-size: 10pt; line-height: 15.3333px;">:</span></b><b style="font-size: medium; text-align: left;"><span lang="ZH-TW" style="font-size: 10pt; line-height: 15.3333px;"> </span></b><b style="font-size: medium; text-align: left;"><span lang="ZH-TW" style="font-family: "pmingliu" , serif; font-size: 10pt; line-height: 15.3333px;">評估與測量空間大小之幾種方法。</span></b></span><br />
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<span style="background-color: black; color: #eeeeee;"><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 11.5pt; line-height: 115%;">夾擊會造成旋轉肌袖的受傷、發炎、沾黏、增生、鈣化、破裂等</span><span style="font-family: "arial" , "sans-serif"; font-size: 11.5pt; line-height: 115%;"><b>…</b></span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 11.5pt; line-height: 115%;">種種病變,此即</span><span lang="ZH-TW" style="font-family: "arial" , "sans-serif"; font-size: 11.5pt; line-height: 115%;"> </span><b><span style="font-family: "arial" , "sans-serif"; font-size: 11.5pt; line-height: 115%;">Rotator Cuff Tendinopathy (旋轉肌袖病變 </span></b><b><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 11.5pt; line-height: 115%;">或稱</span></b><b><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 11.5pt; line-height: 115%;">五十肩</span></b><b><span lang="ZH-TW" style="font-family: "arial" , "sans-serif"; font-size: 11.5pt; line-height: 115%;"> </span></b><b><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 11.5pt; line-height: 115%;">症</span></b><b><span style="font-family: "arial" , "sans-serif"; font-size: 11.5pt; line-height: 115%;">)。</span></b><span style="font-family: "arial" , "sans-serif"; font-size: 11.5pt; line-height: 17.6333px;">旋轉肌袖病變 </span><span style="font-family: "pmingliu" , serif; font-size: 11.5pt;">需手術治療;但要修補已磨損、撕裂、分離、攣縮的肌袖,並使它重新牢固長在新的接骨點上,手術困難度高,成功率也不理想。</span></span></div>
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<span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 11.5pt; line-height: 115%;">旋轉肌袖是</span><span lang="ZH-TW" style="font-family: "arial" , "sans-serif"; font-size: 11.5pt; line-height: 115%;"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 11.5pt; line-height: 115%;">肩關節不可或缺的特殊結構,是肩及上肢抬舉、轉動的啟動器</span><span lang="ZH-TW" style="font-family: "arial" , "sans-serif"; font-size: 11.5pt; line-height: 115%;"> </span><span style="font-family: "arial" , "sans-serif"; font-size: 11.5pt; line-height: 115%;">( </span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 11.5pt; line-height: 115%;">形</span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 11.5pt; line-height: 115%;">同發動汽車的火星塞</span><span lang="ZH-TW" style="font-family: "arial" , "sans-serif"; font-size: 11.5pt; line-height: 115%;"> </span><span style="font-family: "arial" , "sans-serif"; font-size: 11.5pt; line-height: 115%;">)</span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 11.5pt; line-height: 115%;">,功能獨特而無可或缺。在肱骨頭頸端骨折</span><span lang="ZH-TW" style="font-family: "arial" , "sans-serif"; font-size: 11.5pt; line-height: 115%;"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 11.5pt; line-height: 115%;">或</span><span lang="ZH-TW" style="font-family: "arial" , "sans-serif"; font-size: 11.5pt; line-height: 115%;"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 11.5pt; line-height: 115%;">置換</span><span lang="ZH-TW" style="font-family: "arial" , "sans-serif"; font-size: 11.5pt; line-height: 115%;"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 11.5pt; line-height: 115%;">肩人工關節手術,旋轉肌袖難以保全,難以修復的情況下</span><span lang="ZH-TW" style="font-family: "arial" , "sans-serif"; font-size: 11.5pt; line-height: 115%;"> </span><span style="font-family: "arial" , "sans-serif"; font-size: 11.5pt; line-height: 115%;">(</span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 11.5pt; line-height: 115%;">如上述</span><span style="font-family: "arial" , "sans-serif"; font-size: 11.5pt; line-height: 115%;">)</span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 11.5pt; line-height: 115%;">;術後都避免不了會走上肩痛、無力、肩僵硬</span><span lang="ZH-TW" style="font-family: "arial" , "sans-serif"; font-size: 11.5pt; line-height: 115%;"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 11.5pt; line-height: 115%;">、肩活動不全</span><span style="font-family: "arial" , "sans-serif"; font-size: 11.5pt; line-height: 115%;">… </span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 11.5pt; line-height: 115%;">的後遺症。</span></span><br />
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<span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 11.5pt; line-height: 115%;">因應上述術後的問題,專家們轉而從<b>肌腱移轉</b></span><b><span lang="ZH-TW" style="font-family: "arial" , "sans-serif"; font-size: 11.5pt; line-height: 115%;"> </span></b><b><span style="font-family: "arial" , "sans-serif"; font-size: 11.5pt; line-height: 115%;">(Tendon
Transfer)</span></b><span style="font-family: "arial" , "sans-serif"; font-size: 11.5pt; line-height: 115%;"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 11.5pt; line-height: 115%;">的概念,嚐試用</span><span lang="ZH-TW" style="font-family: "arial" , "sans-serif"; font-size: 11.5pt; line-height: 115%;"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 11.5pt; line-height: 115%;">肩三角肌就近取材</span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 11.5pt; line-height: 115%;">兼代</span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 11.5pt; line-height: 115%;">旋轉肌袖的作用。</span><span style="font-family: "arial" , "sans-serif"; font-size: 11.5pt; line-height: 115%;">1990</span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 11.5pt; line-height: 115%;">年代,開始有了</span><span style="font-family: "arial" , "sans-serif"; font-size: 11.5pt; line-height: 115%;"><o:p></o:p></span><b><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 11.5pt; line-height: 115%;">反轉式肩全人工關節置換術</span><span style="font-family: "arial" , "sans-serif"; font-size: 11.5pt; line-height: 115%;">( Reverse Total Shoulder Arthroplasty) </span></b><span style="font-family: "arial" , sans-serif; font-size: 11.5pt; line-height: 115%;">(</span><span lang="ZH-TW" style="font-family: "pmingliu" , serif; font-size: 11.5pt; line-height: 115%;">圖</span><span style="font-family: "arial" , sans-serif; font-size: 11.5pt; line-height: 115%;">6-1) </span><span lang="ZH-TW" style="font-family: "pmingliu" , serif; font-size: 11.5pt; line-height: 115%;">的創新手術,</span></span><br />
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<tr><td style="text-align: center;"><a href="https://1.bp.blogspot.com/-O_D6R6BSsKw/XeEykXSZUgI/AAAAAAAAIwI/PK7MhrMZHx4nfpsWNfDdTKiAwF-mcZhbwCLcBGAsYHQ/s1600/191124-6-1.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="202" data-original-width="139" src="https://1.bp.blogspot.com/-O_D6R6BSsKw/XeEykXSZUgI/AAAAAAAAIwI/PK7MhrMZHx4nfpsWNfDdTKiAwF-mcZhbwCLcBGAsYHQ/s1600/191124-6-1.jpg" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><b><span style="background-color: black; color: #f3f3f3;">圖 6-1 反轉式肩全人工關節</span></b></td></tr>
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</span><span style="background-color: black; color: #f3f3f3;"><span lang="ZH-TW" style="font-family: "pmingliu" , serif; font-size: 11.5pt; line-height: 115%;">作法是</span><span lang="ZH-TW" style="font-family: "arial" , sans-serif; font-size: 11.5pt; line-height: 115%;"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , serif; font-size: 11.5pt; line-height: 115%;">把肱骨頭 </span><span style="font-family: "arial" , sans-serif; font-size: 11.5pt; line-height: 115%;">(</span><span lang="ZH-TW" style="font-family: "pmingliu" , serif; font-size: 11.5pt; line-height: 115%;">球體</span><span style="font-family: "arial" , sans-serif; font-size: 11.5pt; line-height: 115%;">)</span><span lang="ZH-TW" style="font-family: "pmingliu" , serif; font-size: 11.5pt; line-height: 115%;">,種在原肩胛盂;反把肩盂連肱髓柄之假體,植入肱骨幹,藉<b>拉長</b>三角肌肩峰下的軸距</span></span><span style="background-color: black; color: #f3f3f3; font-family: "pmingliu" , serif; font-size: 15.3333px;">,</span><span style="background-color: black; color: #f3f3f3;"><span lang="ZH-TW" style="font-family: "pmingliu" , serif; font-size: 11.5pt; line-height: 115%;">以杆桿原理的作用方式</span></span><span style="background-color: black; color: #f3f3f3; font-family: "pmingliu" , serif; font-size: 15.3333px;">,利用三角肌代替旋轉肌袖的功能</span><span style="background-color: black; color: #eeeeee; font-family: "pmingliu" , serif; font-size: 15.3333px;">。</span><span style="background-color: black; font-size: 15.3333px;"><span style="color: #f3f3f3; font-family: "arial" , sans-serif;">(圖 6-2, 6-3)</span></span><br />
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<span style="background-color: black; color: #f3f3f3;"><span lang="ZH-TW" style="font-family: "pmingliu" , serif; font-size: 11.5pt; line-height: 115%;"><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; margin-right: 1em; text-align: left;"><tbody>
<tr><td style="text-align: center;"><a href="https://1.bp.blogspot.com/-mJ1K-8wXKLo/XeEzKQVGhRI/AAAAAAAAIwU/zX7yDX90VXsQBbsGc_1UhUhAlfYCfKYWQCEwYBhgL/s1600/191124-6-2.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="204" data-original-width="180" src="https://1.bp.blogspot.com/-mJ1K-8wXKLo/XeEzKQVGhRI/AAAAAAAAIwU/zX7yDX90VXsQBbsGc_1UhUhAlfYCfKYWQCEwYBhgL/s1600/191124-6-2.jpg" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><b>圖 6-2</b></td></tr>
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<tr><td style="text-align: center;"><a href="https://1.bp.blogspot.com/-CM5TebvCIZQ/XeE1XHg3h4I/AAAAAAAAIwc/zX-fCJmHJTIX9hqDe1-NQiruMzH22FQCQCLcBGAsYHQ/s1600/191124-6-3.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="203" data-original-width="193" src="https://1.bp.blogspot.com/-CM5TebvCIZQ/XeE1XHg3h4I/AAAAAAAAIwc/zX-fCJmHJTIX9hqDe1-NQiruMzH22FQCQCLcBGAsYHQ/s1600/191124-6-3.jpg" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><b>圖 6-3</b></td></tr>
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<span lang="ZH-TW" style="background-color: black; color: #f3f3f3; font-family: "pmingliu" , "serif"; font-size: 11.5pt; line-height: 115%;"><span lang="ZH-TW" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; font-size: 11.5pt; line-height: 115%;">反轉式全人工肩關節置換術,幾經多次修改,術後的臨床表現的確比傳統式肩全人工關節 </span><span style="font-family: "arial" , sans-serif; font-size: 11.5pt; line-height: 115%;">(</span><span lang="ZH-TW" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; font-size: 11.5pt; line-height: 115%;">圖</span><span style="font-family: "arial" , sans-serif; font-size: 11.5pt; line-height: 115%;">7)<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://1.bp.blogspot.com/-vLK0Lrsyv7g/XeE2ZnhXqrI/AAAAAAAAIwo/K-IuIX0CK-wmb3UprcLArMg8-efXPQXqwCLcBGAsYHQ/s1600/191124-7.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="156" data-original-width="257" height="194" src="https://1.bp.blogspot.com/-vLK0Lrsyv7g/XeE2ZnhXqrI/AAAAAAAAIwo/K-IuIX0CK-wmb3UprcLArMg8-efXPQXqwCLcBGAsYHQ/s320/191124-7.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><b>圖 7 傳統式肩人工關節</b></td></tr>
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</span><span lang="ZH-TW" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; font-size: 11.5pt; line-height: 115%;">好很多,術後關節的疼痛、</span><span lang="ZH-TW" style="font-family: "arial" , sans-serif; font-size: 11.5pt; line-height: 115%;"> </span><span lang="ZH-TW" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; font-size: 11.5pt; line-height: 115%;">僵硬、</span><span lang="ZH-TW" style="font-family: "arial" , sans-serif; font-size: 11.5pt; line-height: 115%;"> </span><span lang="ZH-TW" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; font-size: 11.5pt; line-height: 115%;">活動度都大有改善,術後併發症也大大減少。</span></span><br />
<span style="background-color: black; color: #f3f3f3;"><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 11.5pt; line-height: 115%;"><span lang="ZH-TW" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; font-size: 11.5pt; line-height: 115%;"><br /></span></span>
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<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; text-align: left;"><tbody>
<tr><td style="text-align: center;"><a href="https://1.bp.blogspot.com/-pllwFSrCJH8/XeE3Fmee_eI/AAAAAAAAIw0/xj3881RVX8oC3jB5CXfDE-JYbX-EdITfACEwYBhgL/s1600/191124-8-1.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><span style="background-color: black; color: #f3f3f3;"><img border="0" data-original-height="205" data-original-width="138" src="https://1.bp.blogspot.com/-pllwFSrCJH8/XeE3Fmee_eI/AAAAAAAAIw0/xj3881RVX8oC3jB5CXfDE-JYbX-EdITfACEwYBhgL/s1600/191124-8-1.jpg" /></span></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><b><span style="background-color: black; color: #f3f3f3;">圖 8-1</span></b></td></tr>
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<span style="background-color: black; color: #f3f3f3;"><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 11.5pt; line-height: 17.6333px;">但反轉式全人工肩關節卻存在</span><span lang="ZH-TW" style="font-family: "arial" , "sans-serif"; font-size: 11.5pt; line-height: 17.6333px;"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 11.5pt; line-height: 17.6333px;">肩盂假體 緊貼肩胛頸部的下緣,造成撞擊、</span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 11.5pt; line-height: 17.6333px;">磨損、蝕骨,甚或鬆脫的弊病。</span><span lang="ZH-TW" style="font-family: "arial" , "sans-serif"; font-size: 11.5pt; line-height: 17.6333px;"> </span><span style="font-family: "arial" , "sans-serif"; font-size: 11.5pt; line-height: 17.6333px;">(</span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 11.5pt; line-height: 17.6333px;">圖</span><span style="font-family: "arial" , "sans-serif"; font-size: 11.5pt; line-height: 17.6333px;">8-1, 2, 3)</span></span><br />
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<tr><td style="text-align: center;"><a href="https://1.bp.blogspot.com/-vxiGu7gUiQ4/XeE3enXOiLI/AAAAAAAAIxA/d30gl0NZNuY0pCpcMMYa5vrngQqnjN_jgCEwYBhgL/s1600/191124-8-2.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><span style="background-color: black; color: #f3f3f3;"><img border="0" data-original-height="205" data-original-width="161" src="https://1.bp.blogspot.com/-vxiGu7gUiQ4/XeE3enXOiLI/AAAAAAAAIxA/d30gl0NZNuY0pCpcMMYa5vrngQqnjN_jgCEwYBhgL/s1600/191124-8-2.jpg" /></span></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><b><span style="background-color: black; color: #f3f3f3;">圖 8-3</span></b></td></tr>
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<tr><td style="text-align: center;"><a href="https://1.bp.blogspot.com/-D1d0zWM3W_E/XeE4Su6ZOmI/AAAAAAAAIxE/Hg5Afs-DORkKdOEEjlUe4XTMGV19rb8-ACLcBGAsYHQ/s1600/191124-8-3.jpg" imageanchor="1" style="font-family: arial, sans-serif; font-size: 11.5pt; margin-left: auto; margin-right: auto; text-align: center;"><span style="background-color: black; color: #f3f3f3;"><img border="0" data-original-height="205" data-original-width="160" src="https://1.bp.blogspot.com/-D1d0zWM3W_E/XeE4Su6ZOmI/AAAAAAAAIxE/Hg5Afs-DORkKdOEEjlUe4XTMGV19rb8-ACLcBGAsYHQ/s1600/191124-8-3.jpg" /></span></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><b><span style="background-color: black; color: #f3f3f3;">圖 8-2</span></b></td></tr>
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<span style="background-color: black; color: #f3f3f3;"><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 11.5pt; line-height: 115%;"><span style="font-family: "arial" , sans-serif; font-size: 11.5pt; line-height: 115%;"></span></span><br /></span>
<span lang="ZH-TW" style="background-color: black; font-family: "pmingliu" , "serif"; font-size: 11.5pt; line-height: 115%;"><span style="color: #f3f3f3; font-family: "arial" , sans-serif; font-size: 11.5pt; line-height: 115%;"></span></span></div>
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<span lang="ZH-TW" style="background-color: black; font-family: "pmingliu" , "serif"; font-size: 11.5pt; line-height: 115%;"><span style="color: #f3f3f3; font-family: "arial" , sans-serif; font-size: 11.5pt; line-height: 115%;"></span></span></div>
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<span style="background-color: black; color: #f3f3f3;"><span lang="ZH-TW" style="font-family: "pmingliu" , serif; font-size: 11.5pt; line-height: 115%;">為克服此弊病,專家們正努力從生物力學的角度,把肱骨頭假體</span><span style="font-family: "arial" , sans-serif; font-size: 11.5pt; line-height: 115%;">(</span><span lang="ZH-TW" style="font-family: "pmingliu" , serif; font-size: 11.5pt; line-height: 115%;">球體</span><span style="font-family: "arial" , sans-serif; font-size: 11.5pt; line-height: 115%;">) </span><span lang="ZH-TW" style="font-family: "pmingliu" , serif; font-size: 11.5pt; line-height: 115%;">的<b>旋轉中心 </b></span><span style="font-family: "arial" , sans-serif; font-size: 11.5pt; line-height: 115%;">(Rotation Center) </span><span lang="ZH-TW" style="font-family: "pmingliu" , serif; font-size: 11.5pt; line-height: 115%;">或</span><span lang="ZH-TW" style="font-family: "arial" , sans-serif; font-size: 11.5pt; line-height: 115%;"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , serif; font-size: 11.5pt; line-height: 115%;">肩盂假體,作外移或內縮的改變</span><span style="font-family: "arial" , sans-serif; font-size: 11.5pt; line-height: 115%;"> (</span><span lang="ZH-TW" style="font-family: "pmingliu" , serif; font-size: 11.5pt; line-height: 115%;">圖</span><span style="font-family: "arial" , sans-serif; font-size: 11.5pt; line-height: 115%;">9)</span><span lang="ZH-TW" style="font-family: "pmingliu" , serif; font-size: 11.5pt; line-height: 115%;">,觀察術後的臨床效果。目前臨床結果還未明朗定調。</span></span><br />
<span style="color: #f3f3f3;"><span style="background-color: black; color: #222222; font-family: "pmingliu" , serif;"><span style="font-size: 15.3333px;"><br /></span></span><span lang="ZH-TW" style="background-color: black; font-family: "pmingliu" , serif; font-size: 11.5pt; line-height: 115%;"><table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; margin-right: 1em; text-align: left;"><tbody>
<tr><td style="text-align: center;"><a href="https://1.bp.blogspot.com/-3m38l9_Vzow/XeE6Uh6USqI/AAAAAAAAIxQ/l9n4ThgGwz4oD6sZZQpLK_Cfc5i1D1vZgCLcBGAsYHQ/s1600/191124-9.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" data-original-height="245" data-original-width="594" height="163" src="https://1.bp.blogspot.com/-3m38l9_Vzow/XeE6Uh6USqI/AAAAAAAAIxQ/l9n4ThgGwz4oD6sZZQpLK_Cfc5i1D1vZgCLcBGAsYHQ/s400/191124-9.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><b>圖 9.</b></td></tr>
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<span style="color: #f3f3f3;"><span style="background-color: black; font-family: "pmingliu" , serif;">骨科界殷切期待,專家學者多年的研究、改良與努力,能克服肩人工關節設計上的盲點</span></span><span style="background-color: black; color: #f3f3f3; font-family: "pmingliu" , serif;">,能早一天找出最好的術式,讓</span><span style="background-color: black; color: #f3f3f3; font-family: "pmingliu" , serif;">病人與醫師</span><span style="background-color: black; color: #f3f3f3; font-family: "pmingliu" , serif;">都同感滿意的治療</span><span style="background-color: black; color: #f3f3f3; font-family: "pmingliu" , serif;">, 那</span><span style="background-color: black; color: #f3f3f3; font-family: "pmingliu" , serif;">又是一項了不起的創舉了</span><span style="background-color: black; color: #f3f3f3; font-family: "pmingliu" , serif;">。</span><br />
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<span style="background-color: black; color: #f3f3f3; font-family: "pmingliu" , serif;">資料來源:</span><br />
<span style="background-color: black; color: #f3f3f3; font-family: "pmingliu" , serif;"><br /></span>
<span style="background-color: black; color: #f3f3f3; font-family: "pmingliu" , serif;">1. Djuro Perkovic, MD: David Kovacevic, MD; William N. Levine, MD; Charles M. Jobin, MD, Management of the Failed Arthroplasty for ProximalHumerus Fracture ; J Am Acad Orthop Surg, 2019;27(2):39-49. </span><br />
<span style="background-color: black; color: #f3f3f3; font-family: "pmingliu" , serif;">2. Jason C. Ho, MD; Liam T. Kane, BS; Joseph A Abboud, MD, Lateral Versus Medial Offset Design for Reverse Shoulder Replacement ; Curr. Orthop. Pract. 2019; 30(3);200-207 </span><br />
<span style="background-color: black; color: #f3f3f3; font-family: "pmingliu" , serif;">3. Levy JC, et al. Displaced nonunion,lesser tuberosity osteotomy yield low function , high satisfaction. J Shoulder Elbow Surg. 2019; dol:10.1016/j. jse. 2018.11.052. </span><br />
<span style="background-color: black; color: #f3f3f3; font-family: "pmingliu" , serif;">4. Peter N. Chalmers, MD, Pascal Boileau, MD, PhD; Anthorny A. Romeo, MD; Robert Z Tashjian, MD, Revision Reverse Shoulder Arthroplasty ; J Am Acad Orthop Surg. 2019; 27(12):426-436 </span><br />
<span style="background-color: black; color: #f3f3f3; font-family: "pmingliu" , serif;"> 5. Wen-Gie Lee, MD; Aging Fifty Shoulder Syndrome. (Series Chapters) : http://classic-blog.udn.com/wglee 李文吉醫師 部落格 五十肩專欄 </span><br />
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<br />baba.wg58@gmail.comhttp://www.blogger.com/profile/03790611799966344101noreply@blogger.com0tag:blogger.com,1999:blog-1350268300834830253.post-64698573489876469232019-06-10T00:07:00.000-07:002019-06-11T16:59:12.767-07:00不!病人不是消費者,醫師更不是生意人。 --- 醫療是服務業 ? ( 續篇 )<br />
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<span lang="ZH-TW" style="font-family: DFKai-SB; font-size: 12.0pt;">前言</span><span style="font-family: DFKai-SB; font-size: 12.0pt;">:<o:p></o:p></span></div>
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<span style="font-family: DFKai-SB; font-size: 12.0pt;">2011<span lang="ZH-TW">年四月</span><span style="mso-spacerun: yes;"> </span><span lang="ZH-TW">我在我的部落格及骨科專欄
發表了「 醫療是服務業</span>?<span lang="ZH-TW">」一文</span><span style="mso-spacerun: yes;">
</span>( <span lang="ZH-TW">請參閱 <span style="mso-spacerun: yes;"> </span></span></span><a href="http://classic-blog.udn.com/wglee/5123537"><span style="font-family: DFKai-SB; font-size: 12.0pt;">http://classic-blog.udn.com/wglee/5123537</span></a><span style="font-family: DFKai-SB; font-size: 12.0pt;"><span style="mso-spacerun: yes;"> </span></span><a href="http://docwglee.blogspot.com/2011/04/"><span style="font-family: DFKai-SB; font-size: 12.0pt;">http://docwglee.blogspot.com/2011/04/</span></a><span style="font-family: DFKai-SB; font-size: 12.0pt;"><span style="mso-spacerun: yes;">
</span>)<span lang="ZH-TW">,</span><span style="mso-spacerun: yes;"> </span><span lang="ZH-TW">雖引起醫界一陣漣渏及讀者迴響。事實上,此文於</span>2010<span lang="ZH-TW">年</span>10<span lang="ZH-TW">月早己完稿,斯時筆者還在聯合報副刊寫專欄,投稿後久等未獲刊登 亦未見退稿;詢問主編,主編支支吾吾,表示 </span>“<span lang="ZH-TW">不便刊登</span>”<span lang="ZH-TW">。 轉投醫界的期刊,復遭同等境遇,始知言論忌諱猶在。</span><o:p></o:p></span></div>
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<span lang="ZH-TW" style="font-family: DFKai-SB; font-size: 12.0pt;">筆者對美國醫界不算陌生,平日亦對網路醫療文獻、文章等有所關注。今年</span><span style="font-family: DFKai-SB; font-size: 12.0pt;">4<span lang="ZH-TW">月看到</span>Caplan<span lang="ZH-TW">在</span>Medscape<span lang="ZH-TW">的社論</span> ( <span lang="ZH-TW">含 視訊 並
文稿</span> )<span lang="ZH-TW">,其內容與筆者早先「 醫療是服務業</span>?<span lang="ZH-TW">」多有契合,始有</span>‘<span lang="ZH-TW">吾道不孤 </span>’<span lang="ZH-TW">之慰。今將此</span>Medscape<span style="mso-spacerun: yes;"> </span><span lang="ZH-TW">社論,試譯其文稿,介紹給愛顧我的讀者。</span><u><o:p></o:p></u></span></div>
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<b><span style="color: #222222; font-family: "arial" , "sans-serif"; font-size: 9.0pt;">COMMENTARY</span></b><b><span style="color: #222222; font-family: "pmingliu" , "serif"; font-size: 9.0pt;"> <span lang="ZH-TW">社論</span> </span>Medscape
Orthopedics </b><b><span style="color: #2a2a2a; font-family: "arial" , "sans-serif"; font-size: 9.0pt;">April 23, 2019</span></b><b><span style="color: #222222; font-family: "pmingliu" , "serif"; font-size: 9.0pt;"><o:p></o:p></span></b></div>
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<b><span style="font-size: 12.0pt;">No, Patients Are NOT Consumers, and MDs Are NOT
Providers </span></b><b><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">不!病人不是消費者,醫師更不是生意人。</span><o:p></o:p></b></div>
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<a href="https://www.medscape.com/viewarticle/911562?nlid=129483_5209&src=WNL_mdplsnews_190426_mscpedit_wir&uac=45307PG&spon=17&impID=1947858&faf=1">https://www.medscape.com/viewarticle/911562?nlid=129483_5209&src=WNL_mdplsnews_190426_mscpedit_wir&uac=45307PG&spon=17&impID=1947858&faf=1</a> <o:p></o:p></div>
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<span style="background-color: black; font-family: "arial" , sans-serif; font-size: 9pt;"><span style="color: #f3f3f3;">Arthus L. Caplan PhD Director,
Division of Medical Ethics, New York University Langone Medical Center, <o:p></o:p></span></span></div>
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<span style="background-color: black; color: #f3f3f3;"><span style="font-family: "arial" , sans-serif; font-size: 9pt;">New York, New York </span><span lang="ZH-TW" style="font-family: "pmingliu" , serif; font-size: 9pt;">亞瑟</span><span lang="ZH-TW" style="font-family: "arial" , sans-serif; font-size: 9pt;"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , serif; font-size: 9pt;">卡布蘭</span><span style="font-family: "arial" , sans-serif; font-size: 9pt;"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , serif; font-size: 9pt;">紐約大學郎格醫學中心</span><span lang="ZH-TW" style="font-family: "arial" , sans-serif; font-size: 9pt;"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , serif; font-size: 9pt;">醫學倫理科</span><span lang="ZH-TW" style="font-family: "arial" , sans-serif; font-size: 9pt;"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , serif; font-size: 9pt;">主任</span><span style="font-family: "arial" , sans-serif; font-size: 9pt;"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , serif; font-size: 9pt;">亦為</span><span style="font-family: "arial" , sans-serif; font-size: 9pt;">Medscape </span><span lang="ZH-TW" style="font-family: "pmingliu" , serif; font-size: 9pt;">顧問及特約作家</span></span><span style="background: white; color: #222222; font-family: "arial" , "sans-serif"; font-size: 9.0pt;"><o:p></o:p></span></div>
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<span style="background-color: black; color: #f3f3f3;"><span lang="ZH-TW" style="font-family: "pmingliu" , serif;">大家好!我是<span style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial;">亞瑟</span></span><span lang="ZH-TW" style="font-family: "arial" , sans-serif;"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , serif;">卡布蘭</span><span lang="ZH-TW" style="font-family: "arial" , sans-serif;"> </span><span style="font-family: "arial" , sans-serif;">(Arthur
L.Caplan) </span><span lang="ZH-TW" style="font-family: "pmingliu" , serif;">紐約大學郎格醫學中心</span><span lang="ZH-TW" style="font-family: "arial" , sans-serif;"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , serif;">醫學倫理科</span><span lang="ZH-TW" style="font-family: "arial" , sans-serif;"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , serif;">主任。</span><span style="font-family: "arial" , sans-serif;"><o:p></o:p></span></span></div>
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<span style="background-color: black; color: #f3f3f3;"><span lang="ZH-TW" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; font-family: "pmingliu" , serif;">最近我看到了</span><span lang="ZH-TW" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; font-family: "arial" , sans-serif;"> </span><span lang="ZH-TW" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; font-family: "pmingliu" , serif;">生物倫理學</span><span lang="ZH-TW" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; font-family: "arial" , sans-serif;"> </span><span lang="ZH-TW" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; font-family: "pmingliu" , serif;">哈斯汀中心</span><span lang="ZH-TW" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; font-family: "arial" , sans-serif;"> </span><span style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; font-family: "arial" , sans-serif;">(Hastings
Center) </span><span lang="ZH-TW" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; font-family: "pmingliu" , serif;">的學者們的一篇文章,文章裡有一個很有意思的論點:<u>病人不可以被看成是消費者</u>。</span><sup><span lang="ZH-TW" style="font-family: "arial" , sans-serif;"> </span></sup><span lang="ZH-TW" style="font-family: "pmingliu" , serif;">我</span><span lang="ZH-TW" style="font-family: "arial" , sans-serif;"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , serif;">很同意作者的論點,同時</span><span lang="ZH-TW" style="font-family: "pmingliu" , serif;">我更主張
:<u>醫師不可被看作或當作是生意人</u>。我們的醫療體系,醫病關係,已經越來越受到過多商業行話
的扭曲與改變 。</span><span style="font-family: "pmingliu" , serif;"><o:p></o:p></span></span></div>
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<span style="background-color: black; color: #f3f3f3;"><span lang="ZH-TW" style="font-family: "pmingliu" , serif;">哈斯汀學者
認為把病人看成消費者的看法,意味著病人與醫療並沒有連結。 消費者普遍存有的心態是:我是消費者,我想買啤酒、我在想度假去哪? 或 住哪個飯店好?我可以很輕鬆
動動手指 ,在網路就辦到。我 可以選擇多花錢買好的,也可精打細算,殺殺價。</span><span style="font-family: "pmingliu" , serif;"><o:p></o:p></span></span></div>
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<span style="background-color: black; color: #f3f3f3;"><span lang="ZH-TW" style="font-family: "pmingliu" , serif;">醫療卻不是這樣。醫療有一定的體系,你是什麼病?該看哪個科、該做哪些處置?都有一定的軌道,沒得選擇。你如果是急症,更沒有時間</span><span style="font-family: "arial" , sans-serif;">shopping</span><span lang="ZH-TW" style="font-family: "pmingliu" , serif;">,精挑細選找你想要看的哪位骨科醫師、或你
想要看的那個糖尿病醫師; 你很可能在 看了你的第一線醫師後,很快的就被轉介或轉診到其它醫院或其他醫師;跟你去</span><span style="font-family: "arial" , sans-serif;">shopping</span><span style="font-family: "pmingliu" , serif;"> <span lang="ZH-TW">買東西經驗,大大的不一樣。</span><o:p></o:p></span></span></div>
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<span style="background-color: black; color: #f3f3f3;"><span lang="ZH-TW" style="font-family: "pmingliu" , serif; font-size: 11pt;">說實在的</span><span lang="ZH-TW" style="font-family: "arial" , sans-serif; font-size: 11pt;"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , serif; font-size: 11pt;">,醫療事業</span><span lang="ZH-TW" style="font-family: "arial" , sans-serif; font-size: 11pt;"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , serif; font-size: 11pt;">的經營,不是看市場導向。</span><span lang="ZH-TW" style="font-family: "arial" , sans-serif; font-size: 11pt;"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , serif; font-size: 11pt;">消費行為的特質,也不是醫療照護系統所關注的重點。我們的醫療體系不會提供</span><span lang="ZH-TW" style="font-family: "arial" , sans-serif; font-size: 11pt;"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , serif; font-size: 11pt;">諸如</span><span lang="ZH-TW" style="font-family: "arial" , sans-serif; font-size: 11pt;"> </span><span style="font-family: "arial" , sans-serif; font-size: 11pt;">”</span><span lang="ZH-TW" style="font-family: "pmingliu" , serif; font-size: 11pt;">「看病消費指引」</span><span style="font-family: "arial" , sans-serif; font-size: 11pt;">” </span><span lang="ZH-TW" style="font-family: "pmingliu" , serif; font-size: 11pt;">之類的資訊;再說,要能對醫療體系品頭論足,病人也還不具有這樣的能力</span><span lang="ZH-TW" style="font-family: "arial" , sans-serif; font-size: 11pt;"> <span style="mso-spacerun: yes;"> </span></span><span style="font-family: "arial" , sans-serif; font-size: 11pt;">(</span><span lang="ZH-TW" style="font-family: "pmingliu" , serif; font-size: 11pt;">位置</span><span style="font-family: "arial" , sans-serif; font-size: 11pt;"> (position))</span><span lang="ZH-TW" style="font-family: "pmingliu" , serif; font-size: 11pt;">。</span><span lang="ZH-TW" style="font-family: "arial" , sans-serif; font-size: 11pt;"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , serif; font-size: 11pt;">病人是弱勢、需要協助的,而且常常處在</span><span style="font-family: "arial" , sans-serif; font-size: 11pt;">(</span><span lang="ZH-TW" style="font-family: "pmingliu" , serif; font-size: 11pt;">醫療</span><span style="font-family: "arial" , sans-serif; font-size: 11pt;"> )</span><span lang="ZH-TW" style="font-family: "pmingliu" , serif; font-size: 11pt;">知識不對等、又沒有選擇</span><span lang="ZH-TW" style="font-family: "arial" , sans-serif; font-size: 11pt;"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , serif; font-size: 11pt;">的餘地。你在急診室看到的實況,絕不會像你上網購物的一樣。</span><span style="font-family: "arial" , sans-serif; font-size: 11pt;"><o:p></o:p></span></span></div>
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<span style="background-color: black; color: #f3f3f3;"><span lang="ZH-TW" style="font-family: "pmingliu" , serif; font-size: 11pt;">我真的希望大家停止嚷嚷說 <span style="mso-spacerun: yes;"> </span>病人是消費者,也請不要帶有色的商業眼光把醫師講成是做生意的生意人,醫師就是醫師。我知道這些日子,每個人都很興奮企業方式帶入醫療,譬如
醫院的飯店化、用更好的床單、 更好的膳食</span><span style="font-family: "pmingliu" , serif; font-size: 11pt;">…<span lang="ZH-TW">、來爭取病人的滿意度。 我耽心走上這樣的趨勢, 因為,我不認為醫院要變成飯店。醫院應該是要變成一個 院內感染率低、治療有效率、病人能放心治病的地方。我憂心把醫院往市場推。</span><o:p></o:p></span></span></div>
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<span style="background-color: black; color: #f3f3f3;"><span lang="ZH-TW" style="font-family: "pmingliu" , serif; font-size: 11pt;">總之,我不希望醫學倫理與醫療專業,被商業口號和商業手法所取代,這絕非病人之福。隱喻醫師是生意人或商業代理人,也有損醫師的專業與尊嚴。我知道醫學少不了要花錢,我沒有那麼天真,但這並不表示
若決心要給病人更好的服務,就一定須要仰賴商業架構。</span><span style="font-family: "pmingliu" , serif; font-size: 11pt;"><o:p></o:p></span></span></div>
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<span style="background-color: black; color: #f3f3f3;"><span lang="ZH-TW" style="font-family: "pmingliu" , serif; font-size: 11pt;">我是紐約大學醫學院的 卡布蘭</span><span style="font-family: "pmingliu" , serif; font-size: 11pt;"><span style="mso-spacerun: yes;">
</span><span lang="ZH-TW">謝謝你的收看。</span><o:p></o:p></span></span></div>
<br />baba.wg58@gmail.comhttp://www.blogger.com/profile/03790611799966344101noreply@blogger.com0tag:blogger.com,1999:blog-1350268300834830253.post-85892118830902910852019-03-03T07:18:00.001-08:002020-07-13T17:54:53.325-07:00震波原理、骨震波儀元素 及 骨震波治療操作 <br />
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<span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12.0pt;">震波是什麼</span><span style="font-size: 12.0pt;"> ? </span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12.0pt;">震波是一種高頻與低頻混成的鋸齒狀聲波</span><span style="font-size: 12.0pt;"> (</span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12.0pt;">如圖</span><span lang="ZH-TW" style="font-size: 12.0pt;"> </span><span style="font-size: 12.0pt;">1)</span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12.0pt;">。</span><br />
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<tr><td class="tr-caption" style="text-align: center;"><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12pt;"><span lang="ZH-TW" style="font-size: 9pt; line-height: 13.8px;">左</span><span style="font-family: "calibri" , "sans-serif"; font-size: 9pt; line-height: 13.8px;">: </span><span lang="ZH-TW" style="font-size: 9pt; line-height: 13.8px;">正弦狀</span><span style="font-family: "calibri" , "sans-serif"; font-size: 9pt; line-height: 13.8px;">(</span><span lang="ZH-TW" style="font-size: 9pt; line-height: 13.8px;">連續) </span><span lang="ZH-TW" style="font-size: 9pt; line-height: 13.8px;">超音波</span><span lang="ZH-TW" style="font-family: "calibri" , "sans-serif"; font-size: 10pt; line-height: 15.3333px;"> 示意圖</span><span style="font-family: "calibri" , "sans-serif"; font-size: 10pt; line-height: 15.3333px;"> </span></span><span lang="ZH-TW" style="font-family: "pmingliu" , serif; font-size: 9pt; line-height: 13.8px;">右</span><span style="font-family: "calibri" , sans-serif; font-size: 9pt; line-height: 13.8px;">:</span><span style="font-family: "calibri" , sans-serif; font-size: 9pt; line-height: 13.8px;"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , serif; font-size: 9pt; line-height: 13.8px;">鋸齒狀</span><span style="font-family: "calibri" , sans-serif; font-size: 9pt; line-height: 13.8px;"> (</span><span lang="ZH-TW" style="font-family: "pmingliu" , serif; font-size: 9pt; line-height: 13.8px;">單一</span><span style="font-family: "calibri" , sans-serif; font-size: 9pt; line-height: 13.8px;">) </span><span style="font-family: "pmingliu" , serif; font-size: 9pt;"> 震波 示意圖 </span>新增說明文字</td></tr>
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<tr><td class="tr-caption" style="font-size: 12.8px; text-align: center;"> <span style="font-size: x-small;">右2 : 震波性能參數</span><span style="font-family: "pmingliu" , serif; font-size: 9pt;"> </span></td></tr>
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<span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;">不同於正弦狀超音波的是:這種鋸齒狀的震波,形成於瞬間、帶著</span><span style="font-size: 12.0pt; line-height: 115%;">1,000</span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;">倍超音波的能量、波壓</span><span lang="ZH-TW" style="font-size: 12.0pt; line-height: 115%;"> </span><span style="font-size: 12.0pt; line-height: 115%;">(</span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;">能量</span><span style="font-size: 12.0pt; line-height: 115%;">) </span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;">瞬時到位、波速迅捷行進、穿越三度空間、不受阻擋</span><span lang="ZH-TW" style="font-size: 12.0pt; line-height: 115%;"> </span><span style="font-size: 12.0pt; line-height: 115%;">…</span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;">。</span><span style="font-size: 12.0pt; line-height: 115%;"><o:p></o:p></span><br />
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<span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;">醫界於</span><span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt; line-height: 115%;">1980</span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;">年代成功地「駕馭」震波,首用於泌尿科的碎石術;</span><span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt; line-height: 115%;">90</span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;">年代末期骨科繼之,現今治療範圍擴大,舉凡一些奇難雜症,包括:男性不舉、缺血性心臟病、糖尿病足</span><span style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;">…<span lang="ZH-TW">等,都有人嘗試用震波治療。震波治療是「能量的治療」</span></span><span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt; line-height: 115%;">(</span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;">聽過</span><span lang="ZH-TW" style="font-family: "arial" , "sans-serif"; font-size: 12.0pt; line-height: 115%;"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;">運功療傷</span><span lang="ZH-TW" style="font-family: "arial" , "sans-serif"; font-size: 12.0pt; line-height: 115%;"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;">嗎</span><span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt; line-height: 115%;">?)</span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;">,將震波能量投射入身體,誘導組織或細胞衍生某些效應來治病。最大的特點是不具侵襲性,沒有器械介入、沒有傷口、不見血</span><span style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;">…<span lang="ZH-TW">,</span></span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;">有別於傳統的開刀、復健、藥物、針灸</span><span lang="ZH-TW" style="font-size: 12.0pt; line-height: 115%;"> </span><span style="font-size: 12.0pt; line-height: 115%;">…</span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;">等,是高科技的醫療。</span><span style="font-size: 12.0pt; line-height: 115%;"><o:p></o:p></span></div>
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<span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;">要</span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;">能駕馭並投射震波來治療骨科毛病,必須要有生產震波的機器,是即</span><span lang="ZH-TW" style="font-family: "arial" , "sans-serif"; font-size: 12.0pt; line-height: 115%;"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;">骨震波儀。骨震波儀的製造是一個高難度、高科技的工程。它的製作濫觴於德國,迄今於歐美仍方興未艾;現今的</span><span lang="ZH-TW" style="font-size: 12.0pt; line-height: 115%;"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;">骨震波儀,小巧但能量不減,使用與操作也趨簡便。依震波產生的方式,有聚焦式與非聚焦式</span><span lang="ZH-TW" style="font-size: 12.0pt; line-height: 115%;"> </span><span style="font-size: 12.0pt; line-height: 115%;">(</span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;">如圖</span><span lang="ZH-TW" style="font-size: 12.0pt; line-height: 115%;"> </span><span style="font-size: 12.0pt; line-height: 115%;">2.) </span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;">兩類。</span><span style="font-size: 12.0pt; line-height: 115%; mso-no-proof: yes;"><o:p></o:p></span></div>
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<span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;"> </span><span style="font-size: 12.0pt; line-height: 115%; mso-no-proof: yes;"><o:p></o:p></span><img height="160" src="https://lh4.googleusercontent.com/UylhpIf6Rf1dVW60efrCY-OTU7NnSczzzdcFPEJb9RGJmqLOj1v_hGc_tSkNWF3n8FMgFFfKliXFa2L_16OPgCjh2nTezjY2p_mWfbx2ASUW27bk4WiNf5QtlrXiTTYU72I72QpmU9YZCo_mLA" width="400" /> <span lang="ZH-TW" style="font-family: "pmingliu" , serif; font-size: 9pt; line-height: 115%;">圖</span><span style="font-family: "calibri" , sans-serif; font-size: 9pt; line-height: 115%;">2. </span><span lang="ZH-TW" style="font-family: "pmingliu" , serif; font-size: 9pt; line-height: 115%;">圖示</span><span style="font-family: "calibri" , sans-serif; font-size: 9pt; line-height: 115%;">: </span><span lang="ZH-TW" style="font-family: "pmingliu" , serif; font-size: 9pt; line-height: 115%;">左</span><span lang="ZH-TW" style="font-family: "calibri" , sans-serif; font-size: 9pt; line-height: 115%;"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , serif; font-size: 9pt; line-height: 115%;">聚焦式</span><span style="font-family: "calibri" , sans-serif; font-size: 9pt; line-height: 115%;"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , serif; font-size: 9pt; line-height: 115%;">右</span><span lang="ZH-TW" style="font-family: "calibri" , sans-serif; font-size: 9pt; line-height: 115%;"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , serif; font-size: 9pt; line-height: 115%;">幅射式</span><span style="font-size: 12pt; line-height: 115%;"> </span><br />
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<span lang="ZH-TW" style="font-family: "pmingliu" , serif; font-size: 12pt; line-height: 115%;">聚焦式震波,除聚焦能量大增外,投射時還可減少或避免周遭組織之傷害。非聚焦式震波,以幅射方式行進,</span><span lang="ZH-TW" style="font-size: 12pt; line-height: 115%;"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , serif; font-size: 12pt; line-height: 115%;">能量不高</span><span style="font-size: 12pt; line-height: 115%;"> (</span><span lang="ZH-TW" style="font-family: "pmingliu" , serif; font-size: 12pt; line-height: 115%;">如圖</span><span lang="ZH-TW" style="font-size: 12pt; line-height: 115%;"> </span><span style="font-size: 12pt; line-height: 115%;">3.)</span><span lang="ZH-TW" style="font-family: "pmingliu" , serif; font-size: 12pt; line-height: 115%;">,只能用在表淺皮下激痛點</span><span lang="ZH-TW" style="font-size: 12pt; line-height: 115%;"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , serif; font-size: 12pt; line-height: 115%;">或一般肌腱炎的治療</span><span lang="ZH-TW" style="font-size: 12pt; line-height: 115%;"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , serif; font-size: 12pt; line-height: 115%;">;較深層或其他較複雜的軟組織病變,</span><span lang="ZH-TW" style="font-size: 12pt; line-height: 115%;"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , serif; font-size: 12pt; line-height: 115%;">如各種慢性肌膜炎</span><span lang="ZH-TW" style="font-size: 12pt; line-height: 115%;"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , serif; font-size: 12pt; line-height: 115%;">、鈣化性肌腱炎、肌腱退行性病變</span><span lang="ZH-TW" style="font-size: 12pt; line-height: 115%;"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , serif; font-size: 12pt; line-height: 115%;">等,則須用能量高的聚焦式震波治療,才能奏效。<span id="goog_1652450588"></span><span id="goog_1652450589"></span></span><br />
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<tr><td class="tr-caption" style="text-align: center;">圖 3 . 聚焦 與 非聚焦震波性能參數比較</td></tr>
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<span style="font-family: "calibri" , sans-serif; font-size: 12pt; line-height: 115%;"> 2015</span><span lang="ZH-TW" style="font-family: "pmingliu" , serif; font-size: 12pt; line-height: 115%;">年</span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12pt; line-height: 115%;">,國際骨震波醫學會</span><span style="font-size: 12pt; line-height: 115%;"> (ISMST) </span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12pt; line-height: 115%;">明訂非聚焦式震波</span><span style="font-size: 12pt; line-height: 115%;"> (</span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12pt; line-height: 115%;">即幅射式震波</span><span lang="ZH-TW" style="font-size: 12pt; line-height: 115%;"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12pt; line-height: 115%;">現以</span><span style="font-size: 12pt; line-height: 115%;">rESWT</span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12pt; line-height: 115%;">表示</span><span lang="ZH-TW" style="font-size: 12pt; line-height: 115%;"> </span><span style="font-size: 12pt; line-height: 115%;">)</span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12pt; line-height: 115%;">,應改稱為「壓力波」</span><span style="font-size: 12pt; line-height: 115%;">(Pressure Wave)</span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12pt; line-height: 115%;">,以與真正高能量的骨震波治療</span><span style="font-size: 12pt; line-height: 115%;">( fESWT) </span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12pt; line-height: 115%;">有所曲隔。</span></div>
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<span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;"><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;">聚焦式震波有</span><span style="font-family: "calibri" , "sans-serif"; font-size: 12.0pt; line-height: 115%;">3</span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;">種型式</span><span lang="ZH-TW" style="font-family: "calibri" , "sans-serif"; font-size: 12.0pt; line-height: 115%;"> </span><span style="font-family: "calibri" , "sans-serif"; font-size: 12.0pt; line-height: 115%;">(</span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;">如圖</span><span style="font-family: "calibri" , "sans-serif"; font-size: 12.0pt; line-height: 115%;"> 4.)</span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;">;分別是</span><span style="font-family: "calibri" , "sans-serif"; font-size: 14.0pt; line-height: 115%;">a</span><span style="font-family: "calibri" , "sans-serif"; font-size: 12.0pt; line-height: 115%;">). </span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;">電液壓式</span><span lang="ZH-TW" style="font-family: "calibri" , "sans-serif"; font-size: 12.0pt; line-height: 115%;"> </span><span style="font-family: "calibri" , "sans-serif"; font-size: 12.0pt; line-height: 115%;">(Electro-Hydraulic) b). </span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;">電磁式</span><span lang="ZH-TW" style="font-family: "calibri" , "sans-serif"; font-size: 12.0pt; line-height: 115%;"> </span><span style="font-family: "calibri" , "sans-serif"; font-size: 12.0pt; line-height: 115%;">(Electromagnetic) </span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;">及</span><span lang="ZH-TW" style="font-family: "calibri" , "sans-serif"; font-size: 12.0pt; line-height: 115%;"> </span><span style="font-family: "calibri" , "sans-serif"; font-size: 14.0pt; line-height: 115%;">c</span><span style="font-family: "calibri" , "sans-serif"; font-size: 12.0pt; line-height: 115%;">). </span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;">壓電式</span><span style="font-family: "calibri" , "sans-serif"; font-size: 12.0pt; line-height: 115%;">( Piezoelectric)</span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;">。前兩者採用間接反射式聚焦設計,而</span><span style="font-family: "calibri" , "sans-serif"; font-size: 14.0pt; line-height: 115%;">c</span><span style="font-family: "calibri" , "sans-serif"; font-size: 12.0pt; line-height: 115%;">). </span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;">則採直射式直接對焦,方式雖有不同,</span><span lang="ZH-TW" style="font-family: "calibri" , "sans-serif"; font-size: 12.0pt; line-height: 115%;"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;">但目的都是藉聚焦來提昇震波能量,並避免周邊組織</span></span><span style="font-family: "pmingliu" , serif; font-size: 12pt;">的投射傷害。<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; margin-right: 1em; text-align: left;"><tbody>
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<span style="font-size: x-small;">圖 4. 從左至右 </span> a<span style="font-size: x-small;">),</span> b<span style="font-size: x-small;">), </span>c<span style="font-size: x-small;">).</span><br />
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<span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;">並非所有的骨科毛病都可以</span><span lang="ZH-TW" style="font-size: 12.0pt; line-height: 115%;"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;">用骨震波治療。對哪些</span><span lang="ZH-TW" style="font-size: 12.0pt; line-height: 115%;"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;">是可以用骨震波來治療的軟組織病變</span><span style="font-size: 12.0pt; line-height: 115%;"> (</span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;">即</span><span lang="ZH-TW" style="font-size: 12.0pt; line-height: 115%;"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;">骨震波的適應症</span><span style="font-size: 12.0pt; line-height: 115%;"> )</span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;">,要有明確的認識;除了能正確診斷之外,施術的醫師還須對震波儀的性能及其治療參數</span><span style="font-size: 12.0pt; line-height: 115%;"> (Parameter) </span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;">包括:</span><span lang="ZH-TW" style="font-size: 12.0pt; line-height: 115%;"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;">擊發一次的單位面積震波流量</span><span style="font-size: 12.0pt; line-height: 115%;"> (EFD energy flux density) </span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;">有多少</span><span style="font-size: 12.0pt; line-height: 115%;">? </span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;">投射的範圍</span><span lang="ZH-TW" style="font-size: 12.0pt; line-height: 115%;"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;">有多大</span><span style="font-size: 12.0pt; line-height: 115%;"> ? </span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;">能打得多深</span><span style="font-size: 12.0pt; line-height: 115%;"> ? </span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;">打到焦點區</span><span lang="ZH-TW" style="font-size: 12.0pt; line-height: 115%;"> </span><span style="font-size: 12.0pt; line-height: 115%;">(Focal Zone </span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;">亦即</span><span lang="ZH-TW" style="font-size: 12.0pt; line-height: 115%;"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;">標的</span><span style="font-size: 12.0pt; line-height: 115%;">) </span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;">及</span><span lang="ZH-TW" style="font-size: 12.0pt; line-height: 115%;"> </span><b><span style="font-size: 12.0pt; line-height: 115%;">-</span></b><span style="font-size: 12.0pt; line-height: 115%;">6dB</span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;">區的</span><span style="font-size: 12.0pt; line-height: 115%;">MPa</span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;">能量有多少</span><span style="font-size: 12.0pt; line-height: 115%;">? </span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;">都要瞭解,</span><span style="color: red; mso-no-proof: yes;"><v:shapetype coordsize="21600,21600" filled="f" id="_x0000_t75" o:preferrelative="t" o:spt="75" path="m@4@5l@4@11@9@11@9@5xe" stroked="f">
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</v:imagedata></v:shape></span><span style="color: red; font-family: "pmingliu" , "serif"; font-size: 9.0pt; line-height: 115%;">( </span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 9.0pt; line-height: 115%;">圖</span><span style="font-family: "pmingliu" , "serif"; font-size: 9.0pt; line-height: 115%;">5)</span><span style="font-size: 12.0pt; line-height: 115%;"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;">俾能在治療</span><span lang="ZH-TW" style="font-size: 12.0pt; line-height: 115%;"> </span><span style="font-size: 12.0pt; line-height: 115%;">(</span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;">打</span><span style="font-size: 12.0pt; line-height: 115%;">)</span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;">時,</span><span lang="ZH-TW" style="font-size: 12.0pt; line-height: 115%;"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;">打出該有的治療能量,以達到預期的療效</span><span style="font-size: 12.0pt; line-height: 115%;"> (</span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;">如圖</span><span lang="ZH-TW" style="font-size: 12.0pt; line-height: 115%;"> </span><span style="font-size: 12.0pt; line-height: 115%;">5.)</span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;">。</span><span style="font-size: 12.0pt; line-height: 115%;"> </span></div>
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<span style="font-size: x-small;">圖 5. 圖示 Focal Zone , -6dB 示意圖</span><br />
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<span lang="ZH-TW" style="font-size: 12pt; line-height: 115%;">打</span><span style="font-size: 12.0pt; line-height: 115%;"> (</span><span lang="ZH-TW" style="font-size: 12pt; line-height: 115%;">治療</span><span style="font-size: 12.0pt; line-height: 115%;">) </span><span lang="ZH-TW" style="font-size: 12pt; line-height: 115%;">時,先定位病竈的部位及深度</span><span lang="ZH-TW" style="font-size: 12.0pt; line-height: 115%;"> </span><span style="font-size: 12.0pt; line-height: 115%;">(</span><span lang="ZH-TW" style="font-size: 12pt; line-height: 115%;">如圖</span><span lang="ZH-TW" style="font-size: 12.0pt; line-height: 115%;"> </span><span style="font-size: 12.0pt; line-height: 115%;">6.) </span><span lang="ZH-TW" style="font-size: 12pt; line-height: 115%;">,再將治療頭</span><span lang="ZH-TW" style="font-size: 12.0pt; line-height: 115%;"> </span><span lang="ZH-TW" style="font-size: 12pt; line-height: 115%;">就定位放置並固定。開打時,先作探測性試打,靠病人的回饋</span><span style="font-size: 12.0pt; line-height: 115%;"> (Biofeedback </span><span lang="ZH-TW" style="font-size: 12pt; line-height: 115%;">主要是疼痛指數</span><span style="font-size: 12.0pt; line-height: 115%;">) </span><span lang="ZH-TW" style="font-size: 12pt; line-height: 115%;">,探索</span><span lang="ZH-TW" style="font-size: 12.0pt; line-height: 115%;"> </span><span style="font-size: 12.0pt; line-height: 115%;">(test) </span><span lang="ZH-TW" style="font-size: 12pt; line-height: 115%;">病人能忍受的最大單位面積震波流量</span><span style="font-size: 12.0pt; line-height: 115%;">( EFD)</span><span lang="ZH-TW" style="font-size: 12pt; line-height: 115%;">,</span><span lang="ZH-TW" style="font-size: 12.0pt; line-height: 115%;"> </span><span lang="ZH-TW" style="font-size: 12pt; line-height: 115%;">及</span><span lang="ZH-TW" style="font-size: 12.0pt; line-height: 115%;"> </span><span lang="ZH-TW" style="font-size: 12pt; line-height: 115%;">打的速度</span><span style="font-size: 12.0pt; line-height: 115%;">(Hz)</span><span lang="ZH-TW" style="font-size: 12pt; line-height: 115%;">。一旦決定好,打的過程中,除因應病人的反應,</span><span lang="ZH-TW" style="font-size: 12pt; line-height: 115%;">治療頭可略作微調外,應盡量保持治療頭不動,一路打到好、打到滿</span><span style="font-size: 12pt; line-height: 115%;"> (<span lang="ZH-TW">預估的能量</span>)
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<tr><td class="tr-caption" style="text-align: center;">圖 6.<br />
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<span lang="ZH-TW" style="font-family: "pmingliu" , serif; font-size: 12pt; line-height: 115%;">國際骨震波醫學會</span><span lang="ZH-TW" style="font-family: "pmingliu" , serif; font-size: 12pt; line-height: 115%;"> </span><span style="font-family: "pmingliu" , serif; font-size: 12pt; line-height: 115%;">(ISMST International Society for Medical Shockwave
Treatment )</span><span style="font-family: "pmingliu" , serif; font-size: 12pt; line-height: 115%;">
<span lang="ZH-TW">對軟組織的骨震波治療, 包括骨震波儀的規格,有做出如下的共識</span> ( <span lang="ZH-TW">等同</span></span><span style="font-family: "pmingliu" , serif; font-size: 12pt; line-height: 115%;">guideline</span><span style="font-family: "pmingliu" , serif; font-size: 12pt; line-height: 115%;">)<span lang="ZH-TW">:</span></span></div>
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<span style="font-size: 12.0pt; line-height: 115%;">1).</span><span style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;"> <span lang="ZH-TW">除 表淺激痛點 或類同之表淺肌腱炎,可用輻射壓力波</span></span><span style="font-size: 12.0pt; line-height: 115%;">(rESWT)</span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;">治療外,軟組織病變,須以聚焦式震波 </span><span style="font-size: 12.0pt; line-height: 115%;">(fESWT)</span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;">治療。</span><span style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;"><o:p></o:p></span><br />
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<span style="font-size: 12.0pt; line-height: 115%;">2).</span><span style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;"> <span lang="ZH-TW">治療時,不主張注射止痛劑。注射止痛劑被認為對震波治療有不良影響。</span><o:p></o:p></span><br />
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<span style="font-size: 12.0pt; line-height: 115%;">3).</span><span style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;"> <span lang="ZH-TW">治療的震波能量須足夠,若治療能量不足,治療效果會打折扣。</span><o:p></o:p></span><br />
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<span style="font-size: 12.0pt; line-height: 115%;">4).</span><span style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;"> <span lang="ZH-TW">骨震波儀與身體接觸介面的波壓
</span></span><span style="font-size: 12.0pt; line-height: 115%;">(MPa)</span><span style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;"> <span lang="ZH-TW">,至少需有</span></span><span style="font-size: 12.0pt; line-height: 115%;">5MPa </span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;">的標準,</span><b><span style="font-size: 12.0pt; line-height: 115%;">-</span></b><span style="font-size: 12.0pt; line-height: 115%;">6dB</span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;">區的波壓必須達到最大波壓的</span><span style="font-size: 12.0pt; line-height: 115%;">50%</span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;">。 </span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;">治療時,</span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;">以單位面積的震波流量</span><span style="font-size: 12.0pt; line-height: 115%;"> (EFD energy
flux density ) </span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;">做為治療能量的依據。</span><span style="font-size: 12.0pt; line-height: 115%;"><o:p></o:p></span><br />
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<span style="font-size: 12.0pt; line-height: 115%;">5).</span><span style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;"> <span lang="ZH-TW">建議合宜的治療 是:打
最大忍受度的</span></span><span style="font-size: 12.0pt; line-height: 115%;"> EFD</span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;">,</span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;">每次治療</span><span style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;"> (<span lang="ZH-TW">打</span>) <span lang="ZH-TW">不超過</span></span><span style="font-size: 12.0pt; line-height: 115%;">2,000</span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;">次</span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;">,每週打</span><span style="font-size: 12.0pt; line-height: 115%;">1</span><span style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;">
<span lang="ZH-TW">次,打</span></span><span lang="ZH-TW" style="font-size: 12.0pt; line-height: 115%;"> </span><span style="font-size: 12.0pt; line-height: 115%;">3</span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;">個療程,再視追蹤情況決定後續是否須要追加。</span><span style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;"><o:p></o:p></span><br />
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<span style="font-size: 12.0pt; line-height: 115%;">6). </span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;">骨震波治療</span><span lang="ZH-TW" style="font-size: 12.0pt; line-height: 115%;"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;">是</span><span lang="ZH-TW" style="font-size: 12.0pt; line-height: 115%;"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;">安全、有效的治療。</span><span style="font-size: 12.0pt; line-height: 115%;"><o:p></o:p></span></div>
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<span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;">筆者自</span><span style="font-size: 12.0pt; line-height: 115%;">2002</span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;">年迄今,累積近</span><span style="font-size: 12.0pt; line-height: 115%;">4,000</span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;">軟組織骨震波治療病例,病例追蹤</span><span style="font-size: 12.0pt; line-height: 115%;">4</span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;">週至</span><span style="font-size: 12.0pt; line-height: 115%;">4</span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;">個月,治療成功率超過</span><span style="font-size: 12.0pt; line-height: 115%;">90%</span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;">,比美歐美先進報告。回顧個人多年累積之治療經驗 </span><span style="font-size: 12.0pt; line-height: 115%;">( learning curve ) </span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;">,及之後自擬的</span><span style="font-size: 12.0pt; line-height: 115%;">protocol</span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;">,對照</span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;">前述</span><span style="font-size: 12.0pt; line-height: 115%;">ISMST </span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;">之共識</span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;"> 及所揭謁之治療基準</span><span lang="ZH-TW" style="font-size: 12.0pt; line-height: 115%;"> </span><span style="font-size: 12.0pt; line-height: 115%;">( benchmark )</span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;">,頗有</span><span lang="ZH-TW" style="font-size: 12.0pt; line-height: 115%;"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;">不謀而合之感</span><span lang="ZH-TW" style="font-size: 12.0pt; line-height: 115%;"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;">。</span><span style="font-size: 12.0pt; line-height: 115%;"><o:p></o:p></span></div>
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<span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;">個人相信遵從上述之準則,以其為治療</span><span style="font-size: 12.0pt; line-height: 115%;">SOP</span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;">,則骨震波治療,勢必大見療效,庶幾不無可能成為制式之療法,那也是病人之福了</span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;">。</span><span style="font-family: "pmingliu" , "serif"; font-size: 12.0pt; line-height: 115%;"><o:p></o:p></span></div>
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<span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 10.0pt; line-height: 115%;">參考文獻:</span><o:p></o:p></div>
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<li class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: left;"><span style="font-family: "verdana" , "sans-serif"; font-size: 10.0pt;">J.A.Ogden. R.R.Alvarrez Extracorporeal Shock Wave Therapy in Orthopaediac Clinical Orthopaedics Related
Research No.367 2001 Section I
Symposium</span><o:p></o:p></li>
<li class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: left;"><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 10.0pt;">骨震波(</span><span style="font-size: 10.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: PMingLiU; mso-hansi-font-family: Calibri;">5</span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 10.0pt;">)</span><span lang="ZH-TW"> </span><a href="http://classic-blog.udn.com/wglee/1917865">http://classic-blog.udn.com/wglee/1917865</a> <span style="font-size: x-small;"> <a href="http://classic-blog.udn.com/wglee">http://classic-blog.udn.com/wglee</a></span><span style="font-size: 12.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: PMingLiU; mso-hansi-font-family: Calibri;"><o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: left;">Christoph Schmitz†, *, Nikolaus B. M. Császár, Stefan
Milz, Matthias Schieker, Nicola Maffulli§, Jan-Dirk Rompe, and John P.
Furia Efficacy and safety of
extracorporeal shock wave therapy
for orthopedic conditions: a systematic review on studies listed in
the PEDro database <span style="font-size: 12.8px;">British Medical Bulletin, 2015,
116:115–138 doi: 10.1093/bmb/ldv047 Advance Access</span><span style="font-size: 12.8px;"> </span><span style="font-size: 12.8px;">Publication Date: 18 November
2015 </span></li>
<li class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: left;"><span style="color: #eeeeee;"><span style="font-family: "times" , "times new roman" , serif;"><span style="font-size: 12.8px; text-indent: -0.25in;">Moya, Daniel, MD; Ramón, Silvia, MD, PhD , Schaden, Wolfgang, MD; Wang, Ching-Jen, MD; Guiloff, Leonardo, MD; Cheng, Jai-Hong, MD<sup> </sup></span><span style="font-size: 12.8px; text-indent: -0.25in;"> </span></span><span style="color: #eeeeee; font-size: 12.8px; text-indent: -0.25in;"> </span></span><span style="font-size: 12.8px; text-indent: -0.25in;">The Role of Extracorporeal Shockwave Treatment in Musculoskeletal Disorders</span><span style="font-size: 12.8px; text-indent: -0.25in;"> </span><span style="font-size: 12.8px; text-indent: -0.25in;">JBJS: </span><span style="color: #867c9c; font-size: 12.8px; text-indent: -0.25in;"><a href="https://journals.lww.com/jbjsjournal/toc/2018/02070" style="font-size: 12.8px; text-indent: -0.25in;">February 7, 2018 - Volume 100 - Issue 3 - p 251-263</a> </span><span style="font-size: 12.8px;"> </span><span style="font-size: 12.8px;">doi: 10.2106/JBJS.17.00661</span><span style="font-size: 12.8px;"> </span><span style="font-size: 12.8px;">Current Concepts Review</span><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
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baba.wg58@gmail.comhttp://www.blogger.com/profile/03790611799966344101noreply@blogger.com0tag:blogger.com,1999:blog-1350268300834830253.post-11121591905264272302017-10-08T04:28:00.001-07:002020-07-20T15:23:40.057-07:00<br />
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<span lang="ZH-TW" style="font-family: "microsoft jhenghei" , "sans-serif"; font-size: 12.0pt; line-height: 115%;"><b>取名</b></span><span lang="ZH-TW" style="font-family: "microsoft jhenghei" , "sans-serif"; font-size: 12.0pt; line-height: 115%;"><b>「<u>五十肩症候群</u>」</b></span><u><span style="font-family: "microsoft jhenghei" , "sans-serif"; font-size: 12.0pt; line-height: 115%;">(<b> Aging
Fifty Shoulder Syndrome</b> </span></u><span style="font-family: "microsoft jhenghei" , "sans-serif"; font-size: 12.0pt; line-height: 115%;">)芻</span><span lang="ZH-TW" style="font-family: "microsoft jhenghei" , "sans-serif"; font-size: 12.0pt; line-height: 115%;"><b>議</b></span><span style="font-size: 12.0pt; line-height: 115%;"><o:p></o:p></span></div>
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<span lang="ZH-TW" style="font-family: "microsoft jhenghei" , "sans-serif"; font-size: 12.0pt;">我在「五十肩淺說」一文</span><span style="font-family: "microsoft jhenghei" , "sans-serif"; font-size: 12.0pt;"> ( </span><a href="http://classic-blog.udn.com/wglee/3395660"><span style="font-family: "microsoft jhenghei" , "sans-serif"; font-size: 12.0pt;">http://classic-blog.udn.com/wglee/3395660</span></a><span style="font-family: "microsoft jhenghei" , "sans-serif"; font-size: 12.0pt;"> </span><a href="http://docwglee.blogspot.tw/2009/10/blog-post.html"><span style="font-family: "microsoft jhenghei" , "sans-serif"; font-size: 12.0pt;">http://docwglee.blogspot.tw/2009/10/blog-post.html</span></a><span style="font-family: "microsoft jhenghei" , "sans-serif"; font-size: 12.0pt;"> )<span lang="ZH-TW">,</span> <span lang="ZH-TW">曾回憶當年在西雅圖華大當住院醫師
時, 跟恩師</span> Prof. Matsen <span lang="ZH-TW">開</span>Rotator Cuff Tendinopathy </span><span style="font-family: "microsoft jhenghei" , sans-serif; font-size: 16px;">( </span><span lang="ZH-TW" style="font-family: "microsoft jhenghei" , sans-serif; font-size: 16px;">肩旋轉肌袖病變 </span><span style="font-family: "microsoft jhenghei" , sans-serif; font-size: 16px;">)</span><span lang="ZH-TW" style="font-family: "microsoft jhenghei" , sans-serif; font-size: 12pt;">的一些軼事。 我提到, 我跟刀 跟了一年多,才陡然一想 :莫非這</span><span style="font-family: "microsoft jhenghei" , sans-serif; font-size: 12pt;"> Rotator Cuff Tendinopathy</span><span lang="ZH-TW" style="font-family: "microsoft jhenghei" , sans-serif; font-size: 12pt;">, 就是我們台灣人口中的 五十肩</span><span style="font-family: "microsoft jhenghei" , sans-serif; font-size: 12pt;"> ? </span><span lang="ZH-TW" style="font-family: "microsoft jhenghei" , sans-serif; font-size: 12pt;">這事, 我原是訕笑自己真是遲鈍得可以!但 回國迄今,尤其, 選擇 開五十肩的刀, 作為我的主要專長後, 這 十幾年,五十肩的刀,開得越多,
對</span><span style="font-family: "microsoft jhenghei" , sans-serif; font-size: 12pt;"> Rotator Cuff Tendinopathy </span><span style="font-family: "microsoft jhenghei" , sans-serif; font-size: 12pt;"> </span><span lang="ZH-TW" style="font-family: "microsoft jhenghei" , sans-serif; font-size: 12pt;">的了解越多,就越覺得還是採用 「五十肩 」這樣的稱呼, 比較能反映</span><span style="font-family: "microsoft jhenghei" , sans-serif; font-size: 12pt;">Rotator Cuff Tendinopathy </span><span lang="ZH-TW" style="font-family: "microsoft jhenghei" , sans-serif; font-size: 12pt;">這毛病多樣性的本質與內容。</span><br />
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<span style="font-family: "microsoft jhenghei" , "sans-serif"; font-size: 12.0pt;"><o:p></o:p></span><span lang="ZH-TW" style="font-family: "microsoft jhenghei" , sans-serif; font-size: 12pt;">我會這樣說,主要是覺得教科書裡,對肩旋轉肌袖病變的 病因機轉,尤其是肩峰解剖學中,肩峰下空間</span><span style="font-family: "microsoft jhenghei" , sans-serif; font-size: 12pt;">(<span lang="ZH-TW">圖</span>)<span lang="ZH-TW">的問題,都 有所著墨 </span>(<span lang="ZH-TW">圖1.2.3</span>)<span lang="ZH-TW">;</span></span></div>
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<tr><td class="tr-caption" style="text-align: center;">圖2. Critical Shoulder Angle</td></tr>
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<tr><td class="tr-caption" style="text-align: center;">圖3. 肩峰下的空間(紅點框住)</td></tr>
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<span lang="ZH-TW" style="font-family: "microsoft jhenghei" , sans-serif; font-size: 12pt;">唯獨對旋轉肌袖病變的描述,卻多只繞著肩痛、沾黏、活動受限 </span><span style="font-family: "microsoft jhenghei" , sans-serif; font-size: 12pt;">(Contracture </span><span lang="ZH-TW" style="font-family: "microsoft jhenghei" , sans-serif; font-size: 12pt;">攣縮</span><span style="font-family: "microsoft jhenghei" , sans-serif; font-size: 12pt;">)</span><span lang="ZH-TW" style="font-family: "microsoft jhenghei" , sans-serif; font-size: 12pt;">、及 旋傳肌袖的破裂,以及手術方式打轉;這可能是就大多數美國病人此症的型態而寫。或許美國病人較能早期診斷、積極就醫,少有推託延宕,因此
開刀所見,多僅見沾黏 或簡單破裂,少見長期、慢性的變化,因此認為用關節鏡手術已遊刃有餘。但回來台灣,卻發現用關節鏡手術,無法把刀開得完整,容易留下術後關節強直的問題。</span></div>
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<span lang="ZH-TW" style="font-family: "microsoft jhenghei" , "sans-serif"; font-size: 12.0pt;">台灣的病人,或者是觀念上還停留在五十肩不必開刀的說法、或是怕開刀;多半能拖就拖,少能及時醫治。因此,等到真正願接受開刀時,其旋轉肌袖的病變,很多是我當年在美時未曾見到的「<b>奇景</b>」。 諸如:肥厚增生的滑囊,像牛皮樣,把肱骨頭端裹得緊緊的、不留動彈空間(圖4)</span></div>
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<tr><td style="text-align: center;"><a href="https://1.bp.blogspot.com/-Qbhew45jzAY/WdoFVR902DI/AAAAAAAAF4g/ZBYJ_SqmvSgasrQT8F9Qthbysv9ZUr8agCLcBGAs/s1600/171004%2B4.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="273" data-original-width="224" height="200" src="https://1.bp.blogspot.com/-Qbhew45jzAY/WdoFVR902DI/AAAAAAAAF4g/ZBYJ_SqmvSgasrQT8F9Qthbysv9ZUr8agCLcBGAs/s200/171004%2B4.jpg" width="164" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">圖6.</td></tr>
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<tr><td class="tr-caption" style="text-align: center;">圖4.</td></tr>
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;或是
肌袖撕裂得一條條的 ,加上長期擠壓擰磨,變成串珠似的珠簾<span style="font-family: "microsoft jhenghei" , "sans-serif"; font-size: 12.0pt;">(<span lang="ZH-TW">圖5.6.</span>)<span lang="ZH-TW">;<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://2.bp.blogspot.com/-iW0Bug_scb8/WdoEtL8tGVI/AAAAAAAAF4Y/i8RFOdsdNboRUJCZ0VlfotV_Zjq6_50jQCLcBGAs/s1600/171004%2B3.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" data-original-height="267" data-original-width="275" height="193" src="https://2.bp.blogspot.com/-iW0Bug_scb8/WdoEtL8tGVI/AAAAAAAAF4Y/i8RFOdsdNboRUJCZ0VlfotV_Zjq6_50jQCLcBGAs/s200/171004%2B3.jpg" width="200" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">圖5</td></tr>
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或 肌袖增生褶疊像木耳,一打開,會瞬間像花苞綻開</span>…(<span lang="ZH-TW">圖6.7.</span>)<span lang="ZH-TW">,<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://1.bp.blogspot.com/-PyoAgepUFYY/WdoGKSMJ0nI/AAAAAAAAF4o/kJ-pl7UxbwYBp35Oeabj5nE8wXzjPtAhgCLcBGAs/s1600/171004%2B7.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="206" data-original-width="290" height="142" src="https://1.bp.blogspot.com/-PyoAgepUFYY/WdoGKSMJ0nI/AAAAAAAAF4o/kJ-pl7UxbwYBp35Oeabj5nE8wXzjPtAhgCLcBGAs/s200/171004%2B7.jpg" width="200" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">圖6.</td></tr>
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或是 受了又厚又韌</span>(<span lang="ZH-TW">纖維化</span>)<span lang="ZH-TW">滑膜的箍掐,旋轉肌袖大範圍缺血</span>(<span lang="ZH-TW">蒼白</span>)(<span lang="ZH-TW">圖8.<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://1.bp.blogspot.com/-ppHTegxCsio/WdoHqB_-67I/AAAAAAAAF44/3EWM2pJpqLEUOOAS1fibSf0dgaW8peuAACLcBGAs/s1600/171004%2B9.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" data-original-height="280" data-original-width="289" height="193" src="https://1.bp.blogspot.com/-ppHTegxCsio/WdoHqB_-67I/AAAAAAAAF44/3EWM2pJpqLEUOOAS1fibSf0dgaW8peuAACLcBGAs/s200/171004%2B9.jpg" width="200" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">圖8.</td></tr>
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</span>)<span lang="ZH-TW">, 鬆綁才見血色回現</span>…
<span lang="ZH-TW">的種種奇<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://1.bp.blogspot.com/-jp02p_0IMvY/WdoGVQbC8jI/AAAAAAAAF4w/zAk5l9hjt9MeRhukzoEhxn65OD-6ZHOXgCEwYBhgL/s1600/171004%2B8.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" data-original-height="212" data-original-width="270" height="156" src="https://1.bp.blogspot.com/-jp02p_0IMvY/WdoGVQbC8jI/AAAAAAAAF4w/zAk5l9hjt9MeRhukzoEhxn65OD-6ZHOXgCEwYBhgL/s200/171004%2B8.jpg" width="200" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">圖7</td></tr>
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景!這些,都是我在美國開刀所不曾見到,翻查英文教科書、文獻也無隻字言及!</span><o:p></o:p></span><br />
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<span lang="ZH-TW" style="font-family: "microsoft jhenghei" , "sans-serif"; font-size: 12.0pt;">基於前述此症之臨床症狀及開刀所見到 不同的病理呈現,個人認為英文教科書 所稱之 </span><span style="font-family: "microsoft jhenghei" , "sans-serif"; font-size: 12.0pt;">Subacromial
impingement & Rotator Cuff Tendinopaty <span lang="ZH-TW">,即 中譯 「<b>肩峰下夾擊 及 旋轉肌袖病變</b>」 一詞,並沒能完整含括五十肩這毛病的內容。個人也認為若採關節鏡方式開刀,勢將無法完全妥善處理類似的上述圖示的病灶。</span><o:p></o:p></span></div>
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<span lang="ZH-TW" style="font-family: "microsoft jhenghei" , "sans-serif"; font-size: 12.0pt;">既然此症臨床及病理上都呈現多樣性,本質上,即是一種症候群</span><span style="font-family: "microsoft jhenghei" , "sans-serif"; font-size: 12.0pt;">(symptom
complex)<span lang="ZH-TW">;我個人意見,那就 倒不如 把中文病名回歸大家早已琅琅上口的五十肩,「<b>五十肩症候群</b>」</span><u>( <b>Aging
fifty shoulder Syndrome</b></u>) 作為對照<span lang="ZH-TW">吧!這樣,病的內容不受 僅言「夾擊」之侷限,治療更能澈底 臻於至善,醫病間的溝通也一定更為清楚通暢。</span><o:p></o:p></span></div>
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baba.wg58@gmail.comhttp://www.blogger.com/profile/03790611799966344101noreply@blogger.com0tag:blogger.com,1999:blog-1350268300834830253.post-88749327682312503802017-09-27T02:00:00.000-07:002017-10-04T00:50:07.439-07:00脊椎的退化為甚麼會有「骨牌效應」? 骨牌效應又是怎麼一回事?<br />
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<span lang="ZH-TW" style="background-color: black; font-family: "pmingliu" , serif;"><span style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial;">前言 : 2014/05/27 </span><span lang="ZH-TW" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; font-family: "pmingliu" , serif;">我曾談論「是什麼原因</span><span style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial;"> </span><span lang="ZH-TW" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; font-family: "pmingliu" , serif;">你背痛?」</span><span style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial;">( </span><span lang="ZH-TW" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; font-family: "pmingliu" , serif;">請</span><span lang="ZH-TW" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial;"> </span><span lang="ZH-TW" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; font-family: "pmingliu" , serif;">參閱</span><a href="http://classic-blog.udn.com/wglee/13693895"><span style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; font-family: "helvetica" , sans-serif;">http://classic-blog.udn.com/wglee/13693895</span></a><span style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial;"> </span><a href="http://docwglee.blogspot.tw/2014/05/blog-post_3784.html"><span style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; font-family: "helvetica" , sans-serif;">http://docwglee.blogspot.tw/2014/05/blog-post_3784.html</span></a><span style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial;"> ) </span><span lang="ZH-TW" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; font-family: "pmingliu" , serif;">。引起相當迴響。最近的一些研究,</span><span lang="ZH-TW" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial;"> </span><span lang="ZH-TW" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; font-family: "pmingliu" , serif;">對於下背痛</span><span lang="ZH-TW" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial;"> </span><span lang="ZH-TW" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; font-family: "pmingliu" , serif;">與</span><span lang="ZH-TW" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial;"> </span><span lang="ZH-TW" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; font-family: "pmingliu" , serif;">脊</span><span style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial;">(</span><span lang="ZH-TW" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; font-family: "pmingliu" , serif;">腰</span><span style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial;">) </span><span lang="ZH-TW" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; font-family: "pmingliu" , serif;">椎退化的的機轉,有更進一步的闡釋。</span></span></div>
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<span style="background-color: black;"><span lang="ZH-TW" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; font-family: "pmingliu" , serif;">人類演化到脫離爬行,站了起來,靠的就是一節一節脊椎構成的脊柱。直立的身體,重心是落在骨盆稍上的腰薦椎</span><span style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial;">(</span><span lang="ZH-TW" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; font-family: "pmingliu" , serif;">下背</span><span style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial;">) </span><span lang="ZH-TW" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; font-family: "pmingliu" , serif;">;生物力學上,地心引力加諸於直立的應力,使</span><span style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial;">1</span><span lang="ZH-TW" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; font-family: "pmingliu" , serif;">公斤的體重,在腰薦處變成了</span><span style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial;">4</span><span lang="ZH-TW" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; font-family: "pmingliu" , serif;">公斤。這</span><span style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial;">4</span><span lang="ZH-TW" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; font-family: "pmingliu" , serif;">公斤且一路往下投落到</span><span lang="ZH-TW" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial;"> </span><span lang="ZH-TW" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; font-family: "pmingliu" , serif;">髖、膝、踝、腳;所以,你能想像你每一天的活動,你的身體有多吃重嗎</span><span lang="ZH-TW" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial;"> </span><span style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial;">?</span><span lang="ZH-TW" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; font-family: "pmingliu" , serif;">。年輕、未退化前,除非</span><span lang="ZH-TW" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial;"> </span><span lang="ZH-TW" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; font-family: "pmingliu" , serif;">跌打損傷,你感覺不出它的負擔,你</span><span lang="ZH-TW" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial;"> </span><span lang="ZH-TW" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; font-family: "pmingliu" , serif;">行動輕快自若;但</span><span lang="ZH-TW" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial;"> </span><span lang="ZH-TW" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; font-family: "pmingliu" , serif;">經過數十寒暑的使用與磨損,漸漸,你不再輕快、你不再耐操,你開始看起來有點老態,你的脊椎</span><span style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial;">…</span><span lang="ZH-TW" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; font-family: "pmingliu" , serif;">,</span><span lang="ZH-TW" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial;"> </span><span lang="ZH-TW" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; font-family: "pmingliu" , serif;">退化啦!</span></span><o:p></o:p></div>
<div class="MsoNormal">
<span lang="ZH-TW" style="background: white; font-family: "pmingliu" , "serif";"><br /></span></div>
<div class="MsoNormal">
<span lang="ZH-TW" style="background: white; font-family: "pmingliu" , "serif";"></span></div>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; margin-right: 1em; text-align: left;"><tbody>
<tr><td style="text-align: center;"><a href="https://3.bp.blogspot.com/-DWox55VyHWc/WctRILC1WrI/AAAAAAAAF2E/JEEH38arSKk3dj1Dl6ghP6sxG5Z1TKrZACLcBGAs/s1600/170923%2BFacet%2Bjoint%2B2.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" data-original-height="214" data-original-width="214" height="200" src="https://3.bp.blogspot.com/-DWox55VyHWc/WctRILC1WrI/AAAAAAAAF2E/JEEH38arSKk3dj1Dl6ghP6sxG5Z1TKrZACLcBGAs/s200/170923%2BFacet%2Bjoint%2B2.jpg" width="200" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">圖 1.</td></tr>
</tbody></table>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://1.bp.blogspot.com/-uSnNiquyb4Y/WctSA-J-DQI/AAAAAAAAF2M/Uj2mDuG_tNw2cR4r63I5wZGG5jT6DvGjQCLcBGAs/s1600/170923%2BFacet%2BJoint%2B1.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" data-original-height="154" data-original-width="207" src="https://1.bp.blogspot.com/-uSnNiquyb4Y/WctSA-J-DQI/AAAAAAAAF2M/Uj2mDuG_tNw2cR4r63I5wZGG5jT6DvGjQCLcBGAs/s1600/170923%2BFacet%2BJoint%2B1.jpg" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">圖 2.</td></tr>
</tbody></table>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://2.bp.blogspot.com/-BBoN50_vVto/WctY8klPL8I/AAAAAAAAF2w/dbFzcY3ZbyYvdpRfqRUC_oNTbDVNikOiwCLcBGAs/s1600/170923%2BFacet%2BJoint%2B3.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" data-original-height="222" data-original-width="226" src="https://2.bp.blogspot.com/-BBoN50_vVto/WctY8klPL8I/AAAAAAAAF2w/dbFzcY3ZbyYvdpRfqRUC_oNTbDVNikOiwCLcBGAs/s1600/170923%2BFacet%2BJoint%2B3.jpg" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">圖 3A, B.</td></tr>
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<div class="MsoNormal">
<span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin; mso-no-proof: yes;">解剖學上,每一節的</span><span style="background: white; color: #1f1e1e;"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">脊椎,都有兩組小面關節,左右各</span></div>
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<span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"><br /></span></div>
<div class="MsoNormal">
<span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">一,一組面上,一組面下</span><span lang="ZH-TW"> </span>(<span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">圖</span> 1. <span style="font-size: x-small;">圖</span>2.)<span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">,用來銜接上下一節脊椎。</span></div>
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<span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"><br /></span></div>
<div class="MsoNormal">
<span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">小面關節的表面是非常耐磨且滑順的玻璃樣軟骨,靠組組不同角度的小面關節,銜接成柱的脊椎,才能作出包括</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">垂直的負重、前彎、後仰、側彎、及旋轉等,不同面向的活動:</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">這是巧妙的設計;也是</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">小面關節</span></div>
<div class="MsoNormal">
<span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"></span></div>
<div class="MsoNormal">
<span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">小兵立大功的道理。</span>( <span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">圖 3A,B.)</span></div>
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<span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"><br /></span></div>
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<span lang="ZH-TW" style="font-family: "pmingliu" , serif;"><br /></span></div>
<div class="MsoNormal">
<span lang="ZH-TW" style="font-family: "pmingliu" , serif;">但是</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , serif;">要脊椎要做出這樣的動作,還必須仰賴一段一段,從薦椎延伸至頸椎的</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , serif;">脊椎多裂肌</span>(
Multifidus ) <span lang="ZH-TW" style="font-family: "pmingliu" , serif;">的操控</span> (<span lang="ZH-TW" style="font-family: "pmingliu" , serif;">圖 4A. 4B</span>)<span lang="ZH-TW" style="font-family: "pmingliu" , serif;">。</span></div>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; margin-right: 1em; text-align: left;"><tbody>
<tr><td style="text-align: center;"><a href="https://2.bp.blogspot.com/-YGjH-AT0pzA/WctS-tQEH5I/AAAAAAAAF2Y/cOxHhvhfJqwy6o8Kx8TXVJyIkx7IamNgQCLcBGAs/s1600/170923%2BMultifidus%2B2.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" data-original-height="232" data-original-width="226" height="200" src="https://2.bp.blogspot.com/-YGjH-AT0pzA/WctS-tQEH5I/AAAAAAAAF2Y/cOxHhvhfJqwy6o8Kx8TXVJyIkx7IamNgQCLcBGAs/s200/170923%2BMultifidus%2B2.jpg" width="194" /></a></td></tr>
<tr><td class="tr-caption" style="font-size: 12.8px; text-align: center;">圖 4 A.</td></tr>
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<div class="MsoNormal">
<span lang="ZH-TW" style="font-family: "pmingliu" , serif;"><br /></span></div>
<div class="MsoNormal">
<span lang="ZH-TW" style="font-family: "pmingliu" , serif;"></span></div>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://3.bp.blogspot.com/-8JD1dnctUUg/WctXql1ssdI/AAAAAAAAF2k/eqNA_UCfCL0JI__RCwCQwCRhlgxk3dlGACLcBGAs/s1600/170923%2BMultifidus%2B7.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="137" data-original-width="136" height="200" src="https://3.bp.blogspot.com/-8JD1dnctUUg/WctXql1ssdI/AAAAAAAAF2k/eqNA_UCfCL0JI__RCwCQwCRhlgxk3dlGACLcBGAs/s200/170923%2BMultifidus%2B7.jpg" width="198" /></a></td></tr>
<tr><td class="tr-caption" style="font-size: 12.8px; text-align: center;">圖 4 B</td></tr>
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<span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">脊椎多裂肌是</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">很多、很多、一條條、小片小片薄薄的肌束</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">所組成。肌束</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">從每一個小面關節的隆突處</span><span lang="ZH-TW"> </span>(<span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">近脊椎橫突</span>)<span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">,向內、向上斜走,越過</span>2<span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">至</span>4<span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">節的脊椎,再牢牢地附著在往上</span>2<span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">或</span>3<span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">或</span>4<span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">階高處的脊椎後突棘上。這樣一組組的多裂肌束,延展成整條脊柱的強大的肌力</span>(<span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">圖 4B.</span> )<span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">,功在穩定</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">節節脊椎的銜接、也維持椎間盤的平穩、減少它的</span></div>
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<span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">磨損與退化。正常情況下,穩定的椎間盤,會把垂直的負重</span>(
weight bearing) <span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">與</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">旋轉力</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">的負荷</span>(rotational force) <span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">有效率的</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">轉嫁到小面關節。(圖 3A, 3B)</span><o:p></o:p></div>
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<span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"><br /></span></div>
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<span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">從年輕到老,軀體的姿勢、動作、勞動、運動</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">的過程裡,小面關節</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">會因受力過重,受力不平均,受到磨損,造成受傷、發炎或小面關節本身的退化;這時,節與節的</span><span style="color: #eeeeee;"><span style="background-color: black;"><span lang="ZH-TW" style="font-family: "pmingliu" , serif;">脊椎,會有疼痛、痠痛、灼熱感</span><span lang="ZH-TW" style="font-family: "helvetica" , sans-serif;"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , serif;">與脹痛感等不適,此即是所謂的 小面關節症候群<b> </b> </span><span style="font-family: "helvetica" , sans-serif;">(Facet Joint Syndrome)</span><span lang="ZH-TW" style="font-family: "mingliu";">。嚴格來講,初期的腰椎退化性關節炎的下背痛,都屬於此範疇。</span></span><span style="background-color: #444444; font-family: "mingliu";"><o:p></o:p></span></span></div>
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<span style="background-color: black; color: #eeeeee;"><span lang="ZH-TW" style="font-family: "pmingliu" , serif;">小面關節周遭相關的多裂肌,是由每節的脊椎神經背根</span><span lang="ZH-TW" style="font-family: "arial" , sans-serif;"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , serif;">的內分枝</span><span style="font-family: "arial" , sans-serif;">( medial br. of dorsal ramus </span><span lang="ZH-TW" style="font-family: "pmingliu" , serif;">,</span><span style="font-family: "arial" , sans-serif;"> spinal nerve ) </span><span lang="ZH-TW" style="font-family: "pmingliu" , serif;">所支配。最近一些研究,</span><span lang="ZH-TW" style="font-family: "arial" , sans-serif;"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , serif;">認為多裂肌,可能對椎間盤病變如:椎間盤突出、</span><span lang="ZH-TW" style="font-family: "arial" , sans-serif;"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , serif;">脊椎滑脫、</span><span lang="ZH-TW" style="font-family: "arial" , sans-serif;"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , serif;">神經根受擠壓</span><span style="font-family: "arial" , sans-serif;">…</span><span lang="ZH-TW" style="font-family: "pmingliu" , serif;">等很敏感;但神經分枝反應出的刺激傳遞,會因小面關節的病變,產生阻滯或受到抑制,多裂肌的活性因此被惰化。有長期下背痛的病人,</span><span style="font-family: "arial" , sans-serif;"> MRI</span><span lang="ZH-TW" style="font-family: "pmingliu" , serif;">檢查</span><span lang="ZH-TW" style="font-family: "arial" , sans-serif;"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , serif;">,會看到病人的</span><span lang="ZH-TW" style="font-family: "arial" , sans-serif;"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , serif;">多裂肌萎縮</span><span lang="ZH-TW" style="font-family: "arial" , sans-serif;"> ( 圖 5B.)</span><span lang="ZH-TW" style="font-family: "pmingliu" , serif;">,這被闡釋是多裂肌活性長期被惰化的結果。</span><span lang="ZH-TW" style="font-family: "arial" , sans-serif;"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , serif;">再者</span><span lang="ZH-TW" style="font-family: "arial" , sans-serif;"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , serif;">,小面關節</span><span lang="ZH-TW" style="font-family: "arial" , sans-serif;"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , serif;">的關節炎,會增加一些</span><span lang="ZH-TW" style="font-family: "arial" , sans-serif;"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , serif;">炎性源細胞激素如</span><span style="font-family: "arial" , sans-serif;">tumor necrosis factor-α, interleukin-α, interleukin-1ß </span><span lang="ZH-TW" style="font-family: "pmingliu" , serif;">的分泌,</span><span lang="ZH-TW" style="font-family: "arial" , sans-serif;"> </span></span><span lang="ZH-TW" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; font-family: "pmingliu" , serif;"><span style="background-color: black; color: #eeeeee;">使多裂肌的脂肪浸潤加劇( 圖 6B)、</span><table cellpadding="0" cellspacing="0" class="tr-caption-container" style="background-color: white; color: #333333; float: left; margin-right: 1em; text-align: left;"><tbody>
<tr><td style="text-align: center;"><a href="https://1.bp.blogspot.com/-hDhWfFt3CQ0/WctcyQhX0yI/AAAAAAAAF28/f8dQNX6FIx0hnaXZiw-pYHVieSnSWxFygCLcBGAs/s1600/170923%2BMultifidus%2B4.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" data-original-height="276" data-original-width="624" height="141" src="https://1.bp.blogspot.com/-hDhWfFt3CQ0/WctcyQhX0yI/AAAAAAAAF28/f8dQNX6FIx0hnaXZiw-pYHVieSnSWxFygCLcBGAs/s320/170923%2BMultifidus%2B4.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">圖 5 B 白線圈起部分 顯示萎縮多裂肌</td></tr>
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<tr><td><a href="https://3.bp.blogspot.com/-ETP51FbVNSs/WctePvySKkI/AAAAAAAAF3I/zmNxp729JBc1G4xHqvyo1LLrDMTCGTCJQCLcBGAs/s1600/170923%2BMultifidus%2B5.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="285" data-original-width="624" height="146" src="https://3.bp.blogspot.com/-ETP51FbVNSs/WctePvySKkI/AAAAAAAAF3I/zmNxp729JBc1G4xHqvyo1LLrDMTCGTCJQCLcBGAs/s320/170923%2BMultifidus%2B5.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="font-size: 12.8px;">圖 6 B 黃線圈內 白色區顯示脂肪浸潤</td></tr>
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而加劇的結果又使多裂肌的肌強度或肌力變差。<span lang="ZH-TW" style="background: white; color: #333333; font-family: "arial" , "sans-serif";"> </span><br />
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<span style="background-color: black; color: #f3f3f3;"><span lang="ZH-TW" style="font-family: "pmingliu" , serif;">這些生物力學上,小面關節的退化,衍生出來的</span><span lang="ZH-TW" style="font-family: "arial" , sans-serif;"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , serif;">神經與多裂肌束之間</span><span lang="ZH-TW" style="font-family: "arial" , sans-serif;"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , serif;">的交互作用</span><span lang="ZH-TW" style="font-family: "arial" , sans-serif;"> </span><span style="font-family: "arial" , sans-serif;">(interactive
reaction)</span><span lang="ZH-TW" style="font-family: "pmingliu" , serif;">,變成一種難以中止的 <b>惡性循環</b>,</span><span lang="ZH-TW" style="font-family: "arial" , sans-serif;"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , serif;">終於使脊椎關節一步一步,一節接著一節,走上退化一途。</span><span style="font-family: "arial" , sans-serif;"><o:p></o:p></span></span></div>
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<span style="background-color: black; color: #f3f3f3;"><span lang="ZH-TW" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; font-family: "pmingliu" , serif;">這理論</span><span lang="ZH-TW" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; font-family: "pmingliu" , serif;">點出</span><span lang="ZH-TW" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; font-family: "pmingliu" , serif;">了為什麼下背痛總是醫不好、不會斷根?</span><span lang="ZH-TW" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; font-family: "arial" , sans-serif;"> </span><span lang="ZH-TW" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; font-family: "pmingliu" , serif;">也</span><span lang="ZH-TW" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; font-family: "arial" , sans-serif;"> </span><span lang="ZH-TW" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; font-family: "pmingliu" , serif;">說明了</span><span lang="ZH-TW" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; font-family: "arial" , sans-serif;"> </span><span lang="ZH-TW" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; font-family: "pmingliu" , serif;">為什麼</span><span lang="ZH-TW" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; font-family: "arial" , sans-serif;"> </span><span lang="ZH-TW" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; font-family: "pmingliu" , serif;">脊椎的退化會有所謂的<b>「骨牌效應」</b></span><span style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; font-family: "arial" , sans-serif;"> (Domino Effect)</span><span lang="ZH-TW" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; font-family: "pmingliu" , serif;">。</span></span></div>
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<span style="background-color: black; color: #f3f3f3;"><span lang="ZH-TW" style="font-family: "pmingliu" , serif;">面對這樣的情境,只有殷切寄望學界、醫界</span><span lang="ZH-TW" style="font-family: "arial" , sans-serif;"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , serif;">能有所突破,找到好的對策。</span></span></div>
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<span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">Reference:</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif; font-size: x-small;">1. Bo Yu, Kaibiao
Jiang, Xinfeng Li, Jidong Zhang, Zude
Liu, Correlation
of the Features of the Lumbar Multifidus
Muscle With Facet Joint Osteoarthritis. <i>Orthopedics</i> June 6,
2017 dot. 10.3928/01477447-20170531-05<span style="background: white; color: #333333;"><o:p></o:p></span> <a href="http://dx.doi.org/10.1038/nrrheum.2012.199" target="_blank"><span style="color: #255284; text-decoration-line: none;">[CrossRef]</span></a></span></div>
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<span style="background-color: #444444;"><span style="color: #f3f3f3; font-family: "arial" , "helvetica" , sans-serif; font-size: x-small;"><span style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial;">2. Kong MH, Morishita Y,
He W, et al. Lumbar segmental mobility according to the grade of the disc, the
facet joint, the muscle, and the ligament pathology by using kinetic magnetic
resonance imaging<i> Spine (Phila Pa 1976)</i>. 2009; 34(23):2537–2544. doi:10.1097/BRS.0b013e3181b353ea</span> <a href="http://dx.doi.org/10.1038/nrrheum.2012.199" target="_blank"><span style="color: #255284; text-decoration-line: none;">[CrossRef]</span></a><o:p></o:p></span></span></div>
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<span style="background-color: #444444;"><span style="color: white; font-family: "arial" , "helvetica" , sans-serif; font-size: x-small;">3. Gellhorn AC,
Katz JN, Suri P. Osteoarthritis of the spine: the facet joints. <i>Nat Rev
Rheumatol</i>. 2013; 9(4):216–224. doi:10.1038/nrrheum.2012.199 <a href="http://dx.doi.org/10.1038/nrrheum.2012.199" target="_blank"><span style="color: #255284; text-decoration-line: none;">[CrossRef]</span></a><o:p></o:p></span></span></div>
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<span style="background-color: #444444;"><span style="font-family: "arial" , "helvetica" , sans-serif; font-size: x-small;"><span style="color: white;">4. Hides J,
Gilmore C, Stanton W, Bohlscheid E. Multifidus size and symmetry among chronic
LBP and healthy asymptomatic subjects. <i>Man Ther</i>. 2008; 13(1):43–49.
doi:10.1016/j.math.2006.07.017 <a href="http://dx.doi.org/10.1016/j.math.2006.07.017" target="_blank">[CrossRef]</a></span><span style="color: #f3f3f3;"><o:p></o:p></span></span></span></div>
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<span style="background-color: #444444; color: #f3f3f3; font-family: "arial" , "helvetica" , sans-serif; font-size: x-small;">5. Kjaer P, Bendix T,
Sorensen JS, Korsholm L, Leboeuf-Yde C. Are MRI-defined fat infiltrations in
the multifidus muscles associated with low back pain?<i style="box-sizing: border-box;">BMC
Med</i>. 2007; 5:2. doi:10.1186/1741-7015-5-2 <a href="http://dx.doi.org/10.1186/1741-7015-5-2" style="box-sizing: border-box;" target="_blank">[CrossRef]</a><o:p></o:p></span></div>
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<span style="background-color: #444444; color: #f3f3f3; font-family: "arial" , "helvetica" , sans-serif; font-size: x-small;">6. Hyun JK, Lee JY, Lee SJ,
Jeon JY. Asymmetric atrophy of multifidus muscle in patients with unilateral
lumbosacral radiculopathy. <i style="box-sizing: border-box;">Spine (Phila
Pa 1976)</i>. 2007; 32(21):E598–E602. doi:10.1097/BRS.0b013e318155837b <a href="http://dx.doi.org/10.1097/BRS.0b013e318155837b" style="box-sizing: border-box;" target="_blank">[CrossRef]</a><a href="https://www.blogger.com/null" name="x01477447-20170531-05-bibr9"></a><o:p></o:p></span></div>
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<span style="background-color: #444444; color: #f3f3f3; font-family: "arial" , "helvetica" , sans-serif; font-size: x-small;">7. Saito T, Steinke H, Miyaki
T, et al. Analysis of the posterior ramus of the lumbar spinal nerve: the
structure of the posterior ramus of the spinal nerve. <i style="box-sizing: border-box;">Anesthesiology</i>.
2013; 118(1):88–94. doi:10.1097/ALN.0b013e318272f40a <a href="http://dx.doi.org/10.1097/ALN.0b013e318272f40a" style="box-sizing: border-box;" target="_blank">[CrossRef]</a> <o:p></o:p></span></div>
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<span style="background-color: #444444; color: #f3f3f3; font-family: "arial" , "helvetica" , sans-serif; font-size: x-small;">8. </span><span style="color: #333333; mso-fareast-font-family: "Times New Roman";"><span style="background-color: #444444;"><span style="color: #f3f3f3; font-family: "arial" , "helvetica" , sans-serif; font-size: x-small;">Campbell WW,
Vasconcelos O, Laine FJ. Focal atrophy of the multifidus muscle in lumbosacral
radiculopathy. <i>Muscle Nerve</i>. 1998; 21(10):1350–1353.
doi:10.1002/(SICI)1097-4598(199810)21:10</span></span><1350::aid-mus21><span style="background-color: #444444;"><span style="color: #f3f3f3; font-family: "arial" , "helvetica" , sans-serif; font-size: x-small;">3.0.CO;2-4 <a href="http://dx.doi.org/10.1002/(SICI)1097-4598(199810)21:10%3C1350::AID-MUS21%3E3.0.CO;2-4" target="_blank">[CrossRef]</a></span></span><span style="color: #333333;"><o:p></o:p></span></1350::aid-mus21></span></div>
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baba.wg58@gmail.comhttp://www.blogger.com/profile/03790611799966344101noreply@blogger.com0tag:blogger.com,1999:blog-1350268300834830253.post-60827202370066793272017-09-10T17:37:00.000-07:002017-09-10T17:37:00.780-07:00不再吠的狗<div class="MsoNormal">
<a href="https://2.bp.blogspot.com/-Ynna7qQNWZ4/WbXaNU5jHuI/AAAAAAAAF1g/BNteEX0SSkAOGvFTY1JETsP-cANOSYKOgCLcBGAs/s1600/170911%2BBarking%2BDog.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="183" data-original-width="275" height="132" src="https://2.bp.blogspot.com/-Ynna7qQNWZ4/WbXaNU5jHuI/AAAAAAAAF1g/BNteEX0SSkAOGvFTY1JETsP-cANOSYKOgCLcBGAs/s200/170911%2BBarking%2BDog.jpg" width="200" /></a><span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">已經是陳年往事。</span><o:p></o:p></div>
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<span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">時間是</span>1978<span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">年的某日。隨著</span>Lu<span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">公走出了</span>VIP<span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">病房,看得出</span>Lu<span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">公是板著一張臉,我的心情也跟著沉了下來。回到外科部部主任辦公室,他拋下了一句話,要我在一個禮拜內,把動物實驗室裡</span>33<span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">條狗的聲帶都切掉。</span><o:p></o:p></div>
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<span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">我是外科部總醫師,剛好輪值</span>3<span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">個月的行政管理,必須坐鎮外科部,隨侍在部主任左右。</span><o:p></o:p></div>
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<span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">我的工作除了處理外科部的庶務、調派住院醫師輪訓不同次專科、排定住院醫師的值班、核簽手術排程、看它科的照會與會診,還有的</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">就是三不五時的</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">要陪</span>Lu<span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">公去探視一些</span>VIP<span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">病人。這</span>3<span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">個月我不用看急診,因此不必半夜起來開急診刀,這可是打從</span>R1<span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">開始,從沒有的事,晚上難得能好好睡個覺;那些恓惶終日的小住院醫師們,莫不羨慕的說,當行政總醫師真好,簡直就是在度假嘛!別以為這些小</span>R<span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">只是說話酸,他們可是精得一點都不含糊。</span>Lu<span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">公星期假日喜歡爬爬台北附近的小山,通常交代總醫師找人陪爬山。難就難在這是要怎樣抓公差的呀</span>?
<span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">要住院醫師把盼了一個禮拜的女朋友、妻兒子女,晾一邊,揹著水壺、陪爬山</span>…<span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">,任誰都打死不從的!這樣的「好」差事,自然也就落在我的身上,眾住院醫師還謔說,這是我不可被剝奪的「福利」!</span><o:p></o:p></div>
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VIP<span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">病房在醫院偏僻的西北角小山丘,遠離醫療大樓。周遭林木蒼翠,環境幽雅,站在病房最高點的窗口,隱約還可遠眺關渡平原。當初院方會把</span>VIP<span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">病房設此,想必是認為隱密性高、又安全維護容易,但卻忽略了山丘腳下早就有一兩層平房的動物實驗室。住進</span>VIP<span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">病房的,都是國家的黨政要員,這是這家國家醫院的政治使命;通常他們只是來作一些體檢,住個</span>2<span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">、</span>3<span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">天而已,醫院自有一組醫療人員負責,平常我們是無緣接觸的。這次住進來的可是皇親家族成員,聽說是要來療養一陣子。我是隨著兼任副院長的</span>Lu<span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">公</span>Lu<span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">主任,前來探視這個被狗吠聲吵得無法成眠、一肚子不高興的皇親貴族;沒想到,就這樣意外的接了個棘手的任務。</span><o:p></o:p></div>
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<span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">雖然</span>rotation
<span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">骨科的時候,我曾參與動物實驗,把一種新開發的骨材植入狗的股骨,但也只是在狗的大腿骨打上鋼釘、鋼板,一段時間後又取出而已,我並沒有真正給狗開過刀:現在可好,要作的是要把狗的聲帶切除的手術。我問了耳鼻喉科的醫師,沒人作過,也沒人有興趣;我只好翻翻書,又找了動物實驗室的張技士談,他只答應會替我做麻醉,把狗麻好,其它的,就要靠自己了。我到醫工室翻找了幾支還堪用的牙科張口器,又找了幾支報廢的、不同長短、不同</span>size<span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">與角度的</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">椎間盤咬切器</span><span lang="ZH-TW"> </span>(Disc
Punch)<span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">,又向麻醉科借了一支還堪用的喉頭鏡,湊合著,構想著怎樣進行這項工作。</span><o:p></o:p></div>
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<span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">人稱「</span>Lu<span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">公」的部主任,是外科部的大家長。他頭腦清析、記性好又反應敏捷,主持晨會,誰也甭想矇混過關;哪個</span>R<span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">膽敢準備不充分上場報告,包會被他「電」得腦震盪。他常有令人折服的見解,開起刀來更是乾淨利落,醫界普遍視他是胸腔外科的大師,此之所以「</span>Lu<span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">公」之由來;但脾氣之壞、對下屬之嚴厲,也是出了名,外科部同仁莫不敬畏十二分。但大概也是嚴師出高徒,外科因此士氣高昂,走路生風,在醫院裡是最拉風的科。他的白袍總是筆挺,談吐鏗鏘,英語流利,給人印象深刻;最近才擢昇兼副院長,而他的政治</span>sense<span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">更是正確,甫任國民黨的中常委,就傳出層峰有意要他更上一層樓。隨侍在這樣的部主任左右,也就難怪當總醫師的,個個是如履薄冰、兢兢業業,唯恐出了差錯。</span><o:p></o:p></div>
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<span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">我從台大畢業,恨醫預科時期成績不好,沒能進台大外科,進了這家醫學中心,但卻有焉之非福之感。主要的是這醫學中心學習的環境不錯,老師級的醫師,個個都學有專精,在這樣的環境,接受正統的、嚴格的外科訓練,我每一天都感覺到自己在進步、在成長;而更特別的是,住院醫師也能申請到院區內的眷舍,至少在苦哈哈、日以繼夜的住院醫師生涯中,偶而還可偷溜回家,看一下久別的妻子幼兒。至於,威權氣氛壟罩,帶有軍方色彩的管理,習慣了也就適應了。本來,選擇外科這條路,除了入門要擠破頭之外,一旦進入,心理上就要有</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">西出陽關無故人,</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">受苦受難</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">的準備的,不是嗎?</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">坦白說,</span>R1<span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">的時候,我也曾差一點受不了當上外科逃兵,現在好不容易,捱過了苦日子,當了總醫師,好歹也是成就一樁,更何況總醫師再苦一年,要是表現好,說不定還雀屏中選,主任升你當主治醫師,那不就是自己從學生時代以來一直所憧憬的夢嗎?</span><o:p></o:p></div>
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<span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">動物實驗室的狗是市政府抓來的野狗,豢養在鐵籠裡,注定的都是作完實驗就要被犧牲掉的。狗實在是很有靈性的動物,大概心裡明白會是怎麼一回事,知道這些穿白衣的,並不是牠們的朋友,只要我一走近,牠們就會眼露兇光,惡狠狠的近對著我狂吠。要切狗的聲帶,作起來可也沒想像中容易。因為要切聲帶,麻醉無法採氣管插管的方式;張技士先注射了</span>Ketamin<span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">,再讓狗兒吸乙醚吸一陣子後,把狗仰天五花大綁固定好,我則用</span>2<span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">支張口器,把狗的嘴巴大大翹開,一手持喉頭鏡把狗的舌根挑開,另一手握</span>Disc
Punch<span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">,趁狗呼吸時聲帶一開一閤的當兒,眼明手快的,一舉就要把聲帶給咬斷!</span><o:p></o:p></div>
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<span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">難就難在麻醉,麻得不夠深,狗會中途掙扎,讓你作不下去,要重來;又不能麻太深,把狗麻昏死,聲帶不開閤;再加上差勁的報廢</span>Punch<span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">,有時,一下子咬不斷聲帶,卻惹得狗劇烈咳嗽,喷得我一頭一臉的狗血和涶沫</span>…..<span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">。頭一天,搞了近</span>2<span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">個多小時,張技士跟我都氣喘吁吁,才完成一條狗;我有點緊張,那</span>32<span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">條狗我豈不是要搞一個月嗎?只好加快腳步,中午、傍晚</span> (<span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">又不能太晚、吵到人</span>) <span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">都作,幸好一回生,兩回熟,張技士的狗麻醉技術也愈來愈成熟,狗不會半路掙扎起來,而我再找了一支好一點的</span>Punch<span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">,夠利,一卡,聲帶就應聲斷開。</span><o:p></o:p></div>
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<span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">就這樣,越作越順手,越作越快,我也真後知後覺,作了幾個才發現聲帶不必咬兩邊,只要咬斷一邊,狗就啞了</span>…..<span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">;終於,在</span>Lu<span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">公給的期限內,我完成了這項任務。再一次陪</span>Lu<span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">公去探視這個</span>VIP<span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">的時候,看他神采奕奕,跟</span>Lu<span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">公有說有笑的,我知道我在</span>Lu<span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">公的</span>Credit<span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">上,又加分了一筆。</span><o:p></o:p></div>
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<span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">總醫師的一年,也就在忙碌中渡過;我後來順利的升上主治醫師,開拓了我另一階段的醫師生涯,這段往事,並沒有帶給當時的我太大的衝擊。</span><o:p></o:p></div>
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<span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">事隔多年,有一天在家中閒聊,我像說故事般的,自豪的講給我一對可愛的兒女聽,小學快畢業的兒子叫了起來:「爸!你怎麼可以這樣?」;</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">而更小、平常很乖巧,又非常喜歡小動物的女兒,更生氣我,一個多月都不跟我說話,還不敢靠近我</span>…<span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">;我沒料到他們對這事的反應是那麼大!後悔大嘴巴已來不及。</span><o:p></o:p></div>
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<span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">要狗不吵人,把狗套上嘴箍不就得了嗎?何苦狠心切斷牠們的聲帶?我當初是有這樣想,但年輕的我,卻畏於權勢,連跟</span>Lu<span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">公建議的勇氣都沒有,更不用說敢拒絕聽命。事過,境卻未必遷;動物實驗室的那個角落、張技士氣喘吁吁的模樣、噴得我一臉的狗血、還有</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">看到我就退避三舍、眼神畏懼,但已不會吠叫的狗</span>….<span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">,卻常常會浮現在我的眼前,揮之不去。</span><o:p></o:p></div>
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<span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">回想這一切,我的愧疚與遺憾,直如心底的一道烙印,無法抹滅。</span><o:p></o:p></div>
baba.wg58@gmail.comhttp://www.blogger.com/profile/03790611799966344101noreply@blogger.com0tag:blogger.com,1999:blog-1350268300834830253.post-25357973317407852852017-01-02T04:37:00.000-08:002018-09-02T10:19:18.795-07:00骨頭二三軼事<div class="MsoNormal">
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<span style="font-family: "arial" , "helvetica" , sans-serif;"><span lang="ZH-TW" style="font-size: 12pt; line-height: 115%;">大家都知道,人有</span><span style="font-size: 12pt; line-height: 115%;">206<span lang="ZH-TW">塊骨頭, 但你知道
剛出生的嬰兒 有多少骨頭嗎? 有</span>300<span lang="ZH-TW">塊! 剛出生的嬰兒,全身充滿軟骨; 在成長的過程中 ,一部分的軟骨除了變硬骨外,還會跟相鄰的軟骨融合併成一塊
</span>(<span lang="ZH-TW">稱 骨融合</span>)<span lang="ZH-TW">, 所以 數目會變少,這 應該是所謂 「轉骨」的真義吧!</span><o:p></o:p></span></span></div>
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<span lang="ZH-TW" style="color: #cccccc; font-family: "arial" , "helvetica" , sans-serif;">通常過了青春期後,骨骼 就停止生長**。</span><span style="background-color: black; color: #cccccc; font-family: "arial" , "helvetica" , sans-serif;"> </span><span style="background-color: black; color: #cccccc; font-family: "arial" , "helvetica" , sans-serif;"> </span><span lang="ZH-TW" style="color: #cccccc; font-family: "arial" , "helvetica" , sans-serif;">但 它 並沒停止變化</span><span style="background-color: black; color: #cccccc; font-family: "arial" , "helvetica" , sans-serif;"> </span><span style="background-color: black; color: #cccccc; font-family: "arial" , "helvetica" , sans-serif;">(</span><span lang="ZH-TW" style="color: #cccccc; font-family: "arial" , "helvetica" , sans-serif;">是即:骨的新陳代謝。有 另外的名稱: 「骨重塑</span><span style="background-color: black; color: #cccccc; font-family: "arial" , "helvetica" , sans-serif;"> </span><span style="background-color: black; color: #cccccc; font-family: "arial" , "helvetica" , sans-serif;">remolding</span><span lang="ZH-TW" style="color: #cccccc; font-family: "arial" , "helvetica" , sans-serif;">」</span><span style="background-color: black; color: #cccccc; font-family: "arial" , "helvetica" , sans-serif;">)</span><span style="background-color: black; color: #cccccc; font-family: "arial" , "helvetica" , sans-serif;"> </span><span lang="ZH-TW" style="color: #cccccc; font-family: "arial" , "helvetica" , sans-serif;">。年過</span><span style="background-color: black; color: #cccccc; font-family: "arial" , "helvetica" , sans-serif;">35</span><span style="background-color: black; color: #cccccc; font-family: "arial" , "helvetica" , sans-serif;"> </span><span lang="ZH-TW" style="color: #cccccc; font-family: "arial" , "helvetica" , sans-serif;">,不管男女 ,骨質就開始流失 ,多攝取鈣 維他命</span><span style="background-color: black; color: #cccccc; font-family: "arial" , "helvetica" , sans-serif;">D</span><span style="background-color: black; color: #cccccc; font-family: "arial" , "helvetica" , sans-serif;"> </span><span lang="ZH-TW" style="color: #cccccc; font-family: "arial" , "helvetica" , sans-serif;">有 助骨質健康。</span></div>
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<span style="color: #cccccc; font-family: "arial" , "helvetica" , sans-serif;"><span lang="ZH-TW" style="background-color: black;">骨頭除了建構你的身體、體型外, 還讓你能活動; 它還保護你的 器官, 如: 頭顱保護你的腦, 肋骨構成的胸腔保護你的心、肝、 肺; 骨頭還製造紅血球,攜帶氧氣,營養組織,又 製造白血球 對抗感染的入侵。</span><span style="background-color: white;"><o:p></o:p></span></span></div>
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<span style="background-color: black; color: #cccccc; font-family: "arial" , "helvetica" , sans-serif;"><span lang="ZH-TW">模特兒最愛閃現骨感的鎖骨,是 骨折排行榜的首位。 鎖骨只是幫忙架構你的肩膀,不負責承擔手臂的重量,所以只是一根瘦瘦</span>S<span lang="ZH-TW">形的骨頭;跌倒用手撐,摔車肩撞地,往往就使它斷了。 手腕, 手臂也常因想阻止跌倒造成骨折。</span><o:p></o:p></span></div>
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<span style="background-color: black; color: #cccccc; font-family: "arial" , "helvetica" , sans-serif;"><span lang="ZH-TW">雖然還沒有明確証據,證明碳酸飲料有害骨頭。 但 含咖啡因 或 含磷酸飲料 </span>(<span lang="ZH-TW">如 可樂</span>)<span lang="ZH-TW">,可能有損骨質, 想喝飲料, 建議還是喝牛奶 或 喝 加鈣的果汁最好。</span><span style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial;"><o:p></o:p></span></span></div>
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<span style="background-color: black; color: #cccccc; font-family: "arial" , "helvetica" , sans-serif;"><span lang="ZH-TW" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; font-size: 12pt; line-height: 18.4px;">知抽菸有害肺、心健康人人皆知,</span><span style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; font-size: 12pt; line-height: 18.4px;"> <span lang="ZH-TW">但 越來有越多的證據, 証明尼古丁會妨害鈣的吸收, 又會降低血中維他命</span>D<span lang="ZH-TW">的濃度 ,不利骨質健康,所以抽菸也害骨質疏鬆。</span></span></span></div>
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<span style="background-color: black; color: #cccccc; font-family: "arial" , "helvetica" , sans-serif;"><span lang="ZH-TW" style="font-size: 12pt; line-height: 18.4px;">骨頭端</span><span style="font-size: 12pt; line-height: 18.4px;">-<span lang="ZH-TW">端相接, 就形成一個關節,全身皆如此,</span></span></span></div>
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<span style="color: #cccccc;"><span style="background-color: black; font-size: 12pt; line-height: 18.4px;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><span lang="ZH-TW">唯獨你的喉嚨裡有一個骨頭 :舌骨,</span>( <span lang="ZH-TW">圖</span>1)</span></span></span></div>
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卻 上不勾天、 下不著地, 沒有關節的連結,</span></span><br />
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<span style="font-family: "pmingliu" , serif; font-size: 12pt; line-height: 115%;"><span lang="ZH-TW" style="background-color: black;"><span style="color: #cccccc;">孤伶伶的懸在舌頭下方, 只有你在吞嚥時,</span></span></span></div>
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<span style="background-color: black; font-family: "pmingliu" , serif; font-size: 12pt; line-height: 115%;"><span style="color: #cccccc;"><span lang="ZH-TW">才能查覺
它的存在。</span><o:p></o:p></span></span></div>
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<span lang="ZH-TW" style="background-color: black; font-family: "pmingliu" , serif; font-size: 12pt; line-height: 115%;"><span style="color: #cccccc;"><br /></span></span></div>
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<span lang="ZH-TW" style="background-color: black; font-family: "pmingliu" , serif; font-size: 12pt; line-height: 115%;"><span style="color: #cccccc;"><br /></span></span></div>
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<span style="background-color: black; color: #cccccc;"><span lang="ZH-TW" style="font-family: "pmingliu" , serif; font-size: 12pt; line-height: 115%;">你注意過
你的</span><span style="font-family: "pmingliu" , serif; font-size: 12pt; line-height: 115%;">4<span lang="ZH-TW">個腳趾頭是</span>3<span lang="ZH-TW">個關節,</span> <span lang="ZH-TW">而大拇趾只有</span>2<span lang="ZH-TW">節嗎</span> ? </span></span></div>
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<span style="background-color: black; font-family: "pmingliu" , serif; font-size: 12pt; line-height: 115%;"><span style="color: #cccccc;"><span lang="ZH-TW"><br /></span></span></span>
<span style="background-color: black; font-family: "pmingliu" , serif; font-size: 12pt; line-height: 115%;"><span style="color: #cccccc;"><span lang="ZH-TW">再往上看
,你的</span>4<span lang="ZH-TW">個手指 與 大拇指 也是這樣的。老天爺這樣的「設計」,讓人在用手做事、用腳走路,得到更多的 方便。</span><o:p></o:p></span></span></div>
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<span lang="ZH-TW" style="background-color: black; font-family: "pmingliu" , serif; font-size: 12pt; line-height: 115%;"><span style="color: #cccccc;"><br /></span></span></div>
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<span style="color: #cccccc;"><span lang="ZH-TW" style="font-family: "pmingliu" , serif; font-size: 12pt; line-height: 115%;"><span style="background-color: black;"> 你知道身體最小的骨頭在哪裡嗎</span></span><span style="background-color: black; font-family: "pmingliu" , serif; font-size: 12pt; line-height: 115%;"> ? </span></span></div>
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<span style="font-family: "pmingliu" , serif; font-size: 12pt; line-height: 115%;"><span lang="ZH-TW" style="background-color: black;"><span style="color: #cccccc;"><br /></span></span></span></div>
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<span style="background-color: black; font-family: "pmingliu" , serif; font-size: 12pt; line-height: 115%;"><span style="color: #cccccc;"><span lang="ZH-TW">就在你內耳的
蹬骨</span>( <span lang="ZH-TW">因 形似馬鞍之腳蹬得名 </span>)(<span lang="ZH-TW">圖</span>2)<span lang="ZH-TW">,</span></span></span></div>
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<span style="background-color: black; color: #cccccc;"><a href="https://1.bp.blogspot.com/-a2uU2NjE2X4/WGpEKDyRCVI/AAAAAAAAFzg/PfHMRC4WqP4PQ5vHzOkthQfLR-FnpuTCQCLcB/s1600/170101%2BStirrup%2Bbone.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="199" src="https://1.bp.blogspot.com/-a2uU2NjE2X4/WGpEKDyRCVI/AAAAAAAAFzg/PfHMRC4WqP4PQ5vHzOkthQfLR-FnpuTCQCLcB/s320/170101%2BStirrup%2Bbone.jpg" width="320" /></a></span></div>
<span style="background-color: black; color: #cccccc;"><br /></span>
<span style="background-color: black; color: #cccccc;">它只有2.5 x3.3<span lang="ZH-TW">毫米, 不比果蠅大;</span></span><br />
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<span style="font-family: "pmingliu" , serif; font-size: 12pt; line-height: 115%;"><span lang="ZH-TW" style="background-color: black;"><span style="color: #cccccc;"><br /></span></span></span></div>
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<span style="font-family: "pmingliu" , serif; font-size: 12pt; line-height: 115%;"><span lang="ZH-TW" style="background-color: black;"><span style="color: #cccccc;"><br /></span></span></span></div>
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<span style="background-color: black; color: #cccccc;"><span style="font-family: "pmingliu" , serif; font-size: 12pt; line-height: 115%;"><span lang="ZH-TW">那 身體</span></span><span style="font-family: "pmingliu" , serif; font-size: 12pt;">最長的骨頭在哪裡呢 ? </span></span></div>
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<br />
<span style="background-color: black; color: #cccccc;"><span lang="ZH-TW" style="font-family: "pmingliu" , serif; font-size: 12pt;">當然 ,全身最長的骨頭, 就是</span></span></div>
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<span style="background-color: black; color: #cccccc;"><span lang="ZH-TW" style="font-family: "pmingliu" , serif; font-size: 12pt;">連結骨盆與膝的股</span><span style="font-family: "pmingliu" , serif; font-size: 12pt;">(大</span><span lang="ZH-TW" style="font-family: "pmingliu" , serif; font-size: 12pt;">腿</span><span style="font-family: "pmingliu" , serif; font-size: 12pt;">)</span><span lang="ZH-TW" style="font-family: "pmingliu" , serif; font-size: 12pt;">骨了。</span></span></div>
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<span style="background-color: white; color: blue;">附註:</span><br />
<span style="background-color: white; color: blue;">* 本文亦登載於聯合報 106/1/21D4 健康版</span><br />
<span style="background-color: white; color: blue;">**唯有耳朵的軟骨, 在成年甚至 到年老, 還會持續成長。神話故事裡的耆老,</span><span style="background-color: white; color: blue;">有耳長垂肩云 者,傳聞可能有其根據。</span></div>
baba.wg58@gmail.comhttp://www.blogger.com/profile/03790611799966344101noreply@blogger.com0tag:blogger.com,1999:blog-1350268300834830253.post-34371096356949143702016-12-06T22:23:00.000-08:002016-12-06T22:23:26.446-08:00青中年人 關節保健的撇步<div class="MsoNormal">
<span lang="ZH-TW" style="font-family: PMingLiU, serif;">使用與磨損、</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">是關節退化的主因。人們實實在在的活一天,關節就結結實實的被操、被磨了一天;因此,說</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">關節退化</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">是老年人的宿命,一點也不為過。但對於青、中年人來說,到老還有一段距離,要怎樣疼惜寶貝你的關節,讓它盡量減少磨損呢</span>?
<span lang="ZH-TW" style="font-family: PMingLiU, serif;">以下是一些關節保健的撇步:</span><o:p></o:p></div>
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<span lang="ZH-TW" style="font-family: PMingLiU, serif;"><br /></span></div>
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<span lang="ZH-TW" style="font-family: PMingLiU, serif;"></span></div>
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1). <span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">關節是「動」的器官,</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">保持</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">關節健康的金規玉律</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">就是</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">「要動」。</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">動,</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">使</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">關節解除僵硬,</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">即使在閱讀、</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">看電視、</span> <span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">坐辦公桌</span><span lang="ZH-TW"> </span>…<span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">,趁</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">廣告時間上個廁所,</span> <span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">起來喝口水</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">,</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">動一動都好,切忌長坐不起</span>(Couch potato)<span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">。</span><o:p></o:p></div>
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<span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"></span></div>
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<br /></div>
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2). <span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">要玩滑板、</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">直排輪</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">、曲棍球</span>…<span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">,</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">請先穿好</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">護腕、護肘、膝墊、甚至頭盔</span>(<span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">如圖</span>1.)<span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">。</span></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://3.bp.blogspot.com/-EXXFutkjfHo/WEek4oWZijI/AAAAAAAAFxs/m-zMsBMzJlMk8S2RmQxMuH5cQonbzuvDgCLcB/s1600/161207%2B%2Bpig%2B1.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="200" src="https://3.bp.blogspot.com/-EXXFutkjfHo/WEek4oWZijI/AAAAAAAAFxs/m-zMsBMzJlMk8S2RmQxMuH5cQonbzuvDgCLcB/s200/161207%2B%2Bpig%2B1.jpg" width="141" /></a></div>
<span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">要打排球</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">、籃球、羽毛球,</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">最好穿上適當的護膝。</span><o:p></o:p><br />
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<span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"><br /></span></div>
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<span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"></span></div>
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3). <span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">減重</span>1<span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">公斤</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">就能讓你的下背、</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">大腿關節、</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">膝關節、</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">踝關節</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">少負荷</span>4<span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">公斤</span><span lang="ZH-TW"> </span>(<span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">想想這是多好的投資報酬率</span>?)</div>
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<o:p></o:p>4).<span lang="ZH-TW" style="font-family: PMingLiU, serif;">想拼命跑跳爬山健身房來減重,請先了解你要付出多少的骨科代價!</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">什麼運動最安全</span> ? <span lang="ZH-TW" style="font-family: PMingLiU, serif;">不會重擊關節的運動,</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">像</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">:走路</span>(<span lang="ZH-TW" style="font-family: PMingLiU, serif;">不是快走</span>)<span lang="ZH-TW" style="font-family: PMingLiU, serif;">,</span> <span lang="ZH-TW" style="font-family: PMingLiU, serif;">騎腳踏車</span>( <span lang="ZH-TW" style="font-family: PMingLiU, serif;">不是越野的</span> )<span lang="ZH-TW" style="font-family: PMingLiU, serif;">,</span> <span lang="ZH-TW" style="font-family: PMingLiU, serif;">游泳</span>
<span lang="ZH-TW" style="font-family: PMingLiU, serif;">最好。</span></div>
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5). <span lang="ZH-TW" style="font-family: PMingLiU, serif;">冷肌易傷。</span>
<span lang="ZH-TW" style="font-family: PMingLiU, serif;">暖肌柔軟</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">,</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">比較不會受傷。</span> <span lang="ZH-TW" style="font-family: PMingLiU, serif;">暖肌靠伸展;</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">伸展並不是那種刻意強練的「</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">拉筋</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">」;</span> <span lang="ZH-TW" style="font-family: PMingLiU, serif;">伸展,事實上就是暖身運動。</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">那</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">要怎樣暖身呢</span>? <span lang="ZH-TW" style="font-family: PMingLiU, serif;">很簡單</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">,就是把你即將從事的運動的主要動作,</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">用慢動作</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">,作個</span>5-10<span lang="ZH-TW" style="font-family: PMingLiU, serif;">分鐘;</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">像要打網球前</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">,先輕輕跳跳、</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">揮揮球拍</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">、彎彎腰、</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">惦惦腳踝</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">,小跑一下再上場。</span></div>
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6). <span lang="ZH-TW" style="font-family: PMingLiU, serif;">等張性肌力強化運動</span>(Isometric muscle tonic
exercise) <span lang="ZH-TW" style="font-family: PMingLiU, serif;">如大腿四頭肌強化運動</span> (<span lang="ZH-TW" style="font-family: PMingLiU, serif;">如圖</span>2.)<span lang="ZH-TW" style="font-family: PMingLiU, serif;">,</span></div>
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<a href="https://3.bp.blogspot.com/-EY_ykGis7qE/WEenLtliRqI/AAAAAAAAFx0/rI9lKFr7neoDiB9bvycyno8ZWbsf3iV5wCLcB/s1600/161207%2Bpig%2B2.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="189" src="https://3.bp.blogspot.com/-EY_ykGis7qE/WEenLtliRqI/AAAAAAAAFx0/rI9lKFr7neoDiB9bvycyno8ZWbsf3iV5wCLcB/s200/161207%2Bpig%2B2.jpg" width="200" /></a></div>
<span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">有分擔膝關節壓力的效果,</span> <span lang="ZH-TW" style="font-family: PMingLiU, serif;">除了減少關節受傷,</span> <span lang="ZH-TW" style="font-family: PMingLiU, serif;">還減緩膝關節退化。</span><br />
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7). <span lang="ZH-TW" style="font-family: PMingLiU, serif;">工作後、運動後,肌肉痠痛是正常的,</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">不要就一味按摩推拿。但若痠痛超過</span>48<span lang="ZH-TW" style="font-family: PMingLiU, serif;">小時</span>(<span lang="ZH-TW" style="font-family: PMingLiU, serif;">有休息</span>)<span lang="ZH-TW" style="font-family: PMingLiU, serif;">,</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">就可能有問題了;是肌腱、</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">關節過勞或受傷?</span> <span lang="ZH-TW" style="font-family: PMingLiU, serif;">應讓骨科醫師評估一下;</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">原因沒釐清,關節痛沒改善,逞強硬坳</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">,</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">再來就是很難回復的關節病變了。</span><o:p></o:p></div>
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8). <span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">深海魚,像鮭魚、</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">鯖魚</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">含有</span> omega-3(<span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">魚油</span>)<span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">,</span> <span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">對關節有某種程度的止痛消炎作用,甚至文獻上也有報告對類風溼性關節炎有療效。</span><o:p></o:p></div>
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9). <span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">維持好的骨密,也有助關節健康。多攝食含鈣</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">食物;補充活性維他命</span>D<span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">、多喝牛奶</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">、多吃綠葉</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">蔬菜。</span><span lang="ZH-TW"> </span><o:p></o:p></div>
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<span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"><br /></span></div>
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10). <span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">日常生活起居,不要給關節</span>(<span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">及骨頭</span>)<span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">太多的負擔,負擔能少就少;不要有事沒事,</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">一出門就披掛一大堆包包。</span></div>
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<o:p></o:p>11). <span lang="ZH-TW" style="font-family: PMingLiU, serif;">關節痠痛要用冰敷。</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">冰敷能止痛兼消炎,</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">用一半冰塊加一半水,不能直接用硬梆梆的冰塊冰敷。間歇性冰敷,一次不要超過</span>15<span lang="ZH-TW" style="font-family: PMingLiU, serif;">分鐘。</span></div>
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12). <span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">要買保骨、</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">保關節的保健食品,</span> <span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">請先請教一下醫師藥師。</span></div>
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<span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"><br /></span></div>
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<span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"><br /></span></div>
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<span lang="ZH-TW" style="font-family: "PMingLiU","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">能遵守這些撇步,當成日常生活起居的習慣,且持之以恆,你會發現你的膝關節比較不會退化。</span><o:p></o:p></div>
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baba.wg58@gmail.comhttp://www.blogger.com/profile/03790611799966344101noreply@blogger.com0tag:blogger.com,1999:blog-1350268300834830253.post-33020289831242661412016-04-09T20:45:00.000-07:002018-08-06T09:15:06.782-07:00你的腳痛真的是足底筋膜炎嗎?<div class="MsoNormal">
<b><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">你的腳痛 真的是足底筋膜炎嗎?</span><o:p></o:p></b></div>
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<span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"><br /></span></div>
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<span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"><br /></span></div>
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<span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">扁平足、</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">足底筋膜炎</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">及骨震波治療,是我骨科主治項目的一部分。</span> <span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">這些年</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">,因足底筋膜炎求診</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">的個案,似有</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">越來越多的</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">傾向。</span><span lang="ZH-TW"> </span><span lang="ZH-TW"> </span><span lang="ZH-TW"> </span><br />
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<span lang="ZH-TW" style="font-family: "pmingliu" , serif;"><span lang="ZH-TW" style="font-size: 11pt; line-height: 115%;">足底筋膜炎</span><span style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 115%;">(</span><span lang="ZH-TW" style="font-size: 11pt; line-height: 115%;">圖略</span><span style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 115%;">)</span><span lang="ZH-TW" style="font-size: 11pt; line-height: 115%;">,</span><span lang="ZH-TW" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 115%;"> </span>多發生在中年、或中年稍後的年齡層,</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , serif;">有相當高的比例</span><span lang="ZH-TW"> </span>(<span lang="ZH-TW" style="font-family: "pmingliu" , serif;">約</span>65%) <span lang="ZH-TW" style="font-family: "pmingliu" , serif;">與扁平足有關。</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , serif;">晨起下床初走劇痛是</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , serif;">它的</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , serif;">招牌症狀;臨床上,走路有 避痛踩姿、足底有可察覺的明確痛點、</span> 加上X是<span lang="ZH-TW" style="font-family: "pmingliu" , serif;">扁平足</span><b>* (</b> <span lang="ZH-TW" style="font-family: "pmingliu" , serif;">圖</span>2, 3.) 、看到了<span lang="ZH-TW" style="font-family: "pmingliu" , serif;">跗骨下軟組織有明確的水腫,那</span><span lang="ZH-TW"> 十之</span><span lang="ZH-TW" style="font-family: "pmingliu" , serif;">八九,就是足底筋膜炎了。</span><br />
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<span lang="ZH-TW" style="font-family: "pmingliu" , serif;"><span lang="ZH-TW" style="line-height: 18.4px;">足底筋膜炎,</span>是筋膜或肌腱長期受到</span><span style="font-family: pmingliu, serif;">走、站、跑、跳</span><span lang="ZH-TW" style="font-family: "pmingliu" , serif;">拉扯</span><span lang="ZH-TW" style="font-family: "pmingliu" , serif;">引起,而<b>扁平足</b>因結構上,腳的重量分配不均,更</span><span style="font-family: pmingliu, serif;">是容易因此造成足底筋膜炎。</span><br />
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<tr><td class="tr-caption" style="text-align: center;">圖3. 右足站姿內緣縱弓</td></tr>
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<tr><td class="tr-caption" style="text-align: center;">圖2. Kite Angle</td></tr>
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<span lang="ZH-TW" style="font-family: "pmingliu" , serif;">肌腱或筋膜因</span><span style="font-family: pmingliu, serif;">站走跑跳</span><span lang="ZH-TW" style="font-family: "pmingliu" , serif;">的拉扯引起了</span><span lang="ZH-TW" style="font-family: "pmingliu" , serif; font-size: 11pt; line-height: 115%;">發炎,通常休息、泡泡腳</span><span lang="ZH-TW" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 115%;"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , serif; font-size: 11pt; line-height: 115%;">就會好,這是「正常」的過勞性發炎。</span><span lang="ZH-TW" style="font-family: "pmingliu" , serif;">但在長期慢性發炎情況下,推拖延宕過久怠忽治療,</span><span lang="ZH-TW"> </span><span lang="ZH-TW"> 會</span><span lang="ZH-TW" style="font-family: "pmingliu" , serif;">衍生成</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , serif;">慢性肌腱炎、</span><span lang="ZH-TW" style="font-family: "pmingliu" , serif;">或退化性 </span>(<span lang="ZH-TW" style="font-family: "pmingliu" , serif;">纖維化</span>) <span lang="ZH-TW" style="font-family: "pmingliu" , serif;">筋膜炎,這種情況,頑固難癒,尋常</span><span lang="ZH-TW" style="font-family: "pmingliu" , serif;">治療方式已無法奏效,</span><span lang="ZH-TW" style="font-family: "pmingliu" , serif;">此時,若以<b>高能量的骨震波</b>,打在</span>(<span style="font-family: pmingliu, serif;">投射</span>)
<span lang="ZH-TW" style="font-family: "pmingliu" , serif;">在部足底筋膜</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , serif;">的病灶上,會有促成</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , serif;">微血管新生的效應,讓退化的肌腱</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , serif;">筋膜,</span> <span lang="ZH-TW" style="font-family: "pmingliu" , serif;">因血液循環改善,得以<b>再生(回春療法)</b>,是高科技 又無侵襲性,</span><span style="font-family: "pmingliu" , serif;">治療慢性足底筋膜炎的首選方法。 </span></div>
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<tr><td style="text-align: center;"><a href="https://2.bp.blogspot.com/-fJ7xLbVIRXU/VwnpVFaXv2I/AAAAAAAAFrg/9zHpM6tfmlAnLI_lIZtIe-2gMmqKjuR_A/s1600/pic.4.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="149" src="https://2.bp.blogspot.com/-fJ7xLbVIRXU/VwnpVFaXv2I/AAAAAAAAFrg/9zHpM6tfmlAnLI_lIZtIe-2gMmqKjuR_A/s200/pic.4.jpg" width="200" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">圖4, 蹠底肌膜層 血管瘤<span style="font-size: 12.8px;"> </span></td></tr>
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<tr><td style="text-align: center;"><a href="https://4.bp.blogspot.com/-DTqZUWMa2Mo/VwnpaN0HCqI/AAAAAAAAFr8/jRoPADXhUPIoJdNPxvNo3MZI4FvD5q45A/s1600/pic.%2B5.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="154" src="https://4.bp.blogspot.com/-DTqZUWMa2Mo/VwnpaN0HCqI/AAAAAAAAFr8/jRoPADXhUPIoJdNPxvNo3MZI4FvD5q45A/s200/pic.%2B5.jpg" width="200" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">圖5. 足(蹠)底靜脈曲張症</td></tr>
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<span lang="ZH-TW" style="font-family: "pmingliu" , serif;">但</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , serif;">有一些 (約不到10%)的</span><span style="font-family: pmingliu, serif;">足底筋膜炎 </span><span lang="ZH-TW" style="font-family: "pmingliu" , serif;">,</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , serif;">並沒有晨起下床 </span><span lang="ZH-TW" style="font-family: "pmingliu" , serif;">初走劇痛的招牌症狀、診間檢查、</span>X<span lang="ZH-TW" style="font-family: "pmingliu" , serif;">光檢查也未見上述疑點,此時應僅慎排除其他病因;</span><span lang="ZH-TW" style="font-family: "pmingliu" , serif;">這些</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , serif;"><b>非典型足底筋膜炎 </b>,</span><span lang="ZH-TW" style="font-family: "pmingliu" , serif;">多為足底的靜脈曲張</span> <span lang="ZH-TW" style="font-family: "pmingliu" , serif;">或足底的血管瘤,甚至是</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , serif;">跟骨骨內的病變,如骨內瘤腫</span>… <span lang="ZH-TW" style="font-family: "pmingliu" , serif;">等導致</span><span style="font-family: "pmingliu" , serif;"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , serif;"> </span>(<span lang="ZH-TW" style="font-family: "pmingliu" , serif;">如 圖</span> 4, 5, 6, 7, 8.)<span lang="ZH-TW" style="font-family: "pmingliu" , serif;"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , serif;">。</span><span lang="ZH-TW" style="font-family: "pmingliu" , serif;">即使</span><span lang="ZH-TW" style="font-family: "pmingliu" , serif;">以骨震波治療</span><span lang="ZH-TW" style="font-family: "pmingliu" , serif;">,</span><span lang="ZH-TW" style="font-family: "pmingliu" , serif;">也不見效;</span><span lang="ZH-TW">必須靠開刀手術摘除</span><span lang="ZH-TW" style="font-family: "pmingliu" , serif;">或做內視鏡 導管置入手術,以低頻熱凝或雷射電燒...等處置,才能見效;</span><span style="font-family: pmingliu, serif;"> 而包括糖尿病導致的末梢神經炎等,則需靠神經學的檢查 與內科治療。</span><span lang="ZH-TW" style="font-family: "pmingliu" , serif;">幸賴科技的進步,做 M</span>RI檢查,足底疼痛的疑難雜症,目前大多可以<span lang="ZH-TW" style="font-family: "pmingliu" , serif;">得到鑑別診斷。</span><span style="font-family: pmingliu, serif;"> </span></div>
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<span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: PMingLiU; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"><table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; text-align: left;"><tbody>
<tr><td style="text-align: center;"><a href="https://3.bp.blogspot.com/-il-PMHT4UqY/VwnpexWl4dI/AAAAAAAAFr8/0RR7jlaSK0wSJ8B5HA5ec_xhf27XWgrIQ/s1600/pic.%2B6.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="123" src="https://3.bp.blogspot.com/-il-PMHT4UqY/VwnpexWl4dI/AAAAAAAAFr8/0RR7jlaSK0wSJ8B5HA5ec_xhf27XWgrIQ/s200/pic.%2B6.jpg" width="200" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">圖6. 同圖5 的橫斷切面圖<span lang="ZH-TW" style="font-family: "pmingliu" , serif;"> </span></td></tr>
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<tr><td style="text-align: center;"><a href="https://1.bp.blogspot.com/-_kepZ1FwVW8/VwnpkbDqghI/AAAAAAAAFr8/q5lDGNZRPmoazwPOjBfNaZnzELKqADm_A/s1600/pic.7..jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="150" src="https://1.bp.blogspot.com/-_kepZ1FwVW8/VwnpkbDqghI/AAAAAAAAFr8/q5lDGNZRPmoazwPOjBfNaZnzELKqADm_A/s200/pic.7..jpg" width="200" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">圖7. 跟骨內 囊狀腫瘤</td></tr>
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<tr><td style="text-align: center;"><a href="https://1.bp.blogspot.com/-4Q4Js5EUTEE/Vwnpp2qfiWI/AAAAAAAAFr8/v270NTPAiRA7KbCpcHnRkzXXGywtSL5VA/s1600/pic.%2B8.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="161" src="https://1.bp.blogspot.com/-4Q4Js5EUTEE/Vwnpp2qfiWI/AAAAAAAAFr8/v270NTPAiRA7KbCpcHnRkzXXGywtSL5VA/s200/pic.%2B8.jpg" width="200" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">圖8. 同圖7 的橫斷切面圖<br />
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<span style="font-family: pmingliu, serif;"> </span><span lang="ZH-TW" style="font-family: "pmingliu" , serif;">總之,站走腳痛,雖不是大病,但也不是隨隨便便就能做出診斷;也不是簡簡單單就能治好,必須細心診斷,才能真正根治。 </span><b><span style="font-size: 10.0pt; line-height: 115%;"> </span></b></div>
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<b><span style="font-size: 10.0pt; line-height: 115%;"> P.S.:
* X</span></b><b><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 10.0pt; line-height: 115%;">光檢查</span></b><b><span lang="ZH-TW" style="font-size: 10.0pt; line-height: 115%;"> </span></b><b><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 10.0pt; line-height: 115%;">:腳的站姿側面像,內緣縱弓</span></b><b><span lang="ZH-TW" style="font-size: 10.0pt; line-height: 115%;"> </span></b><b><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 10.0pt; line-height: 115%;">角度</span></b><b><span style="font-size: 10.0pt; line-height: 115%;">(Arch angle)</span></b><b><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 10.0pt; line-height: 115%;">大於</span></b><b><span style="font-size: 10.0pt; line-height: 115%;">120</span></b><b><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 10.0pt; line-height: 115%;">度;腳掌站立正面像,</span></b><b><span lang="ZH-TW" style="font-size: 10.0pt; line-height: 115%;"> </span></b><b><span style="font-size: 10.0pt; line-height: 115%;">Kite Angle </span></b><b><span lang="ZH-TW" style="font-family: "pmingliu" , "serif"; font-size: 10.0pt; line-height: 115%;">角 </span></b></div>
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baba.wg58@gmail.comhttp://www.blogger.com/profile/03790611799966344101noreply@blogger.com0tag:blogger.com,1999:blog-1350268300834830253.post-46727302653154587482015-08-21T23:06:00.001-07:002017-09-06T21:54:21.148-07:00<div align="center" class="MsoNormal" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; line-height: 13.5pt; margin-bottom: 3.75pt; margin-right: 15pt; text-align: center;">
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<b><span style="background-color: black; color: #f3f3f3;"><b><span style="font-family: , serif;">運動傷害知多少</span></b><b><span lang="EN" style="font-family: "arial" , sans-serif;">?<o:p></o:p></span></b></span></b></div>
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<span style="background-color: black; color: #999999;"><span style="font-family: , serif;">休閒兼養身,是一般民眾走向戶外的動機;這「流行」的動機不符運動的真諦,但卻篷勃了現今社會的運動風氣。或許因為沒有很好的運動指引</span><span lang="EN" style="font-family: "arial" , sans-serif;">(</span><span lang="EN-US" style="font-family: "arial" , sans-serif;">guideline)</span><span style="font-family: , serif;">,在台灣,很多民眾對運動可能造成的傷害,渾然不知;更不用說懂得預防或避免了。</span><span lang="EN-US" style="font-family: "arial" , sans-serif;"><o:p></o:p></span></span></div>
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<span style="background-color: black; color: #999999;"><span style="font-family: , serif;">並不是劇烈的運動才會受傷;美國運動醫學會指出,自行車運動在美國</span><span lang="EN-US" style="font-family: "arial" , sans-serif;">(</span><span style="font-family: , serif;">台灣有別</span><span lang="EN-US" style="font-family: "arial" , sans-serif;">)</span><span style="font-family: , serif;">是頭部外傷的主因;身</span><span style="font-family: "arial" , sans-serif;"> </span><span style="font-family: , serif;">體最大肌腱</span><span lang="EN-US" style="font-family: "arial" , sans-serif;">--</span><span style="font-family: , serif;">阿基里氏腱</span><span lang="EN-US" style="font-family: "arial" , sans-serif;">( </span><span style="font-family: , serif;">跟腱</span><span lang="EN" style="font-family: "lato";">Achilles tendon)</span><span style="font-family: , serif;">,在</span><span style="font-family: , serif;">跑跳中小小裂傷的累積,日久也會造成難治的痼疾。</span><span lang="EN-US" style="font-family: "arial" , sans-serif;"><o:p></o:p></span></span></div>
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<span style="background-color: black; color: #999999;"><span style="font-family: , serif;">運動<b>會</b></span><span style="font-family: , serif;"><b>痠</b></span><span style="font-family: , serif;">、<b>會痛</b></span><span style="font-family: "arial" , sans-serif;"> </span><span style="font-family: , serif;">是不是正常</span><span lang="EN" style="font-family: "arial" , sans-serif;">? </span><span style="font-family: , serif;">就運動醫學言,</span><b><span style="font-family: "arial" , sans-serif;"> <span lang="EN-US">”</span></span></b><b><span style="font-family: , serif;">痛</span></b><b><span lang="EN-US" style="font-family: "arial" , sans-serif;">”</span></b><span lang="EN-US" style="font-family: "arial" , sans-serif;"> </span><span style="font-family: , serif;">是警訊,要你「停」,你受傷了;</span><span lang="EN-US" style="font-family: "arial" , sans-serif;"> <b>"</b></span><b><span style="font-family: , serif;">痠</span></b><b><span lang="EN-US" style="font-family: "arial" , sans-serif;">”</span></b><span lang="EN-US" style="font-family: "arial" , sans-serif;"> </span><span style="font-family: , serif;">是你的動作,身體受不了;痠</span><span style="font-family: , serif;">、痛</span><span style="font-family: , serif;">是不是正常</span><span lang="EN-US" style="font-family: "arial" , sans-serif;"> ? </span><span style="font-family: , serif;">不易分辨,簡單的法則是:假如你痠</span><span style="font-family: , serif;">痛</span><span style="font-family: , serif;">,</span><span style="font-family: , serif;">站走困難、抬舉握扭有問題,那你該去看骨科。</span><span style="font-family: "arial" , sans-serif;"><span lang="EN-US"><o:p></o:p></span></span></span></div>
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<span style="background-color: black; color: #999999;"><b><span style="font-family: , serif;">抽筋</span></b><span style="font-family: , serif;">,確切原因還不明朗。抽筋多半發生在小腿腿腹或大腿後方;肌過勞、人太累、脫水、電解質不平衡或氣溫低,都可能有關。抽筋很痛,但通常會自己好;只要不動,溫和伸展,熱敷或冰敷,都有助於抽筋的緩解。</span><span lang="EN" style="font-family: "lato";"><o:p></o:p></span></span></div>
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<span style="background-color: black; color: #999999;"><span style="font-family: , serif;">韌帶過度拉、扯,會<b>「扭傷」</b>。<u>韌帶</u></span><span style="font-family: "lato";"> </span><span style="font-family: , serif;">是骨與骨的連結組織,多見於關節周圍;扭傷容易發生在足踝、膝或腕。常因轉動或彎曲施力不當、角度不對造成,症狀是腫、痛、瘀傷、關節僵硬或不穩。<b>「拉傷」</b>是</span><span style="font-family: "lato";"> </span><u><span style="font-family: , serif;">肌肉</span></u><span style="font-family: "lato";"> </span><span style="font-family: , serif;">或</span><span style="font-family: "lato";"> </span><span style="font-family: , serif;">連結肌肉與骨</span><span style="font-family: "lato";"> </span><span style="font-family: , serif;">的</span><span style="font-family: "lato";"> </span><u><span style="font-family: , serif;">肌腱</span></u><span style="font-family: , serif;">,過度牽引、久撐而造成,三不五時喜歡<b>「練拉筋」</b>的人,請三思。拉傷會造成</span><span style="font-family: "lato";"> </span><span style="font-family: , serif;">肌肉疼痛、肌內血腫、肌</span><span style="font-family: , serif;">抽搐、肌痙攣、肌無力。因運動傷害掛急診,統計上最多的就是扭傷與拉傷;兩者</span><span style="font-family: , serif;">受傷位置不同,治療有別,不要混淆。</span><span lang="EN-US" style="font-family: "helvetica" , sans-serif;"><o:p></o:p></span></span></div>
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<span style="background-color: black; color: #999999;"><b><span style="font-family: , serif;">慢跑</span></b><span style="font-family: , serif;">很容易受傷;原因是相關的關節,既要負重又連續重覆受壓</span><span lang="EN-US" style="font-family: "helvetica" , sans-serif;">(stress)</span><span style="font-family: , serif;">。<b>前膝痛</b>是<b>慢跑膝</b></span><b><span style="font-family: "helvetica" , sans-serif;"> </span></b><span lang="EN-US" style="font-family: "helvetica" , sans-serif;">(Runner’s knee, Bumper’s knee) </span><span style="font-family: , serif;">的主要症狀,痛是因為你的前膝關節軟骨,因受力太大,發生了<b>軟骨軟化</b></span><span style="font-family: , serif;">;</span><span style="font-family: , serif;">延宕不理,就會走上關節磨損退化之路!有了慢跑膝,上下樓梯、蹲、跪</span><span lang="EN-US" style="font-family: "helvetica" , sans-serif;">..</span><span style="font-family: , serif;">更痛。跑前先作暖身,跑完作冰敷、選好鞋、不跑太久太快太陡,可減少慢跑膝發生。</span><span lang="EN-US" style="font-family: "helvetica" , sans-serif;"><o:p></o:p></span></span></div>
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<span style="background-color: black; color: #999999;"><span style="font-family: , serif;">慢跑另一個傷害是 <b>脛前痛</b></span><span lang="EN" style="font-family: "lato";"> ( Shin splints </span><span style="font-family: , serif;">或稱</span><span style="font-family: "lato";"> </span><span style="font-family: , serif;">夾脛痛</span><span lang="EN" style="font-family: "lato";">)</span><span style="font-family: , serif;">。這是小腿脛骨內</span><span style="font-family: , serif;">、</span><span style="font-family: , serif;">後側的肌肉或</span><span style="font-family: "lato";"> </span><span style="font-family: , serif;">肌腱、骨膜、甚至骨頭本身的發炎。慢跑、跳舞、有氧舞蹈,或其他小腿要重踏跳踩者,容易發生;治療靠休息與避免。</span><span lang="EN" style="font-family: "lato";"><o:p></o:p></span></span></div>
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<span style="background-color: black; color: #999999;"><span style="font-family: , serif;"><b>下背痛</b></span><span style="font-family: "lato";"> </span><span style="font-family: , serif;">是</span><span style="font-family: "lato";"> </span><span style="font-family: , serif;">打高爾夫、練重量訓練者的運動傷害。下背,尤其是腰薦椎間,是負重或打高爾夫轉腰時,承擔最大壓力</span><span style="font-family: "lato";"> </span><span style="font-family: , serif;">並吸收扭力的地方,作過了頭,椎間盤被壓恗,甚至破裂或造成間盤或凸出,有些個案需手術治療。體型、</span><span style="font-family: "lato";"> </span><span style="font-family: , serif;">體重、勞動、姿勢以及穿高跟鞋,也都與下背痛有關。</span><span lang="EN" style="font-family: "lato";"><o:p></o:p></span></span></div>
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<span style="background-color: black; color: #999999;"><b><span style="font-family: , serif;">網球肘 </span></b><b><span style="font-family: "lato";"> </span></b><span style="font-family: , serif;">正式名稱是</span><span style="font-family: "lato";"> </span><span style="font-family: , serif;"><b>肘外髁肌腱炎</b>。網球肘是因肘部重覆過勞或過度使力,使肘關節外側的肌腱一次又一次的拉出小裂傷、發炎、而痛痠無力。會演變成網球肘,原因是沒能好好休息好好的治療,致使不瘉,轉成慢性肌腱炎甚或退化;慢跑膝、高爾夫球肘、前脛痛、足底筋膜炎</span><span lang="EN-US" style="font-family: "lato";">…</span><span style="font-family: , serif;">都有如此類同的致病機轉;難治的個案,可考慮打高能量骨震波或開刀。</span><span lang="EN-US" style="font-family: "lato";"><o:p></o:p></span></span></div>
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<span style="background-color: black; color: #999999;"><span style="font-family: , serif;">民間慣說的<b>五十肩,</b>在教科書裡稱</span><span style="font-family: "lato";"> </span><b><span style="font-family: , serif;">肩旋轉肌袖病變。</span></b><span style="font-family: , serif;">肩旋轉肌袖是肩關節重要的特有結構,是抬舉上臂的啓動肌;但礙於肩峰下空間的狹窄,常常造成磨損、受傷、鈣化、甚至破裂,大都在中年後發病</span><span lang="EN-US" style="font-family: "lato";"> (</span><span style="font-family: , serif;">所以有五十肩的大名</span><span lang="EN-US" style="font-family: "lato";">)</span><span style="font-family: , serif;">。症狀除肩膀痠痛活動受限外,特有的是夜痛難眠。手臂上舉的運動,如</span><span style="font-family: "lato";"> </span><span style="font-family: , serif;">打羽毛球、網球、棒球投球,勤於寫黑板、拖地板、洗衣服</span><span lang="EN-US" style="font-family: "lato";">…</span><span style="font-family: , serif;">等,都易得旋轉肌袖毛病。通常保守療法大都效果不彰,常需以手術拓寬肩峰下空間</span><span style="font-family: "lato";"> <span lang="EN-US">(</span></span><span style="font-family: , serif;">整形手術</span><span lang="EN-US" style="font-family: "lato";">) </span><span style="font-family: , serif;">來治療。</span><b><span lang="EN-US" style="font-family: "lato";"><o:p></o:p></span></b></span></div>
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<span style="background-color: black; color: #999999;"><b><span style="font-family: , serif;">足底筋膜炎</span></b><span style="font-family: , serif;">,乍聽似發炎,事實上是肌腱或筋膜接骨點部位的<b>退化</b>。病因是長期,重覆、過度使用,造成小小的、癒合困難的拉傷,進而退化。足底筋膜炎和腳的結構</span><span lang="EN-US" style="font-family: "lato";">(</span><span style="font-family: , serif;">如先天扁平足</span><span lang="EN-US" style="font-family: "lato";">)</span><span style="font-family: , serif;">有關,當然也受運動、工作、鞋子左右。足底筋膜炎症狀</span><span style="font-family: "lato";"> </span><span style="font-family: , serif;">主要是站走足跟</span><span lang="EN-US" style="font-family: "lato";">(</span><span style="font-family: , serif;">觸地點</span><span lang="EN-US" style="font-family: "lato";">)</span><span style="font-family: , serif;">疼痛,晨起下床劇痛是其特徵,久坐站起也痛;雖不是大病,但久久不癒,影響生活品質。通常保守療法效果不彰,高能量骨震波治療或客製化的<b>醫療矯正足墊</b>常可奏效。</span><span lang="EN-US" style="font-family: "lato";"><o:p></o:p></span></span></div>
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<span style="background-color: black; color: #999999;"><b><span style="font-family: , serif;">女性 </span></b><span style="font-family: , serif;">在很多運動項目上都比男性有較高的運動傷害風險,可能的因素包括:本質上體能略遜於男性,女性骨盆結構、大腿肌力及膝關節的差異,女性荷爾蒙的變動,以及女性固有遜於男性的骨密度。統計上,女足球員、女藍球員,有高於男運動員的前十字韌帶受傷率。</span><span lang="EN-US" style="font-family: "lato";"><o:p></o:p></span></span></div>
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<span style="background-color: black; color: #999999;"><span style="font-family: , serif;">運動前好的<b>暖身</b>很重要。暖身的好處在於:增加呼吸率,加快血液循環,使肌肉昇溫。生理學早已證實<b>冷肌容易受傷</b>,</span><b><span lang="EN-US" style="font-family: "lato";"> </span></b><span style="font-family: , serif;">因此暖身可降低運動傷害。暖身的作法不難,簡單說,就是把你將作的運動,先來個<b>「慢動作版」</b>的預習</span><span style="font-family: "lato";"> </span><span style="font-family: , serif;">,活動一下筋骨、</span><span style="font-family: "lato";"> </span><span style="font-family: , serif;">小跑一下、扭扭腰、</span><span style="font-family: "lato";"> </span><span style="font-family: , serif;">彎彎身、揮揮球拍球棍,大概只要</span><span lang="EN-US" style="font-family: "lato";">10</span><span style="font-family: , serif;">分鐘左右,感到呼吸變快,就可以上場了。</span><span lang="EN-US" style="font-family: "lato";"><o:p></o:p></span></span></div>
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<span style="background-color: black; color: #999999;"><span style="font-family: , serif;">坊間流傳運動前<b>拉筋</b>可以減少運動傷害,這說法<b>並沒有得到証實</b>;不正確或過度拉筋,反會造成拉傷已詳述如上。假如你要作拉筋,最好的時間點反而是在運動<b>後</b>的降溫期,因為</span><span lang="EN-US" style="font-family: "lato";">…</span><span style="font-family: , serif;">剛運動完的暖肌較易伸展。假如你就是想<b>運動前拉筋</b>,建議你還是先作暖身,再拉筋。</span><span lang="EN-US" style="font-family: "lato";">( </span><span style="font-family: , serif;">本文為全文完整版。簡明版刊登</span><span lang="EN-US" style="font-family: "lato";">104/08/20 </span><span style="font-family: , serif;">聯合報</span><span lang="EN-US" style="font-family: "lato";"> )<o:p></o:p></span></span></div>
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baba.wg58@gmail.comhttp://www.blogger.com/profile/03790611799966344101noreply@blogger.com0tag:blogger.com,1999:blog-1350268300834830253.post-58701391556071958242014-12-27T22:05:00.000-08:002014-12-29T18:14:47.755-08:00扁平足 ● 腳痛<br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">扁平足與拇趾外翻,是腳先天結構上的問題,問題出在</span><span style="font-family: Calibri;"> </span><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">腳負荷重量的分配不對,</span><span style="font-family: Calibri;"> </span><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">這說不上是病,</span><span style="font-family: Calibri;"> </span><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">但患者還是會有一些身體的表徵,像是在中小學階段的青少年,可能看起來像有脊椎側彎,在壯年後期者</span><span style="font-family: Calibri;">
</span><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">漸漸會有</span><span style="font-family: Calibri;">
</span><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">走路,運動、負重、勞動</span><span lang="EN-US"><span style="font-family: Calibri;">….</span></span><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">時</span><span lang="EN-US"><span style="font-family: Calibri;">, <span style="mso-spacerun: yes;"> </span></span></span><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">不耐久操而腳痛、</span><span style="font-family: Calibri;">
</span><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">膝痛,或下背痛等的症狀。</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">扁平足,外觀即可辨識</span><span lang="EN-US"><span style="font-family: Calibri;">(</span></span><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">如圖</span><span lang="EN-US"><span style="font-family: Calibri;">)</span></span></span></div>
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<tr><td class="tr-caption" style="text-align: center;"> <span style="font-family: Calibri;">扁平足 背後觀 及 內側觀</span></td></tr>
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<span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">赤腳走路更可看出其特有的內傾</span><span lang="EN-US"><span style="font-family: Calibri;">(pronation)</span></span><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">步態;以特定角度照的</span><span lang="EN-US"><span style="font-family: Calibri;">X</span></span><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">光,更可看到某些負重腳骨間的相關角度有差異,或關節骨頭的一些變化</span><span lang="EN-US"><span style="font-family: Calibri;">(</span></span><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">如圖</span><span lang="EN-US"><span style="font-family: Calibri;">)</span></span><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">,</span><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">診斷並不困難</span><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">。</span><span lang="EN-US"><span style="font-family: Calibri;"><span style="mso-spacerun: yes;">
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</span><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">剛開始學走路的小孩都是扁平足,</span><span lang="EN-US"><span style="mso-spacerun: yes;"><span style="font-family: Calibri;"> </span></span></span><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">一直到</span><span lang="EN-US"><span style="font-family: Calibri;">6</span></span><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">、</span><span lang="EN-US"><span style="font-family: Calibri;">7</span></span><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">歲上小學階段,脚會自動修正;但若遲至</span><span lang="EN-US"><span style="font-family: Calibri;">9</span></span><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">歲,仍未改變,則幾可斷言,此童日後一定是扁平足。學理上,腳負重的發展,先是有一相對穩固磐石式的「樁腳」</span><span lang="EN-US"><span style="font-family: Calibri;"> (</span></span><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">如圖</span><span lang="EN-US"><span style="font-family: Calibri;">1. </span></span><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">藍色部分</span><span lang="EN-US"><span style="font-family: Calibri;">)</span></span><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">,其上才是腳負重的「</span><span style="font-family: Calibri;">
</span><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">平台」</span><span lang="EN-US"><span style="font-family: Calibri;">(</span></span><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">如圖</span><span lang="EN-US"><span style="font-family: Calibri;">2. </span></span><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">紅色部分</span><span lang="EN-US"><span style="font-family: Calibri;">)</span></span><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">,平台以浮動的方式,找到它的落點,與磐石(</span><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">樁腳)鑲嵌成一體,腳負重的結構,於焉定形。至於為什麼「平台」</span><span style="font-family: Calibri;">
</span><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">會向內移行以致</span><span style="font-family: Calibri;">
</span><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">造成扁平足,</span><span style="font-family: Calibri;">
</span><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">原因</span><span style="font-family: Calibri;">
</span><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">可能與發育中的</span><span style="font-family: Calibri;">
</span><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">腳,其骨骼、</span><span style="font-family: Calibri;">
</span><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">關節</span><span style="font-family: Calibri;">
</span><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">和</span><span style="font-family: Calibri;">
</span><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">韌帶,在力學上三者相互間</span><span style="font-family: Calibri;">
</span><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">的牽扯或角力有關,機制相當複雜。</span><br />
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<a href="http://3.bp.blogspot.com/-JSBXZfF9ks8/VJ-Z4XPFaGI/AAAAAAAACgk/FyDiI52ndPo/s1600/141227%2Be.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="http://3.bp.blogspot.com/-JSBXZfF9ks8/VJ-Z4XPFaGI/AAAAAAAACgk/FyDiI52ndPo/s1600/141227%2Be.jpg" height="158" width="400" /></a></div>
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<span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">正常的腳,</span><span style="font-family: Calibri;"> 觸</span><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">地的負重點</span><span style="font-family: Calibri;"> </span><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">呈直角三角形</span><span style="font-family: Calibri;"> <span lang="EN-US">(</span></span><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">如圖</span><span lang="EN-US"><span style="font-family: Calibri;">3.)</span></span><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">,這樣的腳,重量的分配</span><span lang="EN-US"><span style="font-family: Calibri;"> (</span></span><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">如圖</span><span lang="EN-US"><span style="font-family: Calibri;">4.) </span></span><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">最符合力學的經濟原則,久站久走跑跳,省力而不累。扁平足的腳 </span><span lang="EN-US"><span style="font-family: Calibri;">(</span></span><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">如上圖</span><span lang="EN-US"><span style="font-family: Calibri;">) <span style="mso-spacerun: yes;"> </span></span></span><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">負重或行走,</span><span style="font-family: Calibri;"> </span><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">腳向內傾斜(</span><span lang="EN-US"><span style="font-family: Calibri;">pronation)</span></span><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">,重心偏向腳的內緣,承重偏離距骨穹隆,重量擠向舟狀骨及跟骨,壓在距骨</span><span lang="EN-US"><span style="font-family: Calibri;">-</span></span><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">舟狀骨關節面、</span><span style="font-family: Calibri;"> </span><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">跗骨底部肌腱</span><span style="font-family: Calibri;"> </span><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">或足底筋膜,造成距骨</span><span lang="EN-US"><span style="font-family: Calibri;">-</span></span><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">舟狀骨關節的退化、或跗底肌腱炎</span><span style="font-family: Calibri;"> </span><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">或足底筋膜炎,這三者的症狀同中有異</span><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">,診斷須要有經驗、細心,佐以</span><span lang="EN-US"><span style="font-family: Calibri;">X</span></span><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">光或</span><span lang="EN-US"><span style="font-family: Calibri;">MRI</span></span><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">的鑑別。</span><br />
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<a href="http://4.bp.blogspot.com/-6RxmEQx2hZE/VJ-cInY0nhI/AAAAAAAACg4/n9EeJSuxRcg/s1600/141201-3%2B%2BFF%2Bc%2Bpf%2BW%2Bview.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://4.bp.blogspot.com/-6RxmEQx2hZE/VJ-cInY0nhI/AAAAAAAACg4/n9EeJSuxRcg/s1600/141201-3%2B%2BFF%2Bc%2Bpf%2BW%2Bview.JPG" height="150" width="200" /></a></div>
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<a href="http://4.bp.blogspot.com/-pSkqUi0wXmw/VJ-bj6DKUlI/AAAAAAAACgw/2KeLDUAOkWg/s1600/141201-4%2BFF%2Bwo%2Bpf%2BW%2Bview%2B2.JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="http://4.bp.blogspot.com/-pSkqUi0wXmw/VJ-bj6DKUlI/AAAAAAAACgw/2KeLDUAOkWg/s1600/141201-4%2BFF%2Bwo%2Bpf%2BW%2Bview%2B2.JPG" height="150" width="200" /></a></div>
<span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">臨床上,並不是所有的扁平足都需要治療;而扁平足治療的精髓是讓腳的負重,回歸到上述正常的負重三角,如此腳痛自然能自行緩解,因此,醫療矯正足墊是扁平足治療之主流。</span><br />
<span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"><br /></span>
<span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">但,治療的方法並不是一成不變,可選擇保守療法,</span><span style="font-family: Calibri;">
</span><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">或矯正足墊,或足墊與骨震波雙管齊下。醫療矯正足墊的製作,要求的是客製化量足訂作,技師須高度專業,也需有相當的實務經驗,才能適足適履,達到效果;絕非一般商業</span>行銷之所能望其項背。至於骨震波治療,除了震波的能量必須夠大外,術中的操作要精準;當然正確的診斷最為首要,庶幾才能分辨什麼情況需雙管齊下來強化療效,能這樣,扁平足脚痛的問題,均可迎刃而解了。<br />
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</span>baba.wg58@gmail.comhttp://www.blogger.com/profile/03790611799966344101noreply@blogger.com0tag:blogger.com,1999:blog-1350268300834830253.post-41939119981051165002014-09-14T08:41:00.000-07:002014-11-15T18:54:45.347-08:00赤足慢跑 (Barefoot Running)<div class="MsoNormal" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; line-height: 22pt;">
<span style="background-color: black; color: #f3f3f3;"><span style="font-family: "新細明體","serif";">慢跑可以加強心肺功能,是一種耐力訓練運動。慢跑不需要什麼裝備、隨時隨地都可以跑,是人類的本能,幾乎是無師自通的運動。</span><span lang="EN-US" style="font-family: "Helvetica","sans-serif";"><o:p></o:p></span></span></div>
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<span style="color: #f3f3f3;">多年前<span style="font-family: "Helvetica","sans-serif";"> </span>美國有一派慢跑者,鼓吹赤足慢跑;不穿鞋跑步<span lang="EN-US" style="font-family: "Helvetica","sans-serif";">, </span>的確有風險<span lang="EN-US" style="font-family: "Helvetica","sans-serif";">, </span>但愛好打赤腳慢跑的人<span lang="EN-US" style="font-family: "Helvetica","sans-serif";">, </span>卻宣稱人類的歷史本來就是赤腳跑出來的<span lang="EN-US" style="font-family: "Helvetica","sans-serif";">, </span>而奧林匹克的馬拉松高手也不乏赤腳大仙<span lang="EN-US" style="font-family: "Helvetica","sans-serif";">, </span>他們更宣稱赤足慢跑<span style="font-family: "Helvetica","sans-serif";"> </span>天然、舒服、自在<span lang="EN-US" style="font-family: "Helvetica","sans-serif";">, </span>還比穿傳統慢跑鞋更能避免腳傷<span lang="EN-US" style="font-family: "Helvetica","sans-serif";">. </span>但赤足慢跑<span style="font-family: "Helvetica","sans-serif";"> </span>是不是真的那麼好<span lang="EN-US" style="font-family: "Helvetica","sans-serif";">, </span>還是另有風險<span lang="EN-US" style="font-family: "Helvetica","sans-serif";">, </span>醫界仍持續在觀察研究中。<span lang="EN-US" style="font-family: "Helvetica","sans-serif";"><o:p></o:p></span></span></div>
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<span style="color: #f3f3f3;">赤足慢跑的風氣,很快也傳進了台灣,在台北街頭人行道、郊區產業道路<span lang="EN-US" style="font-family: "Helvetica","sans-serif";">…</span>,不乏有一群穿著一種看似五趾襪的<span lang="EN-US" style="font-family: "Helvetica","sans-serif";">”</span><span lang="EN-US" style="font-family: "Helvetica","sans-serif";"> </span>五趾鞋<span style="font-family: "Helvetica","sans-serif";"> <span lang="EN-US">“( five-toe shoes)</span></span><span lang="EN-US" style="font-family: "Helvetica","sans-serif";"> ( </span>如圖<span lang="EN-US" style="font-family: "Helvetica","sans-serif";">) </span></span><br />
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<span lang="EN-US" style="color: #f3f3f3; font-family: "Helvetica","sans-serif";"><a href="http://4.bp.blogspot.com/-wjr0mL1OrA0/VBW4KybByTI/AAAAAAAACfM/tKU9USEV7Bc/s1600/140810%2BBare%2Bfoot%2Brunning%2Bshoe.JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="http://4.bp.blogspot.com/-wjr0mL1OrA0/VBW4KybByTI/AAAAAAAACfM/tKU9USEV7Bc/s1600/140810%2BBare%2Bfoot%2Brunning%2Bshoe.JPG" height="136" width="200" /></a></span></div>
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<span style="color: #f3f3f3;">的人在跑。<span style="font-family: "Helvetica","sans-serif";"> </span>五趾鞋<span style="font-family: "Helvetica","sans-serif";"> </span>較薄<span lang="EN-US" style="font-family: "Helvetica","sans-serif";">, </span>較輕<span lang="EN-US" style="font-family: "Helvetica","sans-serif";">, </span>因此防震較差<span lang="EN-US" style="font-family: "Helvetica","sans-serif";">, </span>雖然設計一樣是提供慢跑者<span style="font-family: "Helvetica","sans-serif";"> </span>腳的保護<span lang="EN-US" style="font-family: "Helvetica","sans-serif";">, </span>但效果仍受考驗。<span style="font-family: "Helvetica","sans-serif";"> </span>傳統的慢跑鞋<span lang="EN-US" style="font-family: "Helvetica","sans-serif";">, </span>強調穩固與避震<span lang="EN-US" style="font-family: "Helvetica","sans-serif";">. </span>鞋底較厚<span lang="EN-US" style="font-family: "Helvetica","sans-serif";">. </span>稍有鞋跟<span lang="EN-US" style="font-family: "Helvetica","sans-serif";">. </span>不過<span lang="EN-US" style="font-family: "Helvetica","sans-serif";">, </span>仍沒有實證<span style="font-family: "Helvetica","sans-serif";"> </span>證明這樣就能有效預防腳傷<span lang="EN-US" style="font-family: "Helvetica","sans-serif";">. </span>有人即使穿上名牌慢跑鞋<span lang="EN-US" style="font-family: "Helvetica","sans-serif";">, </span>還是一樣跑傷了腳。<span lang="EN-US" style="font-family: "Helvetica","sans-serif";">
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<span style="color: #f3f3f3;">如果你穿傳統慢跑鞋<span style="font-family: "Helvetica","sans-serif";"> </span>跑得好好的<span lang="EN-US" style="font-family: "Helvetica","sans-serif";">, </span>你沒必要作任何改變<span lang="EN-US" style="font-family: "Helvetica","sans-serif";">. </span>但<span lang="EN-US" style="font-family: "Helvetica","sans-serif";">, </span>假如你想體驗一下打赤腳慢跑<span lang="EN-US" style="font-family: "Helvetica","sans-serif";">, </span>那也無妨<span lang="EN-US" style="font-family: "Helvetica","sans-serif";">. </span>去選擇一雙合腳的赤足慢跑鞋<span lang="EN-US" style="font-family: "Helvetica","sans-serif";">( </span>目前已有多種款式<span lang="EN-US" style="font-family: "Helvetica","sans-serif";"> );</span>也盡量找一個好的<span lang="EN-US" style="font-family: "Helvetica","sans-serif";">, </span>比較軟性的場地來跑<span lang="EN-US" style="font-family: "Helvetica","sans-serif";">. </span>不過還是建議你<span lang="EN-US" style="font-family: "Helvetica","sans-serif";">, </span>在開始慢跑前<span lang="EN-US" style="font-family: "Helvetica","sans-serif";">, </span>先咨詢一下骨科或足科醫師為妙<span lang="EN-US" style="font-family: "Helvetica","sans-serif";">, </span>尤其是你若曾受過腳傷<span lang="EN-US" style="font-family: "Helvetica","sans-serif";">, </span>或你的腳,本來就有結構上的遐疵<span lang="EN-US" style="font-family: "Helvetica","sans-serif";">, </span>更應聽聽醫師的建議。<span lang="EN-US" style="font-family: "Helvetica","sans-serif";">.<o:p></o:p></span></span></div>
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<span style="color: #f3f3f3;">參考資料:<span style="font-family: "Helvetica","sans-serif";"> <span lang="EN-US">Mayo Clinic Fitness for EveryBody by Edward Laskoski, M.D. </span></span></span><br />
<span style="color: #f3f3f3;"><span style="font-family: "Helvetica","sans-serif";"><span lang="EN-US">* <strong>11/16/2014 補註</strong> : 最近對赤足慢跑的研究, 建議 初學者,穿了赤足慢跑鞋後, 不能急著上路慢</span></span></span><br />
<span style="color: #f3f3f3;"><span style="font-family: "Helvetica","sans-serif";"><span lang="EN-US"> 跑;</span></span></span><span style="color: #f3f3f3;"><span style="font-family: "Helvetica","sans-serif";"><span lang="EN-US"> 應先嚐試</span></span></span><span style="color: #f3f3f3; font-family: Helvetica;"> 慢" 走 " 數週, 讓腳先適應鞋子後, 才上路跑, 以避免受傷. </span><br />
<span style="color: #f3f3f3; font-family: Helvetica;"><span style="font-family: times new roman, new york, times, serif;"> Minimalist Running Shoes Tread Lightly, </span><span style="font-family: times new roman, new york, times, serif;">More </span><span style="font-family: times new roman, new york, times, serif;">Naturally, Experts Say </span><span id="yui_3_16_0_1_1416105551415_2503"><span id="yui_3_16_0_1_1416105551415_2498">By Dorene Internicola </span></span></span><span style="color: #f3f3f3; font-family: Helvetica;"> </span><br />
<span style="color: #f3f3f3; font-family: Helvetica;"> November 11, 2014 <a href="http://www.medscape.com/viewarticle/834671?src=wnl_edit_medn_wir&uac=45307PG&spon=34">http://www.medscape.com/viewarticle/834671?src=wnl_edit_medn_wir&uac=45307PG&spon=34</a></span><br />
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baba.wg58@gmail.comhttp://www.blogger.com/profile/03790611799966344101noreply@blogger.com0tag:blogger.com,1999:blog-1350268300834830253.post-35527052178214335352014-07-20T02:05:00.000-07:002020-07-17T17:08:48.293-07:00想運動 請先拿「運動處方」<div class="MsoNormal" style="line-height: 23.25pt; margin-bottom: 9pt; mso-outline-level: 2; mso-pagination: widow-orphan;">
<a href="http://1.bp.blogspot.com/-7Z6DopAzT2w/U8uEOiI-eAI/AAAAAAAACeU/_2AfeqvIcW8/s1600/aerobic.JPG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="129" src="https://1.bp.blogspot.com/-7Z6DopAzT2w/U8uEOiI-eAI/AAAAAAAACeU/_2AfeqvIcW8/s1600/aerobic.JPG" width="200" /></a><span style="font-family: 新細明體; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-bidi-font-weight: bold; mso-font-kerning: 0pt; mso-hansi-font-family: Helvetica;">台灣民間運動風氣鼎盛,問起動機,無非是「休閒」或「養生」。這樣的動機,明講了 並非是追求運動的真諦 *<span style="font-size: x-small;">(註1.)</span>,這 </span><span style="font-family: 新細明體; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-bidi-font-weight: bold; mso-font-kerning: 0pt; mso-hansi-font-family: Helvetica;">無可厚非;但重要的是,民眾大都是<u><b>看廣告</b></u>,然後<st1:chmetcnv hasspace="False" negative="False" numbertype="3" sourcevalue="3" tcsc="1" unitname="兩" w:st="on">三兩</st1:chmetcnv>好友<b><u>「相揪」報名買課程</u></b>;</span><span style="font-family: 新細明體; line-height: 23.25pt;">對運動的性質,與可能會造成傷害,甚至意外猝死,渾然不知,</span></div>
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<a href="http://4.bp.blogspot.com/-SWW8aF-tXQw/U8uEhxpv29I/AAAAAAAACec/DM_Pb2QnVgw/s1600/fittness+1.JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="200" src="https://4.bp.blogspot.com/-SWW8aF-tXQw/U8uEhxpv29I/AAAAAAAACec/DM_Pb2QnVgw/s1600/fittness+1.JPG" width="200" /></a><a href="http://4.bp.blogspot.com/-gSHZeys88Yw/U8uE4mXgwSI/AAAAAAAACek/lqM44EDWakY/s1600/yoga+2.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="200" src="https://4.bp.blogspot.com/-gSHZeys88Yw/U8uE4mXgwSI/AAAAAAAACek/lqM44EDWakY/s1600/yoga+2.JPG" width="200" /></a></div>
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<a href="http://4.bp.blogspot.com/-d-fhTQoXHnk/U8uFaj-fYUI/AAAAAAAACes/zBfYewuv7sg/s1600/Taichi.JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="194" src="https://4.bp.blogspot.com/-d-fhTQoXHnk/U8uFaj-fYUI/AAAAAAAACes/zBfYewuv7sg/s1600/Taichi.JPG" width="200" /></a></div>
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這是值得警惕與省思的。 <br />
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那運動<span style="font-family: "helvetica"; mso-bidi-font-weight: bold; mso-font-kerning: 0pt;"> </span><span style="font-family: 新細明體; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-bidi-font-weight: bold; mso-font-kerning: 0pt; mso-hansi-font-family: Helvetica;">要怎樣才安全、健康呢?</span><span lang="EN-US" style="font-family: "helvetica"; mso-bidi-font-weight: bold; mso-font-kerning: 0pt;"><o:p></o:p></span><br />
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<a href="http://3.bp.blogspot.com/-N7cW2b-8IO4/U8uDsMpqDKI/AAAAAAAACeM/qa58WqKPI1c/s1600/sport+5.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="123" src="https://3.bp.blogspot.com/-N7cW2b-8IO4/U8uDsMpqDKI/AAAAAAAACeM/qa58WqKPI1c/s1600/sport+5.JPG" width="200" /></a> <span style="font-family: 新細明體; line-height: 31px;">要運動,首先要有個概念,那就是:運動</span><span style="font-family: "helvetica"; line-height: 31px;"> </span><span style="font-family: 新細明體; line-height: 31px;"><u>要看年齡</u>!這就像 穿衣服要看場合一樣。 </span><span style="font-family: 新細明體; line-height: 23.25pt;">儘管你年輕曾叱吒風雲,但上了年紀,體能不再,你就不應自恃「老馬」,馳騁球場,逞強鬥勇;若知體型走樣,</span><span style="font-family: 新細明體; line-height: 23.25pt;">已有某些慢性疾病,要從事運動,更應量力而</span><span style="font-family: 新細明體; line-height: 23.25pt;">為,不可過度。</span></div>
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<span style="font-family: 新細明體; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-bidi-font-weight: bold; mso-font-kerning: 0pt; mso-hansi-font-family: Helvetica;"><br /></span>
<span style="font-family: 新細明體; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-bidi-font-weight: bold; mso-font-kerning: 0pt; mso-hansi-font-family: Helvetica;">事實上,從事運動之前,最好先讓<u>專業醫師</u></span><b><span lang="EN-US" style="font-family: 新細明體; mso-bidi-font-family: Helvetica; mso-font-kerning: 0pt;">* </span></b><span lang="EN-US" style="font-family: 新細明體; font-size: 9pt; mso-bidi-font-family: Helvetica; mso-bidi-font-weight: bold; mso-font-kerning: 0pt;">(</span><span style="font-family: 新細明體; font-size: 9pt; mso-bidi-font-family: Helvetica; mso-bidi-font-weight: bold; mso-font-kerning: 0pt;">註2.<span lang="EN-US">)</span></span><span style="font-family: 新細明體; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-bidi-font-weight: bold; mso-font-kerning: 0pt; mso-hansi-font-family: Helvetica;">,瞭解你運動的動機是甚麼?作整體的健康評估,然後告訴你,你可作那些運動?做到怎樣的程度及頻率?</span><span style="font-family: "helvetica"; mso-bidi-font-weight: bold; mso-font-kerning: 0pt;"> </span><span style="font-family: 新細明體; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-bidi-font-weight: bold; mso-font-kerning: 0pt; mso-hansi-font-family: Helvetica;">這種量身訂作的健康咨詢或檢查,就是所謂「</span><span style="font-family: 新細明體; line-height: 23.25pt;"><b>運動處方</b></span><span style="font-family: 新細明體; line-height: 23.25pt;">」</span><span lang="EN-US" style="font-family: "helvetica"; line-height: 23.25pt;">(Exercise Prescription)</span><span style="font-family: 新細明體; line-height: 23.25pt;">;先進國家行之有年,視為理所當然,可惜在台灣,還少了這樣的觀念。</span></div>
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<span style="font-family: 新細明體; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-bidi-font-weight: bold; mso-font-kerning: 0pt; mso-hansi-font-family: Helvetica;">那</span><span style="font-family: "helvetica"; mso-bidi-font-weight: bold; mso-font-kerning: 0pt;"> </span><span style="font-family: 新細明體; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-bidi-font-weight: bold; mso-font-kerning: 0pt; mso-hansi-font-family: Helvetica;">有甚麼情況,想運動你「<b><u>必須</u></b>」要先看醫生呢?</span><span style="font-family: "helvetica"; mso-bidi-font-weight: bold; mso-font-kerning: 0pt;"> </span><span style="font-family: 新細明體; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-bidi-font-weight: bold; mso-font-kerning: 0pt; mso-hansi-font-family: Helvetica;">如果你:</span><span lang="EN-US" style="font-family: "helvetica"; mso-bidi-font-weight: bold; mso-font-kerning: 0pt;"><o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: "helvetica"; mso-bidi-font-weight: bold; mso-font-kerning: 0pt;">1. </span><span style="font-family: 新細明體; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-bidi-font-weight: bold; mso-font-kerning: 0pt; mso-hansi-font-family: Helvetica;">有心臟毛病</span><span lang="EN-US" style="font-family: "helvetica"; mso-bidi-font-weight: bold; mso-font-kerning: 0pt;"><o:p></o:p></span></div>
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<span lang="EN-US">2. </span><span style="font-family: 新細明體; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">有氣喘或肺部毛病</span></div>
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<span lang="EN-US">3. </span><span style="font-family: 新細明體; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">有糖尿病或腎臟病</span> </div>
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<span lang="EN-US">4. </span><span style="font-family: 新細明體; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">有關節或脊柱毛病</span></div>
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<span style="font-family: 新細明體; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">你就</span><span style="font-family: 新細明體; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-bidi-font-weight: bold; mso-font-kerning: 0pt; mso-hansi-font-family: Helvetica;">「<b><u>必須</u></b>」要先看醫生,不可冒然從事。</span><br />
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<span style="font-family: 新細明體; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">如果</span> <span style="font-family: 新細明體; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">你不知你是否有上述毛病,</span> <span style="font-family: 新細明體; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">但你若有</span> <b><u><span style="font-family: 新細明體; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">下述情況</span></u></b><span style="font-family: 新細明體; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">,也請你運動前先看醫師或咨詢,</span><br />
<span style="font-family: 新細明體; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">如你</span> <span style="font-family: 新細明體; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">:</span></div>
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<!--[if !supportLists]--><span lang="EN-US">1.<span style="font-size: 7pt;"> </span></span><!--[endif]--><span style="font-family: 新細明體; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">運動會胸痛或胸悶,脖子、下巴或上臂</span> <span style="font-family: 新細明體; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">會緊繃不舒服。</span></div>
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<!--[if !supportLists]--><span lang="EN-US">2.<span style="font-size: 7pt;"> </span></span><!--[endif]--><span style="font-family: 新細明體; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">運動會眩暈、感到要昏厥。</span></div>
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<!--[if !supportLists]--><span lang="EN-US">3.<span style="font-size: 7pt;"> </span></span><!--[endif]--><span style="font-family: 新細明體; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">連</span> <span style="font-family: 新細明體; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">輕、中度的運動</span> <span style="font-family: 新細明體; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">或</span> <span style="font-family: 新細明體; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">躺下,就呼吸急促。</span><span lang="EN-US"> </span></div>
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<!--[if !supportLists]--><span lang="EN-US">4.<span style="font-size: 7pt;"> </span></span><!--[endif]--><span style="font-family: 新細明體; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">腳踝會浮腫,夜間加重。</span></div>
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<!--[if !supportLists]--><span lang="EN-US">5.<span style="font-size: 7pt;"> </span></span><!--[endif]--><span style="font-family: 新細明體; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">心跳很快。</span></div>
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<!--[if !supportLists]--><span lang="EN-US">6.<span style="font-size: 7pt;"> </span></span><!--[endif]--><span style="font-family: 新細明體; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">醫師曾告知你有心雜音。</span></div>
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<!--[if !supportLists]--><span lang="EN-US">7.<span style="font-size: 7pt;"> </span></span><!--[endif]--><span style="font-family: 新細明體; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">走路小腿腿腹,不時會抽搐,非得停下才能緩和。</span></div>
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<span style="font-family: 新細明體; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">這些狀況,表示你的身體<b><u>可能有</u></b>某些方面的問題,必須要作一些檢查來釐清,不能掉以輕心。</span></div>
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<span style="font-family: 新細明體; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">假如你想從事</span> <b><u><span style="font-family: 新細明體; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">比較</span></u></b><b><u><span style="font-family: 新細明體; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-font-kerning: 0pt; mso-hansi-font-family: Helvetica;">劇烈的運動</span></u></b><span style="font-family: 新細明體; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-font-kerning: 0pt; mso-hansi-font-family: Helvetica;">,</span><span style="font-family: 新細明體; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">美國運動醫學會</span><span lang="EN-US">(</span><span lang="EN-US" style="font-family: "helvetica"; mso-font-kerning: 0pt;">American College of Sports Medicine) </span><span style="font-family: 新細明體; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-font-kerning: 0pt; mso-hansi-font-family: Helvetica;">也慎重提出以下建議,如果你有</span><span lang="EN-US" style="font-family: "helvetica"; mso-font-kerning: 0pt;">2</span><span style="font-family: 新細明體; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-font-kerning: 0pt; mso-hansi-font-family: Helvetica;">個以上的選項,也請你運動前,先看醫師:</span><span lang="EN-US" style="font-family: "helvetica"; mso-font-kerning: 0pt;"><o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US">1.<span style="font-size: 7pt;"> </span></span><!--[endif]--><span style="font-family: 新細明體; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-font-kerning: 0pt; mso-hansi-font-family: Helvetica;">年過</span><span lang="EN-US" style="font-family: "helvetica"; mso-font-kerning: 0pt;">45</span><span style="font-family: 新細明體; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-font-kerning: 0pt; mso-hansi-font-family: Helvetica;">歲的男性;或年過</span><span lang="EN-US" style="font-family: "helvetica"; mso-font-kerning: 0pt;">55</span><span style="font-family: 新細明體; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-font-kerning: 0pt; mso-hansi-font-family: Helvetica;">歲的女性;</span><span style="font-family: 新細明體; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">曾有男性</span><span lang="EN-US">55</span><span style="font-family: 新細明體; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">歲不到、女性</span><span lang="EN-US">65</span><span style="font-family: 新細明體; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">歲不到,就因心臟病過世的家族史。</span></div>
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<!--[if !supportLists]--><span lang="EN-US">2.<span style="font-size: 7pt;"> </span></span><!--[endif]--><span style="font-family: 新細明體; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">你抽煙,或戒煙不滿</span><span lang="EN-US">6</span><span style="font-family: 新細明體; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">個月。</span></div>
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<!--[if !supportLists]--><span lang="EN-US">3.<span style="font-size: 7pt;"> </span></span><!--[endif]--><span style="font-family: 新細明體; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">你每次運動不止</span><span lang="EN-US">30</span><span style="font-family: 新細明體; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">分鐘、每週不止</span><span lang="EN-US">3</span><span style="font-family: 新細明體; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">次、已超過</span><span lang="EN-US">3</span><span style="font-family: 新細明體; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">個多月。</span><br />
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<!--[if !supportLists]--><span lang="EN-US"> 4.<span style="font-size: 7pt;"> </span></span><!--[endif]--><span style="font-family: 新細明體; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">你體重過重</span><span lang="EN-US">*</span><span lang="EN-US" style="font-size: 9pt;">(</span><span style="font-family: 新細明體; font-size: 9pt; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">註3</span><span lang="EN-US" style="font-size: 9pt;">)</span></div>
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<!--[if !supportLists]--><span lang="EN-US"> 5.<span style="font-size: 7pt;"> </span></span><!--[endif]--><span style="font-family: 新細明體; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">你</span> <span style="font-family: 新細明體; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">血壓高</span> <span style="font-family: 新細明體; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">或</span> <span style="font-family: 新細明體; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">膽固醇高。</span></div>
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<!--[if !supportLists]--><span lang="EN-US"> 6.<span style="font-size: 7pt;"> </span></span><!--[endif]--><span style="font-family: 新細明體; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">你血糖耐受性不佳。</span></div>
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<b><span style="font-family: 新細明體; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">另外</span></b><span style="font-family: 新細明體; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">,如你已懷孕,或你並不清楚自己的健康狀況,想去運動,建議你還是問一下你的醫師。即便,一般認為安全無虞的快走</span><span lang="EN-US">(brisk walking)</span><span style="font-family: 新細明體; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">,假如你停了好一陣子沒走了,要再走,也請你咨詢一下你的醫師。(本文亦刊載 103-07-17聯合報 D2 健康板 ) </span></div>
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<b><span style="font-family: 新細明體; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">註:</span></b><span style="font-family: "wingdings"; font-size: 10pt; text-indent: -18pt;"> </span></div>
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<b style="text-indent: -18pt;"><span style="background-color: white; font-family: "verdana" , "arial" , "helvetica" , sans-serif; font-size: x-small; line-height: 22.5px;"> </span><span style="font-family: 新細明體; font-size: 10pt; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">1. 古希臘(古 奧林匹克)揭示運動的精神與目標是:跑得更快, 擲得越遠, 跳得愈高....</span></b></div>
<b style="text-indent: -18pt;"><span style="font-family: 新細明體; font-size: 10pt; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';"> 2. 包括</span></b><b style="text-indent: -18pt;"><span style="font-size: 10pt;"> </span></b><b style="text-indent: -18pt;"><span style="font-family: 新細明體; font-size: 10pt; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">你的家庭醫師、你的心臟科、神經內科、骨科醫師。</span></b></div>
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<span style="font-family: "wingdings"; font-size: 10pt;"> </span><span style="font-family: 新細明體; font-size: 10pt; font-weight: bold;">3. BMI 超過24, 即為</span><b><span style="font-family: 新細明體; font-size: 10pt;">體重過重. * BMI : 體重(</span></b><b style="text-indent: -18pt;"><span style="font-family: 新細明體; font-size: 10pt; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">公斤</span></b><b style="text-indent: -18pt;"><span lang="EN-US" style="font-size: 10pt;">) / 身高(公尺) </span><span lang="EN-US"><span style="font-size: xx-small;">2</span></span></b></div>
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baba.wg58@gmail.comhttp://www.blogger.com/profile/03790611799966344101noreply@blogger.com0tag:blogger.com,1999:blog-1350268300834830253.post-84923051082128596112014-05-27T20:42:00.000-07:002014-05-27T20:59:09.476-07:00是甚麼原因 你背痛 ?你的體重、工作、你的姿勢、動作、勞動、運動,甚至你穿的鞋子或你的生活壓力…,都有可能使你背痛。<br />
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粗估 骨科門診中,有近3成的人是因背痛而來;這些人,都急著想知到:是出了甚麼毛病,(他)會背痛?他們耽心的是:“ 我是不是長了「骨刺」?” 。 在他們的認知裡,長「骨刺」就表示可能要開刀,要開刀就怕像某歌后變癱瘓… (據悉 某歌后是脊髓瘤 是背痛原因中極少碰到的情況)。 背痛真的是那麼令人害怕耽心嗎?背痛 到底是甚麼地方出了毛病?<br />
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<a href="http://2.bp.blogspot.com/-N8vjRebbHCE/U4VVXgR0jRI/AAAAAAAACdU/ZTwZJvPunco/s1600/%25E6%259C%25AA%25E5%2591%25BD%25E5%2590%258D+1.JPG" imageanchor="1" style="clear: left; cssfloat: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" closure_lm_958276="null" src="http://2.bp.blogspot.com/-N8vjRebbHCE/U4VVXgR0jRI/AAAAAAAACdU/ZTwZJvPunco/s1600/%25E6%259C%25AA%25E5%2591%25BD%25E5%2590%258D+1.JPG" height="320" lta="true" width="223" /></a>背痛通常是因下面的原因而來:<br />
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1. 肌肉 肌腱 韌帶的受傷:背(脊椎)部後方的肌肉、肌鍵(韌帶)的受傷,如:拉傷、扭傷、挫傷、姿勢不對,閃了腰…,是背痛最常見的原因,通常幾天、一兩個禮拜就會好起來。序言中,姿勢 動作 勞動 運動 所引起的多半是慢性長期的肌腱炎,而此處所言,是急性背痛。<br />
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2. 脊椎的退化性關節炎:脊椎也像膝關節一樣,是身體負重的關節,因此也會退化;通常是椎間盤變乾癟、萎縮或破裂了,有些則常常是椎體後方的小面關節過度磨損,這是小面關節的退化,會使脊椎 節與節間變鬆,動作的磨擦變大,會造成晨起僵硬,走路走久、站久會背痛。<br />
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3. 椎間盤的問題:<br />
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椎間盤是一節、一節脊椎椎體間的避震器。過度負重 彎腰或 外力,它也會受傷、破裂或爆(凸)出,造成發炎或脊椎神經根的壓迫,此即大家口中的坐骨神經痛,但很多時候,坐骨神經痛並沒有真正神經的壓迫,只還是局部肌腱炎所引起的放射痛(牽痛)。<br />
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4. 骨質疏鬆的問題:這在停經後的婦女較常見,不是真正背痛,比較確切的形容是:撐不住的背痠。通常在要起床時或站久、走久最顯著,骨質疏鬆還容易發生脊椎的壓迫性骨折。<br />
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5. 脊髓腔狹窄症:人體有32節脊椎,一節一節相疊連結的椎體,中央空洞部份構成一個隧道式的管路,給 從腦幹延伸而下的脊髓通過,是即脊髓腔。受脊椎退化的波及,脊髓腔會因環繞增生的贅骨(一般喜歡稱骨刺)而變窄,這會擠壓局部或一小段的脊髓神經;症狀除背痛外,還會有間歇性的跛行,走一段路,下肢就痠麻得非坐下來休息一會兒,才能繼續上路。 <br />
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6. 脊椎滑脫症:一節節的脊椎,前後都有很強的韌帶撐住,結合小面關節撐住,維持整個脊柱的排列。在某些情況,譬如 韌帶退化鬆弛了、小面關節退化磨損了,或脊椎椎腳有缺陷…,會讓上下節的脊椎產生滑動脫位,這也會造成神經的壓迫、造成背痛。<br />
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以上列舉的,是背痛常見的原因。其它如:有脊椎側彎、有扁平足、 有拇趾外翻等足部變異者,因全身重心的縱軸或多或少產生的偏離,也會引起背痛;長期穿高跟鞋者 更是背痛的好發族群。 <br />
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但假如你背痛超過2個禮拜以上,你不是因外力受傷背痛,你背痛又有下肢刺痛麻木、大小便有問題、有不明原因體重變輕,或你已知有癌症、骨質疏鬆或有免疫方面的問題,或你已年過70… ,則不該把背痛等閒視之,應好好就診 找醫師把病因找出來,切莫胡亂投醫而延誤或誤診,才是真正對症治療。<br />
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<br />baba.wg58@gmail.comhttp://www.blogger.com/profile/03790611799966344101noreply@blogger.com0tag:blogger.com,1999:blog-1350268300834830253.post-2562484234290329202013-10-09T01:02:00.002-07:002013-10-09T01:04:49.907-07:00愈老愈嚴重 骨鬆怎麼防?<div class="MsoNormal">
<span style="font-family: 新細明體; font-size: large; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">多年前看診,要花很多時間向病人解釋甚麼是「骨質疏鬆」?這一兩年,情況好很多,病人會主動要求作骨密檢查、詢問治療方式,顯示民眾吸收醫學新知還真快!且已懂得未雨綢繆,這是社會進步的現象,想來,應是媒體居功厥偉。</span></div>
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<span style="font-size: large;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">骨質疏鬆是老化</span><span lang="EN-US">(aging)</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">的一部分,年齡是最主要的原因。在</span><span lang="EN-US">17</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">世紀以前的歐洲,老婦上背圓駝,稱 </span><span lang="EN-US">Dowager’s hump(</span><b><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">貴婦駝</span><span lang="EN-US">)</span></b><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">,是福壽雙全的象徵,人人稱羡;殊不知,這個「駝」,實乃骨質疏鬆造成脊椎壓迫性骨折的外觀,而羨之在於尋常百姓,一生勞苦,平均壽命只有五十幾,渴望有「駝」而不可得歟!</span></span></div>
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<span style="font-size: large;"><span lang="EN-US">1980</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">年代,開始有了初步、單能量級的骨密檢查儀;一直到</span><span lang="EN-US">1993</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">年,世界衛生組織</span><span lang="EN-US">(WHO)</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">才有官方的骨質疏鬆的指引</span><span lang="EN-US"> (guideline)</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">及診斷標準。即使在美國,骨質疏鬆也是這</span><span lang="EN-US">20</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">年的「<b>新</b>」病。因為人口的老化,包括台灣在內的已開發國家,骨質疏鬆已成了衛生官署醫療的重要議題。</span><span lang="EN-US"> </span></span></div>
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<span style="font-size: large;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">這</span><span lang="EN-US">20</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">年,骨質疏鬆的進展,主要是在對抗骨質疏鬆藥物的研發。早年,婦科醫師用荷爾蒙緩解女性更年期的不適,歪打正著,使很多停經後的婦女,在心血管疾病</span>
<span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">及</span> <span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">停經後骨質疏鬆症的病情</span>
<span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">得到改善,一時,婦產科醫師成了對抗骨質疏鬆的先鋒,但</span><span lang="EN-US">2002</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">年</span> <span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">關於停經後荷爾蒙接替治療</span><span lang="EN-US">(HRT)</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">的弊病被揭示後,目前已不再使用荷爾蒙來治療骨質疏鬆了。</span></span></div>
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<span style="font-size: large;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">由於,脊椎壓迫性骨折是骨質疏鬆最常發生的問題,抑鈣激素</span><span lang="EN-US">(calcitonin)</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">打針或鼻噴劑,對脊椎骨折所引起之急性背痛,似乎具有速效,也被用來治療骨質疏鬆,但近年的研究,認為抑鈣激素對骨質疏鬆或骨密的改善,實質效果有限。</span></span></div>
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<span style="font-size: large;"><span lang="EN-US">90</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">年代後期,雙磷酸鹽</span><span lang="EN-US">(bisphosphonates)</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">出現,風起雲湧,口服或針劑被廣泛的用在骨質疏鬆、癌症轉移、器官移植免疫抑制劑副作用</span><span lang="EN-US">…</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">等的預防或治療上;但藥物都需要時間的考驗,雙磷酸鹽使用多年後,先是陸陸續續有下顎骨骨壞死的報導,</span><span lang="EN-US">2006</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">年美國一位小兒科女醫師,發表她服用雙磷酸鹽發生了股骨非典型骨折</span><span lang="EN-US">(Atypical Femoral Shaft Fracture)</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">的始末,引起軒然大波,揭開了媒體及醫界對雙磷酸鹽長期使用可能弊害的關注。在此同時,也還有其它骨鬆藥物如</span>
<span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">副甲狀腺激素、</span><span lang="EN-US">strontium ranelate (锶劑)…</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-font-kerning: 0pt; mso-hansi-font-family: "Times New Roman";">,</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">等製劑,用在骨鬆防治上,但被認為仍有缺憾。</span></span></div>
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<span style="font-size: large;"><span lang="EN-US">2009</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">年新藥</span><span lang="EN-US"><b>Denosumab</b></span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">問世,此藥的藥理機轉有別於其它抗骨鬆劑,僅抑制但不滅絕蝕骨細胞,停藥即可消除對骨重塑的抑制</span><span lang="EN-US">(</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">即 可逆轉</span><span lang="EN-US">)</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">,對其它骨鬆劑的停用或想改藥,也能立即接續或遞補,又可選用在很多不同骨鬆情況的使用,只須每半年皮下注射一次,算是相當理想的骨鬆治劑。</span></span></div>
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<span style="font-family: 新細明體; font-size: large;">骨質會疏鬆是老化。人人會老,活得越老,疏鬆就越厲害,這可不是甚麼</span>
<span style="font-family: 新細明體; font-size: large;">「活得越老,領得越</span><span lang="EN-US" style="font-size: large;">”</span><span style="font-family: 新細明體; font-size: large;">多</span><span lang="EN-US" style="font-size: large;">”</span><span style="font-family: 新細明體; font-size: large;">」的年金!回顧骨鬆防治一路走來的過程,感受的是,醫界好像是卯足了勁,想要實踐「<b>人定勝天</b>」這句話,進展艱辛自是必然,會有怎麼樣的局面,就拭目以待了!</span><span lang="EN-US" style="font-size: large;">(</span><b><span style="font-family: 新細明體;">本文亦登載</span> <st1:chsdate day="5" islunardate="False" isrocdate="False" month="10" w:st="on" year="102"><span lang="EN-US">102-10-05</span></st1:chsdate><span lang="EN-US"> </span><span style="font-family: 新細明體;">聯合報</span> <span lang="EN-US">D2</span><span style="font-family: 新細明體;">健康版</span></b><span lang="EN-US" style="font-size: large;">)</span></div>
baba.wg58@gmail.comhttp://www.blogger.com/profile/03790611799966344101noreply@blogger.com0tag:blogger.com,1999:blog-1350268300834830253.post-19919436806909871192013-08-18T07:17:00.000-07:002013-08-18T17:21:55.303-07:00(續前) 關於五十肩的迷思<span style="font-size: small;">自2012/12/28 「關於五十肩的迷思」登載後( <span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 12pt; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: 新細明體; mso-fareast-language: ZH-TW; mso-font-kerning: 1.0pt;"><a href="http://docwglee.blogspot.tw/search?updated-min=2012-01-01T00:00:00-08:00&updated-max=2013-01-01T00:00:00-08:00&max-results=6">http://docwglee.blogspot.tw/search?updated-min=2012-01-01T00:00:00-08:00&u<span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 12pt; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: 新細明體; mso-fareast-language: ZH-TW; mso-font-kerning: 1.0pt;">pdated-max=2013-01-01T00:00:00-08:00&max-results=6</span></a> ),各方反應熱烈,茲再借部落格一角 再次回覆各方關切的一些問題。</span></span><br />
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<span lang="EN-US">Q1. </span><span style="font-family: 新細明體; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">醫師你說五十肩是因為</span> <span style="font-family: 新細明體; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">肩峰下空間不夠,旋轉肌袖受到擠壓,而導致病變所致。那</span> <span style="font-family: 新細明體; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">肩峰</span></div>
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<span style="font-family: 新細明體; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';"> 下的空間</span> <span style="font-family: 新細明體; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">要多寬才夠ㄚ?</span></div>
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<span style="font-family: 新細明體; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';"><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 12pt; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: 新細明體; mso-fareast-language: ZH-TW; mso-font-kerning: 1.0pt;">A1. </span><span style="font-family: 新細明體; font-size: 12pt; mso-ansi-language: EN-US; mso-ascii-font-family: 'Times New Roman'; mso-bidi-font-family: 'Times New Roman'; mso-bidi-language: AR-SA; mso-fareast-language: ZH-TW; mso-font-kerning: 1.0pt; mso-hansi-font-family: 'Times New Roman';">照得好、標準的</span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 12pt; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: 新細明體; mso-fareast-language: ZH-TW; mso-font-kerning: 1.0pt;">X</span><span style="font-family: 新細明體; font-size: 12pt; mso-ansi-language: EN-US; mso-ascii-font-family: 'Times New Roman'; mso-bidi-font-family: 'Times New Roman'; mso-bidi-language: AR-SA; mso-fareast-language: ZH-TW; mso-font-kerning: 1.0pt; mso-hansi-font-family: 'Times New Roman';">光棘上肌出口投射照</span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 12pt; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: 新細明體; mso-fareast-language: ZH-TW; mso-font-kerning: 1.0pt;">* (Supraspinatus Outlet View</span><span style="font-family: 新細明體; font-size: 12pt; mso-ansi-language: EN-US; mso-ascii-font-family: 'Times New Roman'; mso-bidi-font-family: 'Times New Roman'; mso-bidi-language: AR-SA; mso-fareast-language: ZH-TW; mso-font-kerning: 1.0pt; mso-hansi-font-family: 'Times New Roman';">圖</span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 12pt; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: 新細明體; mso-fareast-language: ZH-TW; mso-font-kerning: 1.0pt;">1.)</span><span style="font-family: 新細明體; font-size: 12pt; mso-ansi-language: EN-US; mso-ascii-font-family: 'Times New Roman'; mso-bidi-font-family: 'Times New Roman'; mso-bidi-language: AR-SA; mso-fareast-language: ZH-TW; mso-font-kerning: 1.0pt; mso-hansi-font-family: 'Times New Roman';">可以看出肩峰下的乾坤。</span></span></div>
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<a href="http://3.bp.blogspot.com/-5SWi_HWLb1s/UhDBYdbzChI/AAAAAAAACJ4/TWo2wKxmPLM/s1600/110525+supraspinatus+1+outlet+view.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" ksa="true" src="http://3.bp.blogspot.com/-5SWi_HWLb1s/UhDBYdbzChI/AAAAAAAACJ4/TWo2wKxmPLM/s320/110525+supraspinatus+1+outlet+view.JPG" width="209" /></a><span style="font-family: 新細明體; font-size: 12pt; mso-ansi-language: EN-US; mso-ascii-font-family: 'Times New Roman'; mso-bidi-font-family: 'Times New Roman'; mso-bidi-language: AR-SA; mso-fareast-language: ZH-TW; mso-font-kerning: 1.0pt; mso-hansi-font-family: 'Times New Roman';">統計上,就棘上肌出口投射照測量,正常肩峰下的寬幅</span><span style="font-family: 'Times New Roman'; font-size: 12pt; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: 新細明體; mso-fareast-language: ZH-TW; mso-font-kerning: 1.0pt;"> </span><span style="font-family: 新細明體; font-size: 12pt; mso-ansi-language: EN-US; mso-ascii-font-family: 'Times New Roman'; mso-bidi-font-family: 'Times New Roman'; mso-bidi-language: AR-SA; mso-fareast-language: ZH-TW; mso-font-kerning: 1.0pt; mso-hansi-font-family: 'Times New Roman';">約</span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 12pt; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: 新細明體; mso-fareast-language: ZH-TW; mso-font-kerning: 1.0pt;">7~<st1:chmetcnv hasspace="False" negative="False" numbertype="1" sourcevalue="11" tcsc="0" unitname="mm" w:st="on">11mm</st1:chmetcnv></span><span style="font-family: 新細明體; font-size: 12pt; mso-ansi-language: EN-US; mso-ascii-font-family: 'Times New Roman'; mso-bidi-font-family: 'Times New Roman'; mso-bidi-language: AR-SA; mso-fareast-language: ZH-TW; mso-font-kerning: 1.0pt; mso-hansi-font-family: 'Times New Roman';">,<strong>平均10mm</strong></span><span style="font-family: 新細明體; font-size: 12pt; mso-ansi-language: EN-US; mso-ascii-font-family: 'Times New Roman'; mso-bidi-font-family: 'Times New Roman'; mso-bidi-language: AR-SA; mso-fareast-language: ZH-TW; mso-font-kerning: 1.0pt; mso-hansi-font-family: 'Times New Roman';">。</span><span style="font-family: 'Times New Roman'; font-size: 12pt; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: 新細明體; mso-fareast-language: ZH-TW; mso-font-kerning: 1.0pt;"> </span><span style="font-family: 新細明體; font-size: 12pt; mso-ansi-language: EN-US; mso-ascii-font-family: 'Times New Roman'; mso-bidi-font-family: 'Times New Roman'; mso-bidi-language: AR-SA; mso-fareast-language: ZH-TW; mso-font-kerning: 1.0pt; mso-hansi-font-family: 'Times New Roman';">開刀實際目測到</span><span style="font-family: 'Times New Roman'; font-size: 12pt; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: 新細明體; mso-fareast-language: ZH-TW; mso-font-kerning: 1.0pt;"> </span><span style="font-family: 新細明體; font-size: 12pt; mso-ansi-language: EN-US; mso-ascii-font-family: 'Times New Roman'; mso-bidi-font-family: 'Times New Roman'; mso-bidi-language: AR-SA; mso-fareast-language: ZH-TW; mso-font-kerning: 1.0pt; mso-hansi-font-family: 'Times New Roman';">肩峰拱門下,包括:肩峰下端及軟骨層</span><span style="font-family: 'Times New Roman'; font-size: 12pt; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: 新細明體; mso-fareast-language: ZH-TW; mso-font-kerning: 1.0pt;"> <span lang="EN-US">+ </span></span><span style="font-family: 新細明體; font-size: 12pt; mso-ansi-language: EN-US; mso-ascii-font-family: 'Times New Roman'; mso-bidi-font-family: 'Times New Roman'; mso-bidi-language: AR-SA; mso-fareast-language: ZH-TW; mso-font-kerning: 1.0pt; mso-hansi-font-family: 'Times New Roman';">旋轉肌袖層</span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 12pt; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: 新細明體; mso-fareast-language: ZH-TW; mso-font-kerning: 1.0pt;"> + </span><span style="font-family: 新細明體; font-size: 12pt; mso-ansi-language: EN-US; mso-ascii-font-family: 'Times New Roman'; mso-bidi-font-family: 'Times New Roman'; mso-bidi-language: AR-SA; mso-fareast-language: ZH-TW; mso-font-kerning: 1.0pt; mso-hansi-font-family: 'Times New Roman';">肱骨頭軟骨層</span><span style="font-family: 'Times New Roman'; font-size: 12pt; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: 新細明體; mso-fareast-language: ZH-TW; mso-font-kerning: 1.0pt;"> </span><span style="font-family: 新細明體; font-size: 12pt; mso-ansi-language: EN-US; mso-ascii-font-family: 'Times New Roman'; mso-bidi-font-family: 'Times New Roman'; mso-bidi-language: AR-SA; mso-fareast-language: ZH-TW; mso-font-kerning: 1.0pt; mso-hansi-font-family: 'Times New Roman';">加總厚度</span><span style="font-family: 'Times New Roman'; font-size: 12pt; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: 新細明體; mso-fareast-language: ZH-TW; mso-font-kerning: 1.0pt;"> </span><span style="font-family: 新細明體; font-size: 12pt; mso-ansi-language: EN-US; mso-ascii-font-family: 'Times New Roman'; mso-bidi-font-family: 'Times New Roman'; mso-bidi-language: AR-SA; mso-fareast-language: ZH-TW; mso-font-kerning: 1.0pt; mso-hansi-font-family: 'Times New Roman';">也在</span><st1:chmetcnv hasspace="False" negative="False" numbertype="1" sourcevalue="10" tcsc="0" unitname="mm" w:st="on"><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 12pt; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: 新細明體; mso-fareast-language: ZH-TW; mso-font-kerning: 1.0pt;">10mm</span></st1:chmetcnv><span style="font-family: 新細明體; font-size: 12pt; mso-ansi-language: EN-US; mso-ascii-font-family: 'Times New Roman'; mso-bidi-font-family: 'Times New Roman'; mso-bidi-language: AR-SA; mso-fareast-language: ZH-TW; mso-font-kerning: 1.0pt; mso-hansi-font-family: 'Times New Roman';">之幅。</span><span style="font-family: 'Times New Roman'; font-size: 12pt; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: 新細明體; mso-fareast-language: ZH-TW; mso-font-kerning: 1.0pt;"> </span><span style="font-family: 新細明體; font-size: 12pt; mso-ansi-language: EN-US; mso-ascii-font-family: 'Times New Roman'; mso-bidi-font-family: 'Times New Roman'; mso-bidi-language: AR-SA; mso-fareast-language: ZH-TW; mso-font-kerning: 1.0pt; mso-hansi-font-family: 'Times New Roman';">旋轉肌袖,尤其是肩棘上肌就僅能在</span><st1:chmetcnv hasspace="False" negative="False" numbertype="1" sourcevalue="10" tcsc="0" unitname="mm" w:st="on"><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 12pt; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: 新細明體; mso-fareast-language: ZH-TW; mso-font-kerning: 1.0pt;">10mm</span></st1:chmetcnv><span style="font-family: 新細明體; font-size: 12pt; mso-ansi-language: EN-US; mso-ascii-font-family: 'Times New Roman'; mso-bidi-font-family: 'Times New Roman'; mso-bidi-language: AR-SA; mso-fareast-language: ZH-TW; mso-font-kerning: 1.0pt; mso-hansi-font-family: 'Times New Roman';">寬幅的肩峰</span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 12pt; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: 新細明體; mso-fareast-language: ZH-TW; mso-font-kerning: 1.0pt;">-</span><span style="font-family: 新細明體; font-size: 12pt; mso-ansi-language: EN-US; mso-ascii-font-family: 'Times New Roman'; mso-bidi-font-family: 'Times New Roman'; mso-bidi-language: AR-SA; mso-fareast-language: ZH-TW; mso-font-kerning: 1.0pt; mso-hansi-font-family: 'Times New Roman';">喙突拱門</span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 12pt; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: 新細明體; mso-fareast-language: ZH-TW; mso-font-kerning: 1.0pt;">(Acromiocoracoid Arch </span><span style="font-family: 新細明體; font-size: 12pt; mso-ansi-language: EN-US; mso-ascii-font-family: 'Times New Roman'; mso-bidi-font-family: 'Times New Roman'; mso-bidi-language: AR-SA; mso-fareast-language: ZH-TW; mso-font-kerning: 1.0pt; mso-hansi-font-family: 'Times New Roman';">圖</span><span lang="EN-US" style="font-family: 'Times New Roman'; font-size: 12pt; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: 新細明體; mso-fareast-language: ZH-TW; mso-font-kerning: 1.0pt;">2. 紅點圈住的部分就是旋轉肌袖活動的空間 )
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下活動;估計,只要拱門標高低 (“矮”)了2mm,就會五十肩,肩峰減壓成形術就是以這數據來作指引。<br />
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Q2. 你說我空間不夠;我這肩膀從年輕到現在都是一個樣;那 為甚麼我以前從不曾五十肩?<br />
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A2. 日常生活起居,肩關節不免會因使用、磨損、受傷…而產生變化。軟組織(指肌肉、肌腱)的退化通常是以肥厚來表現,軟骨則以磨損呈現,而硬骨則是長出贅骨(骨刺),這三者 都會 一天天把肩峰下的空間變窄。旋轉肌袖 好比是人在屋簷下,委曲小心的與狹隘的空間周旋,保持著恐怖平衡;但,只要一個 ”<strong>導火線 </strong>” 打破了平衡,整個肩峰下的生態,就掉進了「<strong>惡性循環</strong>」-- 愈擠愈腫、愈腫再愈擠 --, 終於引爆了各式各樣的五十肩!<br />
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Q3. 我的朋友也有五十肩;為甚麼他(她) 痛一痛就好了,不須要開刀?<br />
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A3. 有肩痛的中年人,約有46%的人會掉入上述惡性循環,得了「<strong>真正</strong>」的五十肩。這 與個人肩峰結構是否有瑕疵?又與個人之體質 (即局部肩關節的自體免疫強弱)、是否有糖尿病、甲狀腺機能異常、肥胖、抽煙、中過風、…有關。有些自以為是五十肩的人,可能只是過度使用造成的 肩旋轉肌袖<strong>肌腱炎</strong>,只要休息、冰敷、吃吃藥、避免再過勞…,就會好起來。真正的五十肩,只有改善空間才能治本。<br />
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Q4. 不開刀 會怎樣?<br />
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A4. 肩峰下空間一天沒有改善,旋轉肌袖就一天解除不了擠壓!為了怕痛,肩膀會不敢動 (肩關節的自我防禦機制),久了, 最可能的結果,就是變成<strong>廢用性凍肩症</strong>,連肩關節周圍的關節囊、肌肉 (三角肌、二頭肌…)、肌腱…,都會<strong>萎縮</strong>殆盡,治療就更困難了。<br />
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* 關於棘上肌出口投射照,歡迎網訪 http://docwglee.blogspot.tw/2011/09/x.html or http://classic-blog.udn.com/wglee/5639719<br />
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baba.wg58@gmail.comhttp://www.blogger.com/profile/03790611799966344101noreply@blogger.com0tag:blogger.com,1999:blog-1350268300834830253.post-6916487846263557292013-03-03T08:18:00.002-08:002017-08-30T02:16:56.831-07:00骨震波治療成功的條件<br />
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<span style="font-size: large;">屢有媒體及骨科同仁要我談談骨震波治療的心得。筆者從事骨震波治療逾十年,個案中以接骨點肌腱炎,如:足底筋膜炎、網球肘…成效最為卓著,打(治療)一次的治癒率已超過90%,茲借部落格一角,以足底筋膜炎為引子,淺述骨震波治療成功的條件。</span><br />
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<span style="font-size: large;"><br /></span><span style="font-size: large;"><br /></span><span style="font-size: large;"><br /></span><span style="font-size: large;">1. 首先,要先釐清的是:骨震波治療並不是要把足底「骨刺」”打”掉。一看到X光 跟骨前下突有「骨刺」,就想當然爾 訛稱 骨刺 是罪魁禍首,要 ” 打 ”掉 (除之而後快乎?) ,十足是 便宜行事的錯誤邏輯及<strong>誤診</strong>。</span><br />
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<span style="font-size: large;">2. 事實上,足跟骨刺並不是足底筋膜炎的病因。足底筋膜炎是接骨點的筋膜(解剖學,在"骨刺"之下層)受傷後久久得不到足夠的血液營養來痊癒,是筋膜久傷不癒而演變成<strong>退化</strong>( Angiofibroblastic degeneration )的表現;治療只有設法改善血液循環,使局部筋膜有機會痊癒(<b>再生)</b>,才是真正的治本。</span><span style="font-size: large;"><br /></span><span style="font-size: large;"><br /></span><span style="font-size: large;"><br /></span><span style="font-size: large;">3. 二請認識:骨震波所挾帶的高能量,透過<strong>聚焦</strong>的增強,投射在已退化的筋膜,會在筋膜的間質 打(”震”)出眾多微細的<strong>空隙</strong> ( Cavitation effect,震波的<strong>機械效應</strong> );提供給後續新生的微血管 有順利的管道(空間) 可以<b>長進去</b> ( Neovascularization effect,震波的<strong>生物效應</strong> ),靠此,循環改善 而 退化得以<strong>再生</strong>,這是骨震波痊癒接骨點筋膜炎的原理。</span><br />
<span style="font-size: large;"><br /></span><span style="font-size: large;"><br /></span><span style="font-size: large;"><br /></span><span style="font-size: large;">4. 知乎此,應能理解:骨震波治療要成功,第一,必須要投射(打)有<strong>高能量</strong>震波 ( 震波儀須有<strong>聚焦設計</strong> 能量才會高 );第二,更重要的是打的<b>位置要對</b>,這就牽涉到<strong>定位</strong>的重要性。定位是三度空間( 3-dimension)定位,精準與否,考驗著醫師對解剖學瞭解的程度與操作震波儀的功力。</span><br />
<span style="font-size: large;"><br /></span><span style="font-size: large;"><br /></span><span style="font-size: large;"><br /></span><span style="font-size: large;">5. 最關鍵的還是在<strong>正確的診斷</strong>*,這是成功與否的先決條件。個人認為病人是否有明確的晨起下床時劇痛,是足底筋膜炎指標性的症狀;當然,細心檢查特定部位的壓痛,佐證以良好的足底軟組織X光( 或MRI),有經驗的醫師都可以無誤的作出診斷。</span><br />
<span style="font-size: large;"><br /></span><span style="font-size: large;"><br /></span><span style="font-size: large;"><br /></span><span style="font-size: large;">6. 震波應打的劑(能)量、強度與次數,須視病人的年齡、症狀之長短、X光之所見、足底脂肪層有否萎縮、筋膜X光呈現的變化如何…而定,應先有個劑量的盤算;定好位,在治療(打)過程中,要確保位置固定 不跑掉,因此,醫師必須很<strong>專注</strong>,而病人也要很<strong>合作 配合</strong>,過程中還須不時評估病人的反應 作適當的調節。</span><br />
<span style="font-size: large;"><br /></span><span style="font-size: large;"><br /></span><span style="font-size: large;"><br /></span><span style="font-size: large;">就靠這樣,正確診斷、嚴格篩選病人、不浮濫開打、用高能量震波儀、精確的定位、專注的打,成功率自然就會高了。</span><br />
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註:* 須與症狀極為類似的 足踝三關節(Triple joint)退化、跗骨隧道症候群(Tarsal tunnel syndrome)、足底筋膜腫瘤 (如 血管瘤…)、足底靜脈曲張(Plantar Venous Varicosis )、足底末梢神經炎...,等 作鑑別診斷。<br />
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<br />baba.wg58@gmail.comhttp://www.blogger.com/profile/03790611799966344101noreply@blogger.com4tag:blogger.com,1999:blog-1350268300834830253.post-49732390518331123142012-12-28T01:50:00.000-08:002013-05-21T17:18:31.724-07:00關於五十肩的迷思<h2>
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<span style="font-size: large;">每一天,在與病人的互動,或回覆部落格讀者的問題中,仍能感受一般人,對五十肩還有許多迷思。茲 借部落格的一角,就一些最常被問到、且的確有必要再釋疑的問題,作如下的說明,希望有助於減少一些人心裡仍有的疑慮。</span></div>
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<strong><span style="font-size: large;">Q1. 我是五十肩嗎?五十肩 不是要等到五十歲 或更晚才會有的嗎?</span></strong></div>
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<span style="font-size: large;">A1. 假如你有肩膀痠、痛、想抬舉時頓感無力,而症狀時好時壞、晚上比白天更厲害,漸漸發現 手臂抬不高、無法反背勾胸罩、或某些動作會「卡」到…;那你極可能已經是五十肩了,你應該好好找專門的醫師作評估。 </span></div>
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<span style="font-size: large;">因為使用鍵盤 (打電腦、…等)手臂的姿勢不對 或長時間工作過度使用,年輕、三十幾 就得五十肩的病人,已愈來愈多了。 </span></div>
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<strong><span style="font-size: large;">Q2. 五十肩是關節的退化嗎? 怎麼會得五十肩?</span></strong></div>
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<span style="font-size: large;">A2. 五十肩不是關節的退化。五十肩是肩關節外環的一層旋轉肌袖(環繞關節3/4、像袖口狀的重要肌腱)有了問題,因此 正式的病名叫 肩旋轉肌袖病變。</span></div>
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<span style="font-size: large;">會得到五十肩,事實上是多重因素造成的。這些因素 主要包括:a). 肩峰(尤其是肩峰下)結構本身 有瑕疵。 b). 一輩子使用肩膀,造成肌袖的發炎、磨損、受傷、退化…。 c). 不同的體質(正確的說:個人自體免疫的差異)。 d). 其它。</span></div>
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<strong><span style="font-size: large;">Q3. 五十肩不是自然會好起來嗎? 做做復健不就得了?</span></strong></div>
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<span style="font-size: large;">A3. 有一些 擬似五十肩的肩旋轉肌袖肌腱炎,休息、冰/熱敷、吃些非類固醇消炎止痛劑…會好起來,但不是人人都如此幸運只是肌腱炎;久痛不癒 或漸漸有活動受限的情況,則你大概不能太樂觀認為「自然會好起來」。</span></div>
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<span style="font-size: large;">假如是旋轉肌袖肌腱炎,做不做復健都沒差,都會好起來。但萬一不是,復健 極有可能會造成二度傷害、N度傷害,不宜輕易嘗試。</span></div>
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<strong><span style="font-size: large;">Q4. 凍肩 跟 五十肩 一樣不一樣?</span></strong></div>
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<span style="font-size: large;">A4. 曾有一段時間認為凍肩是另外一種病,但現在認為凍肩也只是五十肩的另一種表現,是因為自體免疫作用的方式比較不同而已;治療的原理還是一樣的。</span></div>
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<strong><span style="font-size: large;">Q5. 那 五十肩 該怎樣治療?</span></strong></div>
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<span style="font-size: large;">A5. 幾乎所有的五十肩都由於先有了肩峰結構的瑕疵 (通常是肩峰下的空間不夠),在某一次導火線引爆後,後續產生了一連串的反應而造成;治本 勢必要進行肩峰的改造(即 肩峰成形術 )。肩峰的改造,不可能吃吃藥或作復健就能完成,而旋轉肌袖的修補 也是五十肩治療上很重要的步驟之一,這些 都只能以手術來達成。</span></div>
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<strong><span style="font-size: large;">Q6. 我怕開刀,不開刀可以嗎?</span></strong></div>
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<span style="font-size: large;">A6. 講到開刀,大家都怕,這是人之常情。再說 五十肩,一不威脅生命、二又不是急診,你可以有充分的時間考慮或再與醫師討論;但一味反對開刀,等於放棄治療,最可能的結果是 廢用了一個臂膀,殊不值得。</span></div>
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<strong><span style="font-size: large;">Q7. 手術不是採取關節鏡手術比較好嗎?</span></strong></div>
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<span style="font-size: large;">A7. 關節鏡手術標榜的是傷口小,但缺點也因傷口小,很難把手術做到完美,又因關節鏡手術 較花時間,讓病人吸很多麻醉藥,值不值得這樣作,醫界已經在檢討。用mini-open的方式手術,傷口一樣很小,肩峰卻可以改造得更周全,旋轉肌袖也能修補得更穩固,所以,目前我大都採用mini-open的方式手術,時間短,不讓病人麻醉太久。</span></div>
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<strong><span style="font-size: large;">Q8. 手術要住院多久?會很痛嗎?</span></strong></div>
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<span style="font-size: large;">A8. 手術通常住院3 ~ 4天。會同時進行很先進的術後自動輸液疼痛控制(IPPC),不僅不痛,且開刀第二天,即可開始做 術後運動治療,幫忙肩關節動作的早早恢復。</span></div>
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<strong><span style="font-size: large;">Q9. 手術健保有給付嗎?</span></strong></div>
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<span style="font-size: large;">A9. 住院(規定日數內)、手術技術費,健保有給付;一些特材 (視情況須要而異,非一定用到) 及疼痛控制,則健保不給付。</span></div>
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<strong><span style="font-size: large;">Q10. 我可以知道得多一點嗎?</span></strong></div>
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<span style="font-size: large;">A10. 可以。</span><br />
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<span style="font-size: large;">請 Link <span lang="EN-US"><a href="http://www.youtube.com/watch?v=aOarklc8uO4">http://www.youtube.com/watch?v=aOarklc8uO4</a></span></span></div>
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<span style="font-size: large;">請往訪 http://blog.udn.com/wglee/article?f_ART_CATE=211246 </span></div>
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<span style="font-size: large;">或 http://docwglee.blogspot.com/ 五十肩各節相關文章。</span></div>
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baba.wg58@gmail.comhttp://www.blogger.com/profile/03790611799966344101noreply@blogger.com0tag:blogger.com,1999:blog-1350268300834830253.post-39138907642301357882012-11-27T17:45:00.000-08:002012-12-02T00:16:17.594-08:00骨震波在台灣<br />
<span style="font-size: large;">1998年,一位有遠見的骨科醫師<span style="font-size: small;">註1</span>把骨震波引進台灣,在高雄長庚醫院開始生根;初始,連骨科界也沒幾個人聽過<strong>骨震波</strong> (ESWT Extracorporeal Shock Wave Therapy) 這個生澀的名詞。今年十月底在南港展覽館的骨科醫學會,403會議室骨震波的研討會會場,卻擠得水洩不通,甚至超過過半的人,是全程站著與會。這樣的盛況連主持人都表示意外,但卻真實的反映這十多年來骨震波在台灣受到的重視、肯定與發展,投入這項高科技醫療的醫界人仕與日俱增,目前台灣北中南各地,有骨震波治療的醫院、診所已不在少數。</span><br />
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<span style="font-size: large;"><br /></span><span style="font-size: large;"><br /></span><span style="font-size: large;"><br /></span><span style="font-size: large;">筆者在十年前(2002年),因緣際會 在康寧醫院開始從事骨震波治療,迄今已逾十年,治療個案超過千例,主要對象為<strong>接骨點肌腱炎</strong>,如:足底筋膜炎、網球肘、高爾夫球肘、肩鈣化性肌腱炎、髕骨韌帶炎、足踵肌腱炎、…等,成功率已達90%以上,媲美歐美先進。骨震波其它的骨科治療,如對骨折癒合的促進、對股骨頭缺血性壞死、…也有零星成功的個案。</span><br />
<span style="font-size: large;"><br /></span><span style="font-size: large;"><br /></span><span style="font-size: large;"><br /></span><span style="font-size: large;">這次會議,再次闡釋骨震波的治療原理 是透過血管新生(neo-vascularization) 促成組織再生(regeneration),與泌尿科震波碎石的機轉不同,坊間不應再望文生義,訛傳骨震波是「把骨刺打掉」。對骨震波的止痛效應,也有更明確的解釋。而骨震波近年已擴展到非骨科疾病的治療上,高雄長庚應用骨震波治療缺血性冠 心症<span style="font-size: small;">註2</span>,及糖尿病潰瘍足的治療<span style="font-size: small;">註3</span>,証明優於高壓氧,令人印象深刻。國外甚至有用骨震波治療男性不舉的報告…,非骨科的骨震波治療,假以時日,說不定會比用在骨科疾病的治療更蓬勃。</span><br />
<span style="font-size: large;"><br /></span><span style="font-size: large;"><br /></span><span style="font-size: large;"><br /></span><span style="font-size: large;">會議中也提到了 <strong>幅射式震波</strong> ( Radial pressure wave ) 或稱為第4型震波<span style="font-size: small;">註4</span> <span style="font-size: small;">(圖1)</span> 的屬性問題。</span><br />
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<span style="font-size: large;">正宗骨震波的治療目標(原理)是以聚焦(focused)的震波,投射於定位好(localized)的人體部位,藉震波的高能量促成組織再生。而幅射式震波治療(rESWT),則以輻射發散的方式 </span><span style="font-size: small;">(圖2),</span><br />
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<a href="http://1.bp.blogspot.com/-MeOob5-ZK0w/ULVqUB0tumI/AAAAAAAABI0/RMlQiItRohE/s1600/%E5%9C%962++rESWT+vs+ESWT.JPG" imageanchor="1" style="clear: left; cssfloat: left; float: left; margin-bottom: 1em; margin-right: 1em;"><span style="font-size: large;"><img border="0" height="125" src="http://1.bp.blogspot.com/-MeOob5-ZK0w/ULVqUB0tumI/AAAAAAAABI0/RMlQiItRohE/s320/%E5%9C%962++rESWT+vs+ESWT.JPG" tea="true" width="320" /></span></a></div>
<span style="font-size: large;">將震波大範圍的導入人體,操作雖然簡單 (滑動探頭),但輻射式震波能量低,又無聚焦,無法有促成組織再生的效應,治療功效被認為只是</span><br />
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<span style="font-size: large;"><strong>震動按摩</strong>,很多學者因此主張 輻射式震波不宜歸類為骨震波。</span><br />
<span style="font-size: large;"><br /></span><span style="font-size: large;"><br /></span><span style="font-size: large;"><br /></span><span style="font-size: large;">骨震波的治療(ESWT),一無侵襲性,二無併發症,再因治療效果的確不錯,對於特定的某些骨科疾病,應用上,還方興未艾。包括上述非骨科的治療,骨震波的運用,相信在不久的將來會有更大的發展,大家不妨拭目以待。</span><br />
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附註:<br />
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註1、註3 高雄長庚醫院 骨科 王清貞醫師<br />
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註2 高雄長庚醫院 王清貞醫師 傅懋洋醫師<br />
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註4 其它3型正宗高能量骨震波,依其震波產生的方式為:Electrohydraulic(Ossatron), Electromagnetic(Sonocur or Dornier), Piezoelectric (Pizoson). <br />
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<br />baba.wg58@gmail.comhttp://www.blogger.com/profile/03790611799966344101noreply@blogger.com5tag:blogger.com,1999:blog-1350268300834830253.post-6739798218969603072012-10-17T01:30:00.000-07:002012-10-20T23:11:21.167-07:00滑鼠與腕傷<br />
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<span style="font-size: large;">打電腦已經成為現代人生活的一部份,甚至是電腦族的全部。長時間使用電腦造成的頸肩痛、上背痛、下背痛、…,是電腦工作者的通病,大家已經有相當的認識;但很多人,卻對使用滑鼠,也有可能會造成手腕的傷病,渾然不知,不懂得預防與避免。</span><br />
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<span style="font-size: large;"><br /></span><span style="font-size: large;"><br /></span><span style="font-size: large;"><br /></span><span style="font-size: large;">滑鼠一般擺在桌上,用時以掌輕握、用指輕敲或撥滾、用掌腕輕移拉曳;看似簡單、不費力,卻是眼心手合一的極致。重覆、無數次的指掌運動,滑鼠的形狀大小不對,掌握姿勢不對…,長期下來也會造成手腕外側關節韌帶、支撐帶(retinaculum)、肌腱等的毛病,如腱鞘炎、肌腱炎、韌帶纖維化變性、鈣化、三角纖維軟骨群(TFCC)病變等,這些雖屬尋常、過度使用導致的運動傷害(overuse sport injury),但治療上卻相當費事,且不易痊癒。</span><br />
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<span style="font-size: large;">之所以會造成上述腕傷,滑鼠的設計與掌鼠的動作都有關係。使用滑鼠,力學上,手會自然外旋(supination),不同的滑鼠會有不同的外旋角度(圖 1),</span></div>
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<span style="font-size: large;">這是手的生理;研究發現,外旋角度愈大,外腕 ( pisiform area. 如圖2.右,有*標示處)部位的壓力就愈大。</span><br />
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<span style="font-size: large;">掌鼠拉曳的動作會使外腕壓力遽昇,而因掌鼠而外旋的手,若就近以掌腕架桌沿作支撐(圖 2左),</span></div>
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<span style="font-size: large;">則會使外腕(如圖2右)的接觸壓力(contact pressure)大增,與內腕相比,平均壓力竟可達內腕的7.6倍!長時間如此,要不發生外腕傷害還真難。</span></div>
<span style="font-size: large;"><br /></span><span style="font-size: large;"><br /></span><span style="font-size: large;"><br /></span><span style="font-size: large;">電腦既不能不打,減少外腕壓力的措施,自是必需(a must)。 這些措施包括:1). 選擇輕小易滑的滑鼠,少作掌鼠拉曳的動作。 2). 以全前臂,而非掌腕,作支撐(圖3.)。</span><br />
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<a href="http://4.bp.blogspot.com/-Xsg4soZTQlg/UH5TU-jSo4I/AAAAAAAABIc/hFDK_naT49I/s1600/fig+3.+Right+mouse+working+posture.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="239" nea="true" src="http://4.bp.blogspot.com/-Xsg4soZTQlg/UH5TU-jSo4I/AAAAAAAABIc/hFDK_naT49I/s320/fig+3.+Right+mouse+working+posture.JPG" width="320" /></a></div>
<span style="font-size: large;">3). 鍵盤、滑鼠放低。4). 坐 可滑動、有扶手、可調高低、可伸懶腰的椅子。5). 儘量不長時間打;每打2小時 停個10~15分鐘,到洗手間伸伸懶腰作軟體操。</span><br />
<span style="font-size: large;"><br /></span><span style="font-size: large;"><br /></span><span style="font-size: large;"><br /></span><span style="font-size: large;">能遵循這些原則,庶幾就可大大減少打電腦的運動傷害了。</span>(本文亦刊載於101/10/16 聯合報 D2健康版)<br />
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Reference:<br />
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Jong Woo Kang, MD; et al : Contact Pressure in the Wrist During Computer Mouse Work. Oct. 2012 Vol. 35 No.10 , pp 867~71. ORTHOPEDICS Healio.com/Orthopedics<br />
<br />baba.wg58@gmail.comhttp://www.blogger.com/profile/03790611799966344101noreply@blogger.com0tag:blogger.com,1999:blog-1350268300834830253.post-24659301165737976512012-08-30T00:26:00.000-07:002012-08-30T02:03:49.396-07:00關節滑膜炎在關節退化裡所扮演的角色<br />
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<span style="font-size: large;">退化性關節炎是當今全球中老年人最普遍的疾病,但對退化性關節炎的治療,迄今仍脫不出早、中期的藥物對症療法,及晚期的人工關節置換術。80年代,人工關節蓬勃發展,曾有一段時間,醫界興奮的以為找到了退化性關節炎的<strong>「最後的解決方案」(</strong>Final Solution);但人工關節使用10年、15年後,卻因磨損、植體鬆動、介面骨溶蝕…,等種種問題,紛紛回籠 須重新更換;使醫界省思,重回關節退化的基礎研究,想找出<strong>「真正的解決方案」(</strong>Authentic Solution)。</span><br />
<span style="font-size: large;"></span><br />
<span style="font-size: large;"><br /></span><span style="font-size: large;"><br /></span><span style="font-size: large;"><br /></span><span style="font-size: large;">這些年,對退化性關節炎的病因機轉,有了更深的瞭解。臨床上,雖一直以退化性關節「<strong>炎</strong>」稱呼,但退化性關節炎的關節液檢驗,通常是看不到白血球的增加或聚集;臨床上,退化性關節炎也很少有發燒、倦怠、…等 炎性反應的全身症狀;長久來,醫界並不把退化性關節「炎」當作典型的炎症(Classic Inflammation)來看待,而是以<strong>退化</strong>視之。但退化性關節炎關節會痛、會發熱 腫漲、會僵硬,又意味著關節(局部)的炎性反應確實是存在的。</span><br />
<span style="font-size: large;"><br /></span><span style="font-size: large;"><br /></span><span style="font-size: large;"><br /></span><span style="font-size: large;">愈來愈多(包括MRI影像檢查)的研究,証實了關節的退化,幾乎自始至晚,都存在著關節滑膜炎。目前認為關節軟骨一旦受了傷( 壓力、過勞、磨損、創傷、…..),會在關節內啟動酵素的生化作用 產生發炎,同時會激化免疫細胞的增生或聚集,帶動連環的炎性反應與軟骨的破壞。這局部的炎性反應是甚麼呢?是來自關節滑膜的發炎 -- <strong>滑膜炎</strong>(Synovitis)!</span><br />
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<span style="font-size: large;"><br /></span><span style="font-size: large;"><br /></span><span style="font-size: large;"><br /></span><span style="font-size: large;">關節滑膜(Synovium)是一層被覆在關節軟骨表面的保護膜,正常的關節滑膜有4層細胞,底層是富含 脂肪細胞、纖維母細胞、肥胖細胞、巨嗜細胞…的纖維膠原(fibro-collagenous tissue)組織;結構雖然稀疏不緻密,但卻有旺盛的血液循環及豐富的末梢神經分佈。當關節一旦走上退化的路,關節滑膜就會出現如下的病理變化:</span> <span style="font-size: large;"><br /></span><span style="font-size: large;"></span><span style="font-size: large;">• 肥厚</span><br />
<span style="font-size: large;">• 血管增生</span><br />
<span style="font-size: large;">• 炎性細胞 (主要是淋巴球、單核球) 的浸潤</span><br />
<span style="font-size: large;">• 纖維蛋白的沉澱,退化晚期會有滑膜的纖維化。</span><br />
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<span style="font-size: large;"><br /></span><span style="font-size: large;">這些變化是廣泛的,不是只發生在有軟骨傷害的地方。</span><br />
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<span style="font-size: large;"><br /></span><span style="font-size: large;">動物(老鼠)實驗,發現滑膜的巨嗜細胞,會透過金屬蛋白脢(metalloproteinase MMPs),破壞軟骨,這意味,滑膜炎可能是關節剛要開始退化時,破壞軟骨細胞的<strong>元兇</strong>。分子免疫學顯示 IL-1、IL-6,腫瘤壞死因子(TNF-α)等代謝性細胞激素( catabolic cytokines) 與啟動關節軟骨的破壞有關;研究也發現有些人的關節軟骨,可能對TNF-α比較敏感,比較容易受到破壞,這解釋了為什麼有些人關節退化就是比別人來得早。而長期觀察,也發現滑膜炎久了,其關節液會有多量的<strong>VEGF</strong> (可能是經由滑膜巨噬細胞的某些轉化機轉生成);VEGF有使滑膜血管增生的作用,進一步惡化了退化性關節炎。</span><br />
<span style="font-size: large;"><br /></span><span style="font-size: large;">這些免疫學的研究,直指關節滑膜在關節退化的過程中,扮演著重要的角色。醫界對滑膜炎的研究與重視,背後所冀望的是:透過對滑膜的瞭解,研發出一種能 <strong>改變關節退化模式</strong>( Disease Modification) 的治療,若果真成功,那將是治療關節退化的劃時代成就了。</span><br />
<span style="font-size: large;"><br /></span><span style="font-size: large;"><br /></span><span style="font-size: large;"><br /></span><strong>專有名詞 簡譯:</strong><br />
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Metalloproteinase MMPs : 金屬蛋白脢 會破壞軟骨的組織基質(Matrix)<br />
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Interleukin 1, 6 (IL-1, IL-6): 白血球間質素 炎性反應的免疫介質<br />
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TNF-α( Tumor Necrosing Factor): 腫瘤壞死因子 亦為炎性反應的免疫介質<br />
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Catabolic cytokines: 代謝性細胞激素 炎性反應免疫介質<br />
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VEGF( Vessel Endothelial Growth Factor ) : 血管內皮細胞生長因子 能新生微血管 (neovascularization)<br />
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<strong>REFERENCES : </strong><br />
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• Ashraf, S. and Walsh, D.A. (2008) Angiogenesis in osteoarthritis. Curr Opin Rheumatol 20: 573–580.<br />
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• Abramson, S.B., Attur, M. and Yazici, Y. (2006) Prospects for disease modification in osteoarthritis. Nat Clin Pract Rheumatol 2: 304–312.<br />
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• Ayral, X., Pickering, E.H., Woodworth, T.G., Mackillop, N. and Dougados, M. (2005) Synovitis: a potential predictive factor of structural progression of medial tibiofemoral knee osteoarthritis—results of a 1 year longitudinal arthroscopic study in 422 patients. Osteoarthritis Cartilage 13: 361–367.<br />
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• Baker, K., Grainger, A., Niu, J., Clancy, M., Guermazi, A., Crema, M. et al. (2010)Relation of synovitis to knee pain using contrast-enhanced MRIs. Ann Rheum Dis, in press. <br />
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• Benito, M.J., Veale, D.J., FitzGerald, O., van den Berg, W.B. and Bresnihan, B. (2005) Synovial tissue inflammation in early and late osteoarthritis. Ann Rheum Dis 64: 1263–1267.<br />
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• Blom, A.B., van Lent, P.L., Libregts, S., Holthuysen, A.E., van der Kraan, P.M., van Rooijen, N. et al. (2007) Crucial role of macrophages in matrix metalloproteinase-mediated cartilage destruction during experimental osteoarthritis: involvement of matrix metalloproteinase 3. Arthritis Rheum 56: 147–157.<br />
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• Bonnet, C.S. and Walsh, D.A. (2005) Osteoarthritis, angiogenesis and inflammation. Rheumatology (Oxford) 44: 7–16.<br />
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• Claire Y. J. Wenham, BM , Philip G. Conaghan, The Role of Synovitis in Osteoarthritis. Therapeutic Advances in Musculoskeletal Dis. 2010; 2(6):349-359. © 2010 Sage Publications, Inc. <br />
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• Fernandes, J.C., Martel-Pelletier, J. and Pelletier, J.P. (2002) The role of cytokines in osteoarthritis pathophysiology. Biorheology 39: 237–246.<br />
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• Haywood, L., McWilliams, D.F., Pearson, C.I., Gill, S.E., Ganesan, A., Wilson, D. et al. (2003) Inflammation and angiogenesis in osteoarthritis. Arthritis Rheum 48: 2173–2177.<br />
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• Livshits, G., Zhai, G., Hart, D.J., Kato, B.S., Wang, H., Williams, F.M. et al. (2009) Interleukin-6 is a significant predictor of radiographic knee osteoarthritis: The Chingford Study. Arthritis Rheum 60: 2037–2045.<br />
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<br />baba.wg58@gmail.comhttp://www.blogger.com/profile/03790611799966344101noreply@blogger.com0tag:blogger.com,1999:blog-1350268300834830253.post-87225673222988623702012-04-29T07:50:00.001-07:002012-05-02T15:56:02.104-07:00五十肩外一章---肩峰小骨(Os Acromiale)<br />
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<span style="font-size: large;">絕大部分的五十肩,其病因都種因於肩峰下的空間不足,引起旋轉肌袖的受擠壓所造成。臨床上,會偶遇到一種五十肩卻因為是肩峰端會「擺動」而造成,病因明顯與上述不同,不啻是另類的五十肩。</span><span style="font-size: large;"><br /></span><div class="separator" style="clear: both; text-align: center;">
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<a href="http://1.bp.blogspot.com/-GcOwb5fZd6Q/T5nxlBFvkZI/AAAAAAAAA7A/kuEJm09Lfr4/s1600/%E6%9C%AA%E5%91%BD%E5%90%8D2.JPG" imageanchor="1" style="clear: right; cssfloat: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="195" oda="true" src="http://1.bp.blogspot.com/-GcOwb5fZd6Q/T5nxlBFvkZI/AAAAAAAAA7A/kuEJm09Lfr4/s200/%E6%9C%AA%E5%91%BD%E5%90%8D2.JPG" width="200" /></a><span style="font-size: large;">肩峰端會「擺動」,是因為長了肩峰小骨(Os Acromiale)。(圖1)</span><br />
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<span style="font-size: large;">解剖學上肩峰只是肩胛骨(Os Scapular)的一個突起(令一突起是 喙突coronoid):在青春期之前,肩峰是多個骨核 (或稱骨化中心Ossification Center),成長期間因骨化作用,漸漸與肩胛主體融合,通常在15歲至22歲左右完成融合,變成肩胛的一個突起,與喙突、肩盂(Glenoid)三者,合組成肩關節。在某些情況*,骨化的進行或過程不成功,未與主體融合,發展成另一小骨,用纖維軟骨以關節的形態,與主體聯結;這個小骨就是「肩峰小骨」(Os Acromiale),臨床上並不多見*。</span><span style="font-size: large;"><br /></span><span style="font-size: large;"></span><br />
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<a href="http://4.bp.blogspot.com/-Huqrt3o5QzQ/T5n0ePiA3XI/AAAAAAAAA7M/mzeHex-56js/s1600/%E6%9C%AA%E5%91%BD%E5%90%8D3.JPG" imageanchor="1" style="clear: right; cssfloat: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="226" oda="true" src="http://4.bp.blogspot.com/-Huqrt3o5QzQ/T5n0ePiA3XI/AAAAAAAAA7M/mzeHex-56js/s320/%E6%9C%AA%E5%91%BD%E5%90%8D3.JPG" width="320" /></a><span style="font-size: large;">正如上述,肩峰小骨與肩胛是以關節方式依存,也像關節一樣是會動的,支撐的強度自不能與一體成形的肩峰相比;因此,當手臂抬舉動作時,肩三角肌的拉扯的力量,會把肩峰小骨扯低(往下擺);這個變化,頓時會減縮肩峰下空間,一樣壓迫了旋轉肌袖,一樣造就了五十肩。(圖2)</span><br />
<a href="http://3.bp.blogspot.com/-GBjiGVFXVzA/T5ntz7Jha1I/AAAAAAAAA60/tVa6TPIkWSo/s1600/%E6%9C%AA%E5%91%BD%E5%90%8D.JPG" imageanchor="1" style="clear: left; cssfloat: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="200" oda="true" src="http://3.bp.blogspot.com/-GBjiGVFXVzA/T5ntz7Jha1I/AAAAAAAAA60/tVa6TPIkWSo/s200/%E6%9C%AA%E5%91%BD%E5%90%8D.JPG" width="190" /></a><span style="font-size: large;"></span><br />
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<span style="font-size: large;">肩峰小骨在肩部X光,尤其是肩的腋窩投射照(Axillar view),可以清晰看到小骨關節,診斷不難(圖3)。</span><br />
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<span style="font-size: large;">臨床上,肩峰小骨造成的五十肩,與尋常五十肩還是有不同。有經驗的醫師在門診作搬動病人肩膀的檢查(passive motion)時,可以感覺出 關節卡住的feeling,不像一般五十肩會在某階段忽然鬆開(let go),而是一路「罩」住;這種感覺,加上X光或仔細一點用MRI檢查,就可以診斷出來。</span><br />
<span style="font-size: large;"></span><span style="font-size: large;"><br /></span><span style="font-size: large;">肩峰小骨造成的五十肩,治療上,一般只須把小骨切除乾淨就可以了,與肩峰減壓成形術差不多,手術效果也一樣的好。</span><br />
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* 附註:</div>
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1. 考古人類學家,在海底打撈出的古希臘戰船水兵骨骸,發現弓箭手大多有肩峰小骨,認為這些弓箭手,骨骼發育還未成熟前,就接受了過度的拉弓訓練所致。</div>
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2. 從骨骼博物館及歐洲一些修道院所收集的無主骨骸中,考古人類學家及解剖學家,認為肩峰小骨的流行率,在一般人口約在8%左右;但有肩峰小骨者,有多少會有五十肩,則未見文獻。</div>
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3. 筆者自2008迄今有4例肩峰小骨造成五十肩的個案,均以切除治療,手術成績都很好。<br />
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<br /></div>baba.wg58@gmail.comhttp://www.blogger.com/profile/03790611799966344101noreply@blogger.com4tag:blogger.com,1999:blog-1350268300834830253.post-39695772335955569932012-03-01T00:25:00.000-08:002018-02-08T16:39:08.075-08:00五十肩術後疼痛控制 與 術後運動治療<br />
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<span style="font-size: large;">肩關節是全身活動度最大的關節,假如不挑剔一定要同一平面,它幾可360度旋轉(圖1) 。</span><br />
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<a href="http://2.bp.blogspot.com/-kGAguBKsu0g/T02_xHh2NXI/AAAAAAAAA58/7prEtgSe9KY/s1600/%25E5%259C%25961.shoulder%2BROM.JPG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><span style="font-size: large;"><img border="0" height="183" src="https://2.bp.blogspot.com/-kGAguBKsu0g/T02_xHh2NXI/AAAAAAAAA58/7prEtgSe9KY/s200/%25E5%259C%25961.shoulder%2BROM.JPG" width="200" /></span></a></div>
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<span style="font-size: large;">肩關節也是一個很惹不得的關節,一旦有了傷、或 動了手術,也比其它關節更容易變僵硬 (Stiffness 強直) 甚至 動不了(Frozen Shoulder 凍肩)!</span></div>
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<span style="font-size: large;">原來,肩關節自我保護機制(即免疫反應)很強,遇到傷、害、…,會以強烈的痠、痛以及周邊肌肉即時的攣縮,來「鎖」住自己,靠不動,來降低疼痛並避免傷害擴大。同時,關節內具修護任務的滑膜等組織,隨即展開炎性反應,意圖快快修復傷害。 但被「鎖」住的關節,關節腔內很快就被旺盛的炎性反應所瀰漫,不動的結果就是造成廣泛的關節沾粘。 早年,五十肩 的手術,術後是打石膏固定肩關節的,目的是在止痛並保護修補好的旋轉肌袖等傷口,不因動作而逬裂;殊不知這樣的作法,等於把關節鎖得更牢,雖解決了痛的問題也助於傷口癒合,但幾個禮拜下來,石膏一拆,肩膀已硬梆梆動不了啦!舊問題沒解決,反而製造了新難題 -- 凍肩症 (沾粘性肩關節囊炎 Adhesive Capsulitis))。</span></div>
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<a href="http://2.bp.blogspot.com/-BDo8fZSOlPY/T03AEwbjRnI/AAAAAAAAA6I/Og8iyrbm7dI/s1600/%25E5%259C%25962.%2BInfusion%2BPump.JPG" imageanchor="1" style="clear: right; cssfloat: right; float: right; margin-bottom: 1em; margin-left: 1em;"><span style="font-size: large;"></span></a><span style="font-size: large;">五十肩手術 是作者的專長。</span><span style="font-size: large;">因為手術技術改進、專用錨釘( Anchor Suture)作肌袖修補的使用、術後疼痛控制的應用,現今五十肩手術,不僅不再打石膏,反而鼓勵病人術後積極的作肩關節運動,是即 <strong>術後運動治療</strong>。為克服運動帶動傷口痛,作者三年多前,即在關傷口的同時,埋入一條細導管(另端另處帶出),連接一個自動輸液的特殊針筒裝置,成功的作出不影響肩動作的<strong>術後疼痛控制</strong> (Infusion Pump Pain Control) (圖2),<a href="http://2.bp.blogspot.com/-BDo8fZSOlPY/T03AEwbjRnI/AAAAAAAAA6I/Og8iyrbm7dI/s1600/%25E5%259C%25962.%2BInfusion%2BPump.JPG" imageanchor="1" style="clear: right; cssfloat: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="166" src="https://2.bp.blogspot.com/-BDo8fZSOlPY/T03AEwbjRnI/AAAAAAAAA6I/Og8iyrbm7dI/s200/%25E5%259C%25962.%2BInfusion%2BPump.JPG" width="200" /></a></span></div>
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<span style="font-size: large;">病人可在術後第一天,即進行運動治療。又為了避免動作不當影響傷口癒合,作者也設計了一套<strong>「不出力(assisted / Effortless)」</strong></span><strong style="font-size: x-large;">的</strong><strong style="font-size: x-large;">肩</strong><span style="font-size: large;"><b>關節</b></span><strong style="font-size: x-large;">運動</strong><span style="font-size: large;">;</span><span style="font-size: large;">應用人體工學配合力學原理(</span><span style="color: #f3f3f3; font-size: large;"><span style="color: black;">如 地心引力</span><span style="font-family: 新細明體; font-size: 12pt; mso-ansi-language: EN-US; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-fareast-language: ZH-TW; mso-font-kerning: .5pt; mso-hansi-font-family: "Times New Roman";"><span style="color: black;">、</span></span></span><span style="font-size: large;">滑輪、手臂本身重量、三節棍、姿勢…),教會病人</span><strong style="font-size: x-large;">用好手幫患肩做動作</strong><span style="font-size: large;">,只須用少許力、甚至不出力,就可啟「</span><strong style="font-size: x-large;">動</strong><span style="font-size: large;">」肩活動(圖3),</span></div>
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<a href="http://4.bp.blogspot.com/-FYYMLPr7Jr4/T03AfI7ELJI/AAAAAAAAA6U/HaHonNYVFXA/s1600/%25E5%259C%25963.Motion%2BTherapy%2B2.JPG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><span style="font-size: large;"><img border="0" height="126" src="https://4.bp.blogspot.com/-FYYMLPr7Jr4/T03AfI7ELJI/AAAAAAAAA6U/HaHonNYVFXA/s400/%25E5%259C%25963.Motion%2BTherapy%2B2.JPG" width="400" /></span></a></div>
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<span style="font-size: large;">讓 滑膜、肌袖、關節面…等,因 動 而 沾黏不上<strong>,「搶」先機</strong> (tide over)<strong> 癒合</strong>,這些組織一旦癒合,逃過沾黏,就不會有關節殘留強直的問題了。</span><br />
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<span style="font-size: large;">術後運動治療,原則上住院期間,要先教會病人動作的要領;出院後(通常只住院3天)繼續居家DIY,回診時矯正動作缺失,一般4~6週後,內部傷口大致已痊癒平整,不虞(逃過了)沾粘;而錨釘因具縫合與固定雙重設計,修補肌袖不會有縫線逬裂的顧慮 (但位置的選擇是key point)。 就這樣,按部就班,肩關節活動一天天擴展,先前攣縮的關節囊、三角肌、二頭肌腱、…..也漸次拉鬆拉開,終致達到最大肩的活動度(ROM, range of motion) 。</span><br />
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<span style="font-size: large;">關節是一個運動器官;關節疾患的任何治療,若不能還回一個無痛、自由活動的關節,就不算圓滿。 靠醫學的進步,現今五十肩用手術治療,幾已臻於此境,這是骨科學近二十多年來了不起的成就;早年「五十肩治不好、也不用醫」的說法,是可以終結了!</span><br />
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a). 英文文獻沒有「五十肩」這個病名;而稱之為:肩峰下夾擊 (Subacromial Impingement) 或 肩旋轉肌袖病變 (Rotator Cuff Tendinopathy)<br />
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b). 詳細內容 請網訪 http://blog.udn.com/wglee/article?f_ART_CATE=211246 五十肩(11) 各節。<br />
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<br />baba.wg58@gmail.comhttp://www.blogger.com/profile/03790611799966344101noreply@blogger.com2tag:blogger.com,1999:blog-1350268300834830253.post-74567447820659532582011-09-13T20:45:00.000-07:002011-09-13T21:18:34.113-07:00五十肩的X-光檢查<div><br /><br /><br /><br /><div><span style="font-size:130%;">人過中年,肩痛、手抬不起來,我們說 是得了五十肩;洋人卻說 是得了 肩峰下夾擊 或說 有了 肩旋轉肌袖病變 <span style="font-size:85%;">註1</span>,說法雖不同,講的卻是同一件事。人會得五十肩,到底有多久,史已不可考,只知道它造成醫師、病人的困擾,中外都一樣 <span style="font-size:85%;">註2</span>。 一直到1970年代,它才真正被認定 是運動醫學 的一種疾病。<br /><br />五十肩是<strong>「有動作才會有的病」,</strong>換言之,是功能上的問題,它不是急診也要不了命,病況卻多樣性,X光不易看出端倪,病因也很難檢驗,因此醫師們說法紛歧,也拿不出具體的治療方法。1972年美國哥倫比亞大學尼爾醫師,發表論文 <span style="font-size:85%;">註3</span>,主張五十肩的病因是 <strong>肩峰下空間不夠</strong>,應以 <strong>肩峰端前下減壓成形術</strong>(像拓寬工程) 開刀治療 ( <span style="font-size:85%;">圖1</span>)。<a href="http://1.bp.blogspot.com/-LD7Ejj9VOzo/TnApiugkF_I/AAAAAAAAAsc/HjT0gw6Vd_Q/s1600/Neer%2B%25E5%259C%25963.JPG"><img style="MARGIN: 0px 10px 10px 0px; WIDTH: 320px; FLOAT: left; HEIGHT: 261px; CURSOR: hand" id="BLOGGER_PHOTO_ID_5652063208926877682" border="0" alt="" src="http://1.bp.blogspot.com/-LD7Ejj9VOzo/TnApiugkF_I/AAAAAAAAAsc/HjT0gw6Vd_Q/s320/Neer%2B%25E5%259C%25963.JPG" /></a>1972那時還沒有核磁共振(MRI),尼爾的理論與主張,一樣因驗證困難,受到挑戰與爭議。<br /><br />一般X光可以看骨頭、看關節輪廓,但無法看軟組織;肩峰下發生甚麼事 看不到。90年代有了MRI,可以清楚看到肩峰下空間以及軟組織的變化;也果真看到五十肩會有肩峰擠壓旋轉肌袖的狀況,甚至造成肌袖破裂、鈣化…的情形,總算証實這個動態的「毛病」確實是一個病;而尼爾的理論與開刀的方式,自此成為五十肩治療的經典。<br /><br />五十肩的肩痛及關節會卡住,病人自己就知道;會卡住,是因為肩鋒下空間不夠。空間會狹隘,與肩峰的 形狀(有直、彎、鉤3型)、傾斜度、退化(長骨刺)、….有關,這是每個人結構上的不同,雖然差異很微小,但是可以在肩關節的 棘上肌投射照 看出來。 棘上肌投射照 <span style="font-size:85%;">註4</span> (棘上肌是旋轉肌袖的主要部份),最能顯現肩鋒下的空間(<span style="font-size:85%;">圖2</span>); <a href="http://1.bp.blogspot.com/-NV-FHfNlK2s/TnAqQLJiX5I/AAAAAAAAAsk/ptlWgvQ-uFg/s1600/Neer%2B%25E5%259C%25964.JPG"><img style="MARGIN: 0px 10px 10px 0px; WIDTH: 224px; FLOAT: left; HEIGHT: 320px; CURSOR: hand" id="BLOGGER_PHOTO_ID_5652063989709037458" border="0" alt="" src="http://1.bp.blogspot.com/-NV-FHfNlK2s/TnAqQLJiX5I/AAAAAAAAAsk/ptlWgvQ-uFg/s320/Neer%2B%25E5%259C%25964.JPG" /></a></span></div><br /><br /><br /><div><span style="font-size:130%;">經驗好的醫師 從棘上肌投射照 就可以看出 肩峰是否會擠壓旋轉肌袖?空間又該如何拓寬? 而旋轉肌袖有沒有破裂,有經驗的醫師,也可以技巧的以徒手檢查即知。就靠著這樣,筆者這幾年在康寧醫院與X光的同仁合作,就棘上肌投射照,作攝影技術的改良,目前幾乎張張都拍得很成功,對五十肩診斷的確立 與 術前規劃,提供了必要資訊,幾乎不再樣樣都依賴MRI了。<br /><br />這不僅替健保省下大筆費用,病人也避免不必要的磁場曝露或引發封閉空間恐慌症,更重要的是病人不再要苦等MRI排程;可以及早治療不耽誤病情。當然,少數X光的判讀與病情有出入的個案,則還是一定要作MRI檢查,以避免誤診。(<span style="font-size:100%;"><strong>本文亦發表於100-08-30 聯合報 健康版</strong></span>)<br /><br /><br /><br /><br /></span><span style="font-size:100%;">註1: 英文文獻的只稱 Rotator Cuff Syndrome﹝旋轉肌袖病變﹞;或 Subacromial impingement﹝肩峰下夾擊﹞)<br />註2: 教廷還在法國亞維儂的時代,有一陣子,在歐洲還認為這毛病是褻瀆了神明,是要靠禱告與懺悔(買贖罪卷)來治療!<br />註3: Neer CS, 2nd. Anterior acromioplasty for the chronic impingement syndrome in the shoulder: a preliminary report. J Bone Joint Surg Am. 1972;54:41–50<br />註4: 棘上肌投射照 Suprapinatus Outlet View.<br /></div></span></div>baba.wg58@gmail.comhttp://www.blogger.com/profile/03790611799966344101noreply@blogger.com0