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1 自行車運動傷害簡介長庚醫院骨科部脊椎科賴伯亮醫師

2 資料來源 Mountain Biking injury: a Review Micheal R. Carmont British Medical Bulletin 2008;85: Neurologic Injuries in Cycling and Bike Riding James Kennedy. Neuroloic clinics 2008; 26: Advances in the Prevention of Children s Injury Patricia C. Parkin and Andrew W. Howard. Current Opinion in Pediatrics 2008,20: Bicycle related Injury Matthew J. Thompson & Frederic P Rivara. American Family Physician 2001, 63:2007 Google Image

Neuroloic clinics 2008; 26:271-279 Advances in the Prevention of Children s Injury Patricia C.

3 General Cycling Information 單車風雲 Sports, transportation, recreation 運動, 交通, 休閒 Aerobic nonimpact exercise, beneficial cardiovascular effects 有氧非衝擊性運動, 有益心肺功能 Increasing population 運動人口增加 Gender, age 不分性別, 年齡 Economic 促進經濟

beneficial cardiovascular effects 有氧非衝擊性運動, 有益心肺功能

4 Cycling 騎自行車 Type 類形 High energy 高能量 : mountain biking Low energy 低能量 : cycling Injury pattern 傷害形式 Acute physical trauma 急性身體創傷 Chronic overuse 慢性運動傷害

6 Bicycle Injury 自行車運動傷害 Bicycle mortality 自行車死亡率 900 persons per year Motor mortality 汽車死亡率 45,800 persons per year High risk for morbidity and mortality 高危險群者 Older person 老年人 Male cyclist 男性 Collison with motorcycle 與機車碰撞 Down hill 下坡

year High risk for morbidity and mortality 高危險群者 Older person

7 Injury Location 受傷部位 Head & face 頭部顏面 Face, brain Chest 胸部 Clavicle, rib, hemothorax, pneumothorax Abdomen 腹部 Liver, spleen, bowel Spine 脊柱 Cervical 頸椎, thoracic 胸椎, lumbar 腰椎 Extremity 肢體 Abrasion 擦傷, laceration 撕裂傷, sprain 扭傷, fracture 骨折, dislocation 脫臼

$Abrasion 擦傷, laceration 撕裂傷, sprain 扭傷, fracture 骨折,$

8 Head and Face 頭與顏面 Presentation 受傷位置 Facial bone fracture 顏面骨折 Dentoalveolar injury 齒槽受傷 ICH 顱內出血 Close head injury( brain contusion) 腦震盪 Helmet 頭盔 Reduced head injury 39% Reduced facial injury 28% McDermot et al J of Trauma 34,

injury( brain contusion) 腦震盪 Helmet 頭盔 Reduced head injury

10 Zygomatic Fracture 顴骨骨折

11 Intracranial Hemorrhage 顱內出血

12 Chest 胸腔 Pneumothorax 氣胸 Sternoclavicular Syndrome 胸鎖骨症候群不是心臟病的前胸痛 Lower costal margin pain 下肋緣疼痛

13 Pneumothorax 氣胸

14 Sternoclavicular Syndrome 不是心臟病的前胸痛胸鎖骨症候群

15 Clavicle Fracture 鎖骨骨折

17 Abdominal Viscera 腹部內臟 Liver hematoma 肝血腫 Handlebar blunt focal blow to right side of abdomen Spleen injury 脾受傷 Small bowel injury 小腸破裂

18 Live Hematoma 肝血腫

19 Spine 脊柱 Posterior nuchal Pain 後頸部疼痛 Cervical radiculopathy 頸椎神經根病變 Cervical spondylosis 頸部退化性脊椎炎 Cervical myofascial pain 頸肌筋膜疼痛 Tendinitis of Interspinous Ligament 棘間韌帶炎芒刺在背 Scoliosis 脊椎側彎 Lumbar Radiculoapthy 腰椎神經根病變 Herniation of intervertebral disc 椎間盤突出 Lumbar spinal stenosis syndrome 腰椎狹窄症 Coccydynia 尾骨疼痛症群

Ligament 棘間韌帶炎芒刺在背 Scoliosis 脊椎側彎 Lumbar Radiculoapthy 腰椎神經根病變 Herniation

21 Cervical fracture (C6) Kyphosis Anterior Fusion with Allograft and Plating

22 Posterior Nuchal Pain 後頸部疼痛 Cervical radiculopathy 頸椎神經根病變 Cervical spondylosis 頸部退化性脊椎炎 Cervical myofascial pain 頸肌筋膜疼痛

24 Tendinitis of Interspinous Ligament 芒刺在背棘間韌帶炎

25 Lumbar Radiculoapthy 腰椎神經根病變 Herniation of intervertebral disc 椎間盤突出 Lumbar spinal stenosis syndrome 腰椎狹窄症

26 Scoliosis 脊椎側彎

27 Idiopathic Scoliosis 穿背架治療 Bone immature Cobb angle > 25 - Brace Cobb angle > 40 - Surgery Bone mature Cobb angle > 50

28 手術治療

29 L5-S1 Spondylolytic Spondylolisthesis 第五腰椎椎弓解離滑脫

30 術後三個月

31 Spine Fracture 脊椎骨折

32 Osteoporotic Compression Fracture 骨質疏鬆骨折圖一 ( 術前 ) 圖二 ( 術後 ) 圖三 ( 術前 ) 圖四 ( 術後 )

34 Spinal Cord Injury 脊髓受傷 12 % spinal injury in patient with cyclic injury 脊椎受傷佔自行車運動傷害百分之十二 Cervical spine is most common 頸椎最常見 Cord injury: 24% 脊髓傷害佔百分之二十四 Mechanism 受傷機轉 : flexion, extension or direct blow Usually need immediate operative management. 脊髓傷害通常須立即手術 Kim et al J trauma 2006;60:312-8

35 Perineum 會陰 Repeated microtrauma 重覆微創 Abnormal scrotal ultrasound finding (96% vs 16%) 異常超音波撿查 Scrotal calculi (81%) 陰囊結石 Epididymal cyst (46%) 附睾囊腫 Epididymal calcification (32%) 附睾鈣化 Testicular calcification (32 %) 睾丸鈣化 Hydrocele (28%) 陰囊積水 Varicocele (11%) 精索靜脈曲張 Frauscher et al Lancet 356,1414

36 Pudendal Nerve 會陰神經

37 Pudendal Nerve Palsy 會陰神經痲痹 Presentation 症狀 Genital numbness 生殖器麻木 Erectile dysfunction 勃起功能障礙 Difficulty in achieving orgasm 難以達到高潮 Reduced sensation of defecation 降低排便感覺 Risk factor of erectile dysfunction 勃起功能障礙的危險因子 Age>50 y/o 大於 50 歲 Elevated body weight 體重過重 >10 years cycling history 騎超過 10 年 High intensity of training 密集訓練 Female cyclists also have symptoms 女性也有類似症狀

38 Pudendal Nerve Compression Management: Rest and cessation of cycling Changes in riding program Change bicycle saddles Alternating riding program Surgical decompression in rare indicated 會陰神經壓迫

39 Coccydynia 尾骨疼痛症群

40 骨折非手術固定 External skeletal fixation Cast 石膏 Splint and brace 護具 Traction 牽引

41 Internal fixation 內固定 Pins and wire Plate and screw Intramedullary nail 骨折手術固定 External skeletal fixation 外固定 planar or ring fixator

42 Upper Limb 上肢 Ulnar nerve palsy 尺神經痲痹 Tardy ulnar nerve palsy 遲發性尺神經麻痺 Cyclist palsy 尺腕隧道症 Median nerve palsy 正中神經麻痺 Carpal tunnel syndrome 腕隧道症 Lateral humeral epicondylitis 外側肱骨髁炎 Tennis elbow 網球肘 De Quervain's disease 拇外展及伸拇短肌腱滑膜炎媽媽手

43 Anatomy: Ulnar Nerve 尺神經解剖位置 Cubital tunnel 肘隧道 Guyon s canal 尺腕隧道 Sensory branch Motor branch

44 Cyclist s Palsy 單車騎士痲痹症 Ulnar Nerve Palsy 尺神經痲痹 Presentation Sensory: numbness over 1 ½ ulnar side (most) Motor: weakness of abduction or adduction of finger Management Take rest and stop cycling 休息停止騎車 Use gloves, Paddle handbar and change hand position Surgical decompression is rare indicated.

45 Anatomy: Median Nerve 正中神經 Medial and lateral cord Deep and superfial head of pronator teres Anterior interosseous nerve Carpal tunnel 腕遂道

46 Carpal Tunnel Syndrome 腕隧道症

47 Carpal Tunnel Syndrome 腕隧道症 Presentation: The numbness and parethesia in the thumb, index, and middle fingers. Management: the same as cyclist palsy Take rest and stop cycling 休息停只騎車 Surgical decompression is rare indicated.

48 媽媽手 De Quervain's disease 拇外展及伸拇短肌腱滑膜炎

49 Lateral Humeral Epicondylitis Tennis elbow 網球肘外側肱骨髁炎

50 Lower Limb 下肢 Abrasion 擦傷 Pretibial laceration 脛前部位裂傷 Femoral neck fracture 股骨頸骨折 femoral intertrochanteric fracture 股骨轉子間骨折 Lisfranc s dislocation 蹠跗關節脫位

52 傷口處理 5 大步驟用生理食鹽水或純水, 來沖洗傷口上異物確認傷口已沖洗乾上藥蓋上敷料包紮

54 撕裂傷

55 Lower Limb 下肢 Pyriformis Syndrome 梨狀肌症候群 Snapping Hip 彈響髖 Iliotibial band friction syndrome 髂脛束摩擦症候群 Knee Osteoarthritis 膝關節退化症 Patellofemoral joint arthritis 髕股關節關節炎 Patella chondromalacia 髕骨軟骨軟化症 Ankle Sprain 踝扭傷 Gout 痛風

56 Pyriformis Syndrome 梨狀肌症候群

57 Snapping Hip 彈響髖 Iliotibial band friction syndrome 髂脛束摩擦症候群

58 Knee Osteoarthritis 膝關節退化症 Patellofemoral joint arthritis 髕股關節關節炎

59 Patella Tendinitis 髕骨肌腱炎

60 Chondromalacia 髕股軟化症 Excessive load on the PF joint Most common in young ladies

61 Chondromalacia: Treatment Non-OP - Q muscle exercise - reduced strenuous activities OP - Lateral retinacular release - Re-alignment surgery

62 Achille s Tendinitis 跟腱發炎

63 Ankle Sprain 踝扭傷 Anterior talofibular ligament 距腓韌帶受傷

64 Lisfranc s Dislocation 蹠跗關節脫位

65 Gout 痛風 Avoid dehydration 避免脫水

66 大腦皮質止痛藥的使用 4. PERCEPTION Net result of three events the subjective experience of pain 視丘背角神經脊髓 3. MODULATION Process by which impulse travel from the brain back down to the spinal cord to selectively inhibit (or sometimes amplify) pain impulses A delta & C fiber 周邊神經痛覺接受器 2. TRANSMISSION 1. TRANSDUCTION Communication of the nerve impulse from the periphery to the spinal cord, up the spinothalamic track to the thalamus and cerebral cortex Conversion of noxious, or harmful stimuli (mechanical, thermal, chemical) into nervous impulse, or action potential 66 66

67 Take Home Message 在適當的地點騎車避免跌倒適度的休息防曬與補充水份不要害怕吃藥

伸展操動作圖示與說明

伸展操動作圖示與說明伸展操動作圖示與說明一頸部伸展 ( 向前 ) ( 一 ) 伸展肌肉部位頸部 1 頸夾肌 2 頭夾肌 3 枕肌 1 採站立姿勢 2 將頭向前下垂 3 雙手合併抱頭輕微下壓 97 製 103.6.4 製初學者或中年人以上者不宜以雙手下壓, 應以頭部自然前垂方式,