糖尿病患者之分區足底壓力分析; Sub-division of Plantar Pressure Analysis in Diabetic Patients

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(1)! ύ! ୯!. ύ!୯!ᙴ!ᛰ!ε!Ꮲ!! ᙴᏢࣴ‫!܌ز‬. ᙴ ᛰ! ε! Ꮲ!. ᅺγᏢՏፕЎ! ! ! ᑗֿੰ஻‫ޣ‬ϐϩ୔‫ۭى‬ᓸΚϩ‫!݋‬. ! ! ᙴ Ꮲ ࣴ ‫ز‬ ‫!܌‬ !. !. ! ᅺ!. !. γ! Ꮲ!. Sub-division of Plantar Pressure Analysis in. Տ! ፕ! Ў!. Diabetic Patients. ! !. !. ᑗ ֿ. !. ੰ ஻. ࡰ!Ꮴ!௲!௤!Ǻ!ֆᗶЎ!շ౛௲௤!. ϐ ϩ. ӅӕࡰᏤ௲௤!Ǻ!஭Ў҅!௲!௤!. ୔ ‫ى‬. !!!. ۭ ᓸ. !. Κ ϩ. ࣴ!‫!ز‬ғǺ!‫׵‬ᇇ‫!!!ށ‬. ‫!݋‬ ! ! ! ! ! !. !. ύ๮҇୯ΐΜϖԃΎД!.

(2) ύЎᄔा ङඳᆶҞ‫ޑ‬Ǻ‫ۭى‬ውᅬ΋‫ޔ‬аٰࢂӒ্ᑗֿੰΓғࢲࠔ፦‫ޑ‬΋εϡӁǴѬ ৒ܰᡣΓ౧۹ՠࢂࠅΞᜤаዴჴ‫ݯ‬ᕍ‫ޑ‬੝‫܄‬۳۳ᡣΓག‫ډ‬ᒪᏬǴࡺ‫ۭى‬ው ᅬ‫ޑ‬ว౜ᆶႣٛ΋‫࣬ࢂޔ‬ᜢࣴ‫ޑޣز‬ขᗺǶҞ߻࣬ߞǴ‫ۭى‬ውᅬ‫ޑ‬วғᆶ ‫ۭى‬ᓸΚԖ๱ஏόёϩ‫ޑ‬ᜢ߯Ǵՠቹៜ‫ۭى‬ᓸΚϐӢનᕷӭǴᜤа‫ۓ‬ፕǶ ࡺ೸ၸ‫ۭى‬ϩ୔ᓸΚٰঁձᢀჸόӕ୔ୱϐᓸΚᡂϯǴԖշ‫ܭ‬ᙶమӧࣴ‫ز‬ ‫ۭى‬ᓸΚᆶᑗֿੰ‫ى‬ϐ໔‫ޑ‬ᜢ߯ǶҁፕЎϐࣴ‫ز‬Ҟ‫ޑ‬ӧ‫ܭ‬೸ၸϩ୔‫ޑ‬БԄ ௖૸ᑗֿੰ஻‫؁‬Չਔϐ‫ۭى‬ᓸΚǴஒ‫ۭى‬ϩࣁ 10 ঁ୔ୱǴϩձᆶ‫ٿ‬໨Ո ᑗ௓‫ࡰڋ‬኱ˇᑗϯՈՅનаϷ໭߻ՈᑗჹྣǴᔠᡍ‫ۭى‬ᓸΚᆶՈᑗ௓‫ڋ‬ϐ ਏ݀ࢂց‫ڀ‬Ԗᜢᖄ‫܄‬Ƕ Б‫ݤ‬ǺҁჴᡍӅԖ 432 Ӝ‫ڙ‬ෳ‫ޣ‬Ǵࣣࣁᑗֿੰ஻Ƕҁჴᡍ௨ନค‫ݤ‬ᐱҥՉ ‫و‬ǵ‫ڀ‬Ԗ‫ى‬೽ઓ࿶ੰᡂ‫܈‬ᜢ࿯ᡂ‫ޣ׎‬ǴаϷԖ‫ځ‬дቹៜၮ୏фૈϐઓ࿶Լ Ժମᓝ‫س‬಍੯஻Ƕ‫܌‬Ԗ‫ڙ‬ෳ‫ࣣޣ‬຾Չᖏ‫׉‬ᔠࢗǵ‫ۭى‬ᓸΚෳໆаϷੰўԏ ໣Οঁ໘ࢤϐࢬำǶԏ໣‫ڙ‬ෳ‫ޣ‬ϐ୷ҁ‫ي‬ᡏၗ਑ǵ‫ۭى‬ᓸΚ࣬ᜢୖኧǵᑗ ϯՈՅન‫ک‬໭߻ՈᑗǶനࡕϩձᢀჸӚ୔ᓸΚ‫ޑ‬੝ቻǴаϷӚ໨ᓸΚ࣬ᜢ ୖኧᆶՈᑗࡰ኱໔‫ޑ‬ᜢᖄ‫܄‬Ƕ ่݀Ǻҁჴᡍว౜Ǵаനεѳ֡ᓸΚԶ‫ق‬Ǵᑗֿੰ஻ಃΒඓମᆶಃΟඓମ Π‫ޑ‬ᓸΚനεǴ‫ځ‬ԛࣁဌၟǶԶӧॄၩ౗Ǵဌၟ‫ॄޑ‬ၩ౗നଯǴ‫ځ‬Ꭹ೽Տ ϐॄၩ౗ܴᡉၨեǶӧፂໆ΢ǴനεॶΨр౜ӧಃΒဌඓᆶಃΟဌඓମ୔ ୱǴᡉҢҁ୔‫ڙ܍‬നӭૈໆǶԶൂᗺനεᓸΚӕኬࣁಃΒಃΟဌඓମԖന εॶǴՠܴᡉε‫ܠ‬೩‫ൂޑ‬ᗺനεᓸΚКӕ୔ୱϐѳ֡ᓸΚε೚ӭǶӧᓸΚ ୖኧᆶᖏ‫׉‬ᔠࢗϐ࣬ᜢ‫܄‬Ǵҁჴᡍว౜ѳ֡ᓸΚᆶᑗϯՈՅનӧεဌ೩ᆶ ಃ΋ဌඓମ୔ୱԖύࡋ҅࣬ᜢǴ‫ځ‬Ꭹ߾คᜢᖄ‫܄‬ǶൂᗺനεᓸΚᆶᑗϯՈ ՅનЬाӧεဌ೩ᆶಃ΋ဌඓମԖեࡋ҅࣬ᜢǴ‫ځ‬Ꭹ࣬ᜢ‫߾܄‬όܴᡉǶ I.

(3) ่ፕǺᑗֿੰ஻‫ۭىޑ‬ᓸΚኳԄᆶՈᑗ௓‫ڋ‬ԖᜢǶϐࡕ‫زࣴޑ‬ёаϩ୔ᢀ ჸࣁ୷ᘵǴుΕ௖૸‫ۭى‬ᓸΚᆶຼᜐՈᆅੰᡂ฻࣬ᜢ‫ٳ‬วੱϐ໔ϐᜢᖄ ‫܄‬Ƕ. ᜢᗖӷǺᑗֿੰǵ‫ۭى‬ᓸΚǵઓ࿶ੰᡂǵᜢ࿯ᡂ‫׎‬ǵ‫ۭى‬ውᅬ. II.

(4) Abstract Purpose and background: The prevalence of diabetes mellitus is increasing every year in Taiwan. Many complications of DM have a great impact on the individuals with DM for life time. Neuropathy, sensory loss and muscle deficit make DM patients change there gaits and postures. These changes of walking mechanism maybe affect their plantar pressure abnormally. Alternant plantar pressure applies on different areas of plantar side of feet repeat and repeat. Finally, patients may suffer form foot ulceration without definite trauma. Individuals with DM have a higher rate of foot ulceration and lower extremity amputation than those without diabetes. Result form previous research, foot ulceration of DM patient is associated with 1)neuropathy 2)avescular disease. Physical examinations for neuropathy and avescular disease combine with plantar pressure can predict the possibility of foot ulceration of DM patients. Furthermore, plantar pressure can also provide clinicians and health professionals a direct evidence to make up a proper decision. The purpose of this study was to determine the pattern of DM patient’s plantar pressure during level walking. By separating plantar pressure to 10 regions, and discus pressure associated parameters of these region with other clinical data, the relationships between plantar pressure and result of clinical examinations could be found. Methods: 432 subjects with DM patients participated in this study. DM patients with neuropathy, foot deformity and unable to walk independently. III.

(5) were excluded. HbAlc and the fasting blood glucose level(A.C.) were measured. And all of the subjects completed the pressure data collection and history taking. Result: We found that subjects with DM have increased mean pressure on 2nd metatarsal bone and 3rd metatarsal bone. Mean load rate on heel was higher than other areas. Impulse on 2nd metatarsal bone was the highest of foot. Maximum peak pressure was located on 2nd metatarsal and 3rd metatarsal done. Discussion: The highest plantar pressure was located on forefoot 2nd metatarsal bone area. As HbA1c increased, mean pressure and max peak pressure increased.. Key words: Diabetes mellitus(DM), plantar pressure, neuropathy, deformity, ulceration.. IV.

(6) ᇞᖴ ೭ঁࣴ‫ز‬Ǵࢂҗ‫ܭ‬೚ӭΓӅӕ‫ޑ‬брԶֹԋ‫ޑ‬Ƕ२ӃѸ໪གᖴ‫ך‬ ‫ࡰޑ‬ᏤԴৣˇֆᗶЎԴৣаϷཥഋжᖴࣽ‫ޑ‬ഡ௲௤ࡰᗺ‫ך‬ӵԜ‫ڀ‬Ԗ ว৖‫ޑ܄‬ᚒ‫׷‬Ƕ‫ځ‬ԛǴനٌध‫ޑ‬ோΥаϷഩฑǶдॺ೭΋ԃٰ‫ڐ‬շ‫ך‬ ֹԋ൳Я‫܌‬Ԗ‫ޑ‬πբǴջ٬ؒԖҺՖൔၿǴΨவ҂Ԗ΋ѡ࡜‫ق‬Ƕૈ୼ ள‫ډ‬೭ሶᓬ‫ޑذ‬Ꮲ‫ޑۂ׌‬ᔅշǴࢂ‫ך‬ӧᙴࣴ‫္܌‬ന۩ၮ‫ޑ‬΋ҹ٣ǶԶ ϘྈᏢߏ‫܌‬ග‫ޑٮ‬ၮᆉำԄǴ‫׏‬۵շ‫ך‬ԭΓϐΚǴᡣനᕷፄ‫ޑ‬πբΨ ᡂ‫ܰޑ‬ӵϸඓǶӕࣁࣴ‫ز‬ғ‫ޑ‬ᘑӄǴΨӧӚБय़ᆶ‫ך‬۶ԜࠀᓰǵගឫǴ ૈ୼Ԗ೭ኬუՔǴ੿ࢂ‫ך‬Ο፸ηঅٰ‫ޑ‬ᅽ਻Ƕᙴࣴ‫ޑ܌‬ഋ๷িԴৣǵ ཥഋжᖴࣽ‫ޑ‬ਦఘ‫ۆ‬ǵሸᒕ‫ۆ‬ǵаϷЎฐǴӵ݀ؒԖ೭٤຦Γ‫ޑ‬ᔅշǴ ೭ঁࣴ‫ز‬ஒᜤа௢৖ǶᗋԖᆛၡ΢Ǵӧጕ΢Ք‫ࡋך‬ၸ‫؂‬΋ঁπբ‫ڹޑ‬ ఁǴᔅ‫ך‬у‫ݨ‬Ѻ਻‫ॺ϶ܻޑ‬ǴᖴᖴգॺǶ! നࡕǴ‫ך‬ाགᖴ‫ޑך‬Р҆Ǵдॺ๏‫ך‬คచҹ‫ޑ‬ၗշǴᡣ‫ך‬ёаค ኁคቾ‫ֹޑ‬ԋᏢ཰Ƕ! ΋ঁπբ‫ֹޑ‬ԋǴཀ‫ښ‬๱Π΋ঁπբ‫ޑ‬໒‫ۈ‬Ƕ‫׆‬ఈΠ΋ԛǴ‫ך‬ᗋ ૈԖᐒ཮ୖᆶႽ೭ኬᑼࢳ‫زࣴޑ‬ဂǴࣁΓᜪ‫ޑ‬ค‫ޕ‬Ǵബ೷ӭ΋ᗺᗺ‫ޑ‬ ёૈ‫܄‬Ƕ!. V.

(7) !. Ҟᒵ ύЎᄔा..................................................................................................... I मЎᄔा...................................................................................................III ᇞᖴ............................................................................................................V Ҟᒵ.......................................................................................................... VI კҞᒵ...................................................................................................... IX ߄Ҟᒵ...................................................................................................... XI ಃ൘ക. ᆣፕ ......................................................................................- 1 -. ಃ΋࿯. ࣴ‫ز‬ङඳᆶ୏ᐒ ...........................................................- 1 -. ಃΒ࿯. ࣴ‫ز‬Ҟ‫ ޑ‬.......................................................................- 5 -. ಃມക. Ў᝘௖૸ ..............................................................................- 6 -. ಃ΋࿯. ᑗֿੰᆶ‫ٳځ‬วੱ .......................................................- 6 -. ಃΒ࿯. ᑗֿੰᆶ‫ى‬೽ውᅬ .......................................................- 6 -. ಃΟ࿯. ‫ى‬೽ውᅬ‫ޑ‬ᔠෳ ...........................................................- 7 -. ಃѤ࿯. ‫ۭى‬ውᅬౢғϐёૈᐒᙯ ...........................................- 9 -. ಃϖ࿯. ‫ۭى‬ᓸΚᆶ‫ى‬೽ውᅬ .................................................- 10 -. ಃϤ࿯. ‫ۭى‬ውᅬϐႣٛ .........................................................- 13 -. VI.

(8) ಃΎ࿯. ‫ۭى‬ᓸΚϐᔈҔ .........................................................- 14 -. ಃΖ࿯. ϩ୔‫ۭى‬ᓸΚϐ௖૸ .................................................- 15 -. ಃୖക. ࣴ‫ز‬Б‫ݤ‬ᆶ‫؁‬ᡯ ................................................................- 18 -. ಃ΋࿯. ࣴ‫ࢎز‬ᄬ .....................................................................- 18 -. ಃΒ࿯. ࣴ‫ز‬ჹຝ .....................................................................- 19 -. ಃΟ࿯. ࣴ‫ز‬೛ഢ .....................................................................- 21 -. ಃѤ࿯. ၗ਑ԏ໣ .....................................................................- 22 -. 3-4-1 ᖏ‫׉‬ᔠࢗ ......................................................................- 23 3-4-2 ‫ۭى‬ᓸΚෳໆ ..............................................................- 23 3-4-3 ੰўፓࢗ ......................................................................- 28 ಃϖ࿯. ख़ाӜຒញကᆶᏹբࠠ‫ۓ‬က .....................................- 29 -. ಃϤ࿯. ၗ਑ϩ‫݋‬Ϸೀ౛ .........................................................- 30 -. ಃစക. ࣴ‫ ่݀ز‬............................................................................- 32 -. ಃ΋࿯. ‫ڙ‬ෳ‫ ޣ‬.........................................................................- 32 -. ಃΒ࿯. ‫ۭى‬ᓸΚୖኧ .............................................................- 32 -. ಃΟ࿯. ᖏ‫׉‬ᔠࢗၗ਑ .............................................................- 38 -. ಃѤ࿯. ᖏ‫׉‬ᔠࢗၗ਑ᆶ‫ۭى‬ᓸΚϐ࣬ᜢ‫ ܄‬.........................- 39 -. 4-4-1 ᖏ‫׉‬ᔠࢗၗ਑ᆶӚ୔୔ୱѳ֡ᓸΚϐ࣬ᜢ‫܄‬.........- 39 4-4-2 ᖏ‫׉‬ᔠࢗၗ਑ᆶൂᗺനεᓸΚϐ࣬ᜢ‫܄‬.................- 45 -. VII.

(9) ಃҴക. ૸ፕ ....................................................................................- 50 -. ಃ΋࿯. ୔ୱѳ֡ᓸΚ .............................................................- 50 -. ಃΒ࿯. ѳ֡ॄၩ౗ .................................................................- 52 -. ಃΟ࿯. ፂໆ .............................................................................- 52 -. ಃѤ࿯. ൂᗺനεᓸΚ .............................................................- 53 -. ಃഌക. ่ፕᆶࡌ᝼ ........................................................................- 56 -. ಃ΋࿯. ่ፕ .............................................................................- 56 -. ಃΒ࿯. Ϟࡕࣴ‫ز‬Бӛᆶࡌ᝼ .................................................- 57 -. ୖԵЎ᝘..............................................................................................- 58 ߕᒵ......................................................................................................- 68 -. VIII.

(10) კҞᒵ! კ 3-1: ࣴ‫ࢎز‬ᄬკ .................................................................................... - 18 კ 3-2: ‫ۭى‬ᓸΚ‫س‬಍Ϸ 0.5mᓸΚ݈....................................................... - 22 კ 3-3: ӀᏢቹႽ ........................................................................................ - 25 კ 3-4: ᓉᄊ‫ۭى‬ᓸΚϩѲკ.................................................................... - 26 კ 3-5: ୏ᄊ‫ۭى‬ᓸΚϩѲკ.................................................................... - 26 კ 3-6: ‫ۭى‬ᓸΚϩ୔კ ............................................................................ - 28 კ 4-1: ᄍҔᆶߚᄍҔဌѳ֡ᓸΚϩѲКၨკ........................................ - 35 კ 4-2: ᄍҔᆶߚᄍҔဌѳ֡ॄၩ౗ϩѲКၨკ.................................... - 36 კ 4-3: ᄍҔᆶߚᄍҔဌፂໆϩѲКၨკ................................................ - 36 კ 4-4: ᄍҔᆶߚᄍҔဌൂᗺനεᓸΚϩѲКၨკ................................ - 36 კ 4-5: ߚᄍҔဌT1 ୔ᑗϯՈՅનᆶനεᓸΚॶණթკ ...................... - 40 კ 4-6: ߚᄍҔဌMT1 ୔ᑗϯՈՅનᆶനεᓸΚॶණթკ................... - 40 კ 4-7: ߚᄍҔဌMH୔ᑗϯՈՅનᆶനεᓸΚॶණթკ ..................... - 41 კ 4-8: ᄍҔဌT1 ୔ᑗϯՈՅનᆶനεᓸΚॶණթკ .......................... - 41 კ 4-9: ᄍҔဌMT1 ୔ᑗϯՈՅનᆶനεᓸΚॶණթკ....................... - 42 კ 4-10: ᄍҔဌMT2 ୔ᑗϯՈՅનᆶനεᓸΚॶණթკ..................... - 42 კ 4-11: ᄍҔဌMT2 ୔໭߻ՈᑗᆶനεᓸΚॶණթკ......................... - 43 -. IX.

(11) კ 4-12: ᄍҔဌMT3 ୔໭߻ՈᑗᆶനεᓸΚॶණթკ......................... - 44 კ 4-13: ߚᄍҔဌT1 ୔ᑗϯՈՅનᆶനεൂᗺᓸΚණթკ ................ - 46 კ 4-14: ᄍҔဌMT1 ୔ᑗϯՈՅનᆶനεൂᗺᓸΚණթკ................. - 46 კ 4-15: ᄍҔဌT1 ୔ᑗϯՈՅનᆶനεൂᗺᓸΚණթკ .................... - 47 კ 4-16: ᄍҔဌMT1 ୔ᑗϯՈՅનᆶനεൂᗺᓸΚණթკ................. - 47 კ 4-17: ᄍҔဌMT2 ୔ᑗϯՈՅનᆶനεൂᗺᓸΚණթკ................. - 48 -. X.

(12) ߄Ҟᒵ! ߄ 3-1:‫ۭى‬ᓸΚ‫س‬಍ೕ਱ಒ໨.................................................................. - 21 ߄ 4-1: ‫ڙ‬ෳ‫୷ޣ‬ҁၗ਑ϐѳ֡ॶᆶ኱ྗৡ(Mean±S.D)........................ - 32 ߄ 4-2: ߚᄍҔဌӚ୔ୱᓸΚୖኧѳ֡ॶᆶ኱ྗৡ(Mean±S.D.)........... - 34 ߄ 4-3:ᄍҔဌӚ୔ୱᓸΚୖኧѳ֡ॶᆶ኱ྗৡ(Mean±S.D.)................. - 35 ߄ 4-4: ᖏ‫׉‬ᔠࢗၗ਑ѳ֡ॶᆶ኱ྗৡ(Mean± S.D.).............................. - 38 ߄ 4-5: ᑗϯՈՅનᆶӚ୔ѳ֡ᓸΚ࣬ᜢ߯ኧ߄.................................... - 39 ߄ 4-6: ໭߻ՈᑗᆶӚ୔ѳ֡ᓸΚ࣬ᜢ߯ኧ߄........................................ - 43 ߄ 4-7: ᑗϯՈՅનᆶӚ୔ൂᗺനεᓸΚ࣬ᜢ߯ኧ߄............................ - 45 ߄ 4-8: ໭߻ՈᑗᆶӚ୔ൂᗺനεᓸΚ࣬ᜢ߯ኧ߄................................ - 48 -. XI.

(13)

(14) ಃ൘കʳ ᆣፕ ಃ΋࿯ʳ ࣴ‫ز‬ङඳᆶ୏ᐒ ᒿ๱ਔж‫ޑ‬ᡂᎂǴ࿶ᔮ‫ޑ‬ว৖ǴѠ᡼҇౲‫ޑ‬ғࢲಞᄍᆶ໯१Ўϯ Ψ೴ᅌ‫ׯ‬ᡂǶԶᙴᕍ‫ޑ‬຾‫؁‬ᆶғࢲНྗ‫ޑ‬ගଯǴᡣၸѐόܰЇଆख़ຎ ‫ޑ‬ୢᚒԋࣁᙴᕍሦୱ‫ݙ‬Ҟ‫ޑ‬ขᗺǶѳ֡Ꭹ‫ޑڮ‬ගଯǴᄌ‫ੰ܄‬೴ᅌԋࣁ Ьा‫ޑ‬ԝӢǴԶЪ࡭ុቚуǶਥᏵՉࡹଣፁғ࿿‫ޑ‬಍ीǴᑗֿੰԾ҇ ୯ 72 ԃଆԋࣁ୯ΓΜεԝӢϐ΋ǴӵϞς៌ϲࣁಃѤεԝӢ(Չࡹଣ ፁғ࿿, 2004)Ƕό໻ӵԜǴჹ‫ܭ‬ᑗֿੰ‫ޑ‬ᙴᕍЍрǴΨ೴ԃᛙ‫ۓ‬ԋߏ (Չࡹଣፁғ࿿, 2004)Ƕ٩Ҟ߻Γᜪ‫ޑ‬ᙴᕍࣽ‫מ‬Ǵᑗֿੰۘค‫ֹݤ‬ӄ ਥ‫ݯ‬Ǵՠ࿶ၸ‫ؼ‬ӳ‫ޑ‬Ոᑗ௓‫ڋ‬аϷ଼நྣៈǴ஻‫ޣ‬٩ᙑёаගଯғࢲ ࠔ፦Ǵ‫ߏۯ‬ტ‫ڮ‬Ƕ җᑗֿੰ‫܌‬Їว‫ٳޑ‬วੱ࣬྽ᕷӭǴЪ࿶தჹ஻‫཮ޣ‬೷ԋ΋፸η (life time)‫ޑ‬ቹៜǶӧᑗֿੰፏӭ‫ٳ‬วੱύǴຼᜐՈᆅੰᡂ‫ຼک‬ᜐઓ࿶ ੰᡂ࿶தᝄख़ቹៜᑗֿੰ஻‫ޑޣ‬ғࢲࠔ፦Ƕҗ‫ڬ‬ᜐઓ࿶ੰᡂ‫܌‬Їଆ‫ޑ‬ ੱ‫ރ‬Ԗག᝺લѨ(sensory loss)ǵഞЕǵག᝺౦தǵԼԺቻєਏ౗फ़ե Զ೷ԋԼΚό‫ى‬฻ࡕᒪੱǹຼᜐՈᆅ‫ੰޑ‬ᡂ߾཮ЇวҜጥ‫ރ‬ᄊ౦தǵ խࣝૈΚΠफ़ǵ໾αόܰᘰӝǵ‫ڹ‬໔ΠަੵภаϷ৒ܰౢғՈᆅਵ༞ ฻౜ຝǶຼᜐઓ࿶ੰᡂόѝ೷ԋၮ୏ૈΚ‫ޑ‬૰ଏǴҗ‫҃ܭ‬ᆄઓ࿶‫ੰޑ‬ -1-.

(15) ᡂǴ೷ԋ஻‫ޣ‬Ӣੵภག੃Ѩ‫ࢂ܈‬෧১Զ഼ѨԾ‫ߥך‬ៈаϷ᝾᝺‫ޑ‬ᐒ ‫ڋ‬Ǵ‫܌‬а‫׳‬৒ܰ‫ڙ‬໾ǶԶҁᡏག᝺‫ޑ‬౦தǵԼΚΠफ़ǵᜢ࿯ᡂ‫׎‬฻Ӣ ન‫ޑ‬ቹៜǴ߾཮٬ᑗֿੰ஻‫؁ޑޣ‬ᄊวғѦᢀόܰჸ᝺‫ޑ‬ಒ༾ᡂϯǴ ೭ᅿᡂϯஒϸࢀ‫ܭ‬Չ‫و‬ਔ‫ۭىޑ‬ᓸΚϩѲ(van Deursen, 2004)ǶᓸΚ ‫ޑ‬໣ύ೷ԋֽ೽‫ޑ‬ነᔔΚǵᓸΚ೿Ԗ΢ϲ‫ޑ‬ᖿ༈Ǵ೭ኬ‫ޑ‬ϸᙟᔈΚ‫ޑ‬ ໣ύǴஒ཮٬ளҜጥಔᙃᡂ‫ૄޑ‬১Ǵр౜आဍ(dependent rubor)Ǵࣗ Կ‫ܭ‬ውᅬǶ җ‫ܭ‬ᑗֿੰ஻‫ޣ‬Ծ‫ߥך‬ៈᐒ‫ڋ‬Πफ़Ǵ‫ڙ‬໾‫ࢂ܈‬ౢғҜጥውᅬ (ulceration)‫ޑ‬ᐒ౗ගଯǴ໾αόܰᘰӝǴխࣝΚΠफ़೷ԋ஻೽৒ܰ΋ ӆགࢉǶ౲ӭӢનҬϕբҔΠǴ۳۳೷ԋᑗֿੰ஻‫ޑ‬Πަ੝ձ৒ܰ‫ڙ‬ ໾Ǵ٠Ъᜤа౫ᘰǴനࡕёૈሡाᄒަǶԶᄒަϐᘰࡕҭό٫ǴΒࡋǵ ΟࡋᄒަаϷᄒަࡕԝΫ౗೿ၨ҅தΓଯ(මቼֵ, 1994)Ƕ ਥᏵ୯Ѧ‫ࡰزࣴޑ‬рǴ΋ঁ೏ບᘐрԖᑗֿੰ‫ޑ‬ΓǴӧд‫ޑ‬΋ғ ύεऊԖ 15%‫ޑ‬ᐒ཮วғ‫ى‬೽ውᅬ(Reiber, 1996)ǴԶᑗֿੰ஻ύǴ‫ى‬ ೽ውᅬ‫؂‬ԃ‫ޑ‬วғ౗(Incidence)ऊࣁ 1%~4%(Reiber, 2001)Ǵ౰Չ౗ε ऊ 4%~10%Ƕ‫ى‬೽ውᅬჹᑗֿੰ஻‫ޑޣ‬ቹៜό໻ӵԜǴᑗֿੰ஻‫ى‬೽ ውᅬԶሡाᄒަ‫ޑ‬К‫ٯ‬Ψᇻຬ‫҅ܭ‬தΓǹᑗֿੰ஻Ӣࣁ‫ى‬೽ውᅬԶሡ ाᄒަ‫ޑ‬К‫ٯ‬Ǵࢂ҅தΓ‫ ޑ‬10 ७‫ ډ‬30 ७(Reiber, 2001)Ƕ‫׳‬ᕪ‫ࢂޑ‬Ǵ ᑗֿੰ஻ᄒަϐࡕ‫ޑ‬ԝΫ౗Ψᇻଯ‫ܭ‬΋૓คᑗֿੰ‫ޣ‬Ӣࣁബ໾฻Ӣ. -2-.

(16) નԶᄒަ‫ޑ‬ԝΫ౗Ǵᑗֿੰ஻ӧᄒަϐࡕ΋ԃԝΫ౗ࢂ 13%‫ ډ‬40%Ǵ ΟԃԝΫ౗ࢂ 45%‫ ډ‬65%ǴϖԃԝΫ౗‫׳‬ଯၲ 39%‫ ډ‬80%Ǽ(Reiber, 2001)җ‫ىܭ‬೽ውᅬόѝҁ‫ي‬ቹៜ஻‫ޣ‬ғࢲࠔ፦Ǵ‫ੰځ‬ำว৖ҭ࿶த ‫و‬ӛзΓᒪᏬ‫ֽ่ޑ‬Ǵ‫܌‬аႣٛ‫ى‬೽ውᅬ‫ޑ‬วғǴ൩ԋࣁΑзΓ‫ݙ‬Ҟ ‫ޑ‬ख़ᗺϐ΋Ƕ ᑗֿੰ஻‫ىޑ‬೽ውᅬٰԾ‫ܭ‬೚ӭӢનǴՠࢂനᜤႣٛ‫ޣ‬൩ࢂٰԾ ‫ىܭ‬೽ᓸΚ‫ޑ‬ᡂϯǴҗ‫ܭ‬٠ߚ೸ၸཀѦ໾্೷ԋǴ஻‫ޣ‬Ծ‫ي‬Ψᜤаག ‫ڙ‬೭ኬ‫ޑ‬ᓸΚ‫ׯ‬ᡂǴ‫ࢂܭ‬೴ᅌಕᑈ೷ԋውᅬǶԐӧ 90 ԃж߃ය൩Ԗ ೚ӭЎ᝘ࡰрǴ‫ۭى‬ᓸΚᆶ‫ۭى‬ውᅬ‫ޑ‬วғ‫ڀ‬Ԗ҅࣬ᜢ‫܄‬Ƕ1990 ԃ Sosenko฻Γ‫زࣴޑ‬ύࡰрǴ೸ၸ‫߄ۭى‬Ҝᓸ᝺લཞ‫ޑ‬ෳ၂Ǵჹ‫ىܭ‬ ۭውᅬ‫ޑ‬ᜢᖄ‫܄‬ε‫ൂܭ‬પ‫ޑ‬᎜୏ག᝺ෳ၂аϷྕࡋෳ၂ǶᡉҢᓸ᝺લ ཞዴჴёૈࣁߦԋ‫ۭى‬ውᅬ‫ޑ‬Ӣનϐ΋(Sosenko et al., 1990)Ƕ‫ۭى‬ው ᅬ‫ࢂ܈‬ᓸΚᡂϯ٠ߚൂપٰԾ‫؁ܭ‬ᄊ‫ׯޑ‬ᡂǴ1992 ԃVeves฻Γ‫ࣴޑ‬ ‫ࡰز‬рǴջ٬ࢂӢѦ໾Զᄒަ‫ޑ‬஻‫ߚ(ޣ‬ᑗֿੰ஻)Ǵ‫ۭىځ‬ᓸΚѳ֡ ॶϝฅᇻե‫ܭ‬คᄒަ‫ޑ‬ᑗֿੰ஻‫ޣ‬Ǵ೭ᡉҢ‫ۭى‬ᓸΚϐගଯ٠ߚൂપ ٰԾ‫؁ܭ‬ᄊ‫ׯޑ‬ᡂǴԶࢂԖ‫ځ‬дӢનӅӕ‫ޑ‬ቹៜǴԶԜว౜ӆࡋஒё ૈ‫ࡰ܄‬ӛΑᑗֿੰ‫ޑ‬ઓ࿶ੰᡂ(Veves, Van Ross & Boulton, 1992b)Ƕӕ ԃǴVevesϐќ΋߻ᘳ‫زࣴ܄‬Ǵᇡࣁӕਔ‫ڀ‬Ԗଯ‫ۭى‬ᓸΚᆶઓ࿶ੰᡂ ‫ޑ‬ᑗֿੰ஻‫ٰޣ‬ᇥǴཱུԖёૈӧอਔ໔ϣวғ‫ۭى‬ውᅬǴѸ໪уаႣ. -3-.

(17) ٛ(Veves et al., 1992a)Ƕᘜય೭٤Ў᝘‫ޑ‬ᇥ‫ݤ‬Ǵઓ࿶ੰᡂཱུԖёૈࢂЇ ว‫ۭى‬ᓸΚϲଯ‫ޑ‬ЬӢǴԶ‫ۭى‬ᓸΚ‫ޑ‬ගଯǴᆶวғውᅬ‫ޑ‬ᐒ౗և౜ ҅࣬ᜢǶ ਥᏵ 2005 ԃ Singh ฻Γ‫ޑ‬ӣ៝‫܄‬Ўകύ‫ޑ‬಍ीǴ߈ 24 ԃԖᜢ‫ܭ‬ ᑗֿੰ‫ۭى‬ውᅬ‫زࣴޑ‬Ǵೕኳ൳Я೿໻З‫ܭ‬ኧԭΓǴᗨฅΨԖ೽ϩί Γа΢‫ޑ‬Ў᝘дॺؒԖӣ៝‫ډ‬Ǵՠ೭‫ޑ‬ዴࢂϿኧ(Singh, Armstrong & Lipsky, 2005)Ƕ‫ٯ‬ӵ 2003 ԃ Lavery ฻Γவ 2001-2003 ϐ໔൩຾ՉΑ 1666 Γ‫ ޑ‬2 ԃଓᙫ(Lavery et al., 2003)Ƕ٠ЪਥᏵдॺ‫ޑ‬ӣ៝Ǵ‫ۭى‬ ᓸΚ‫ޑ‬ෳໆऩӝ‫ځٳ‬дઓ࿶Ꮲ‫ޑ‬ෳ၂Ǵჹ‫ۭىܭ‬ውᅬ‫ޑ‬Ⴃෳঋ‫ࡋߞڀ‬ аϷਏࡋǶՠΨӢࣁ‫ۭى‬ᓸΚ‫܌‬ϸࢀ‫ࢂޑ‬΋ঁᆕӝ‫่݀ޑ܄‬Ǵ೷ԋ‫ى‬ ۭᓸΚӧᓸΚ੝ቻ΢‫ޑ‬ղ᠐኱ྗፄᚇǶ‫ۭى‬ᓸΚෳ၂നε‫ޑ‬ୢᚒӧ ‫ܭ‬Ǵന࡞྽‫ޑ‬ᓸΚᖏࣚᗺ(optimal cutoff)ᜤаࣚ‫ۓ‬Ƕόӕ‫زࣴޑ‬ൔ֋ ύόӕ‫ڙޑ‬ෳ‫ޣ‬ङඳǴόӕ‫ޑ‬ሺᏔǴόӕ‫ޑ‬ෳ၂БԄǴόӕ‫ޑ‬ෳ၂ࢬ ำჹ‫ܭ‬ᓸΚෳ၂‫ޑ‬ኧॶቹៜߚதεǴόӕ‫زࣴޑ‬ϐ໔‫ޑۓु܌‬ᓸΚᖏ ࣚॶόᆅӧኧᏵ΢‫ࢂ܈‬኱ྗ΢۳۳લЮ΋ठ‫܄‬Ƕ ᗨฅӧόӕ‫ޑ‬Ꮲ‫ޣ‬Ǵӧόӕ‫ޑ‬୯ৎǴόӕ‫ޑ‬ෳໆࢬำύǴ೿ӚԾ ‫פ‬р‫ۭى‬ውᅬᆶ‫ۭى‬ᓸΚ‫ޑ‬ᜢ߯Ƕа‫ۭى‬ᓸΚ‫ޑ‬ໆෳǴբࣁ௖૸ᑗֿ ੰ‫ۭى‬ውᅬԋӢ‫ࡰޑ‬኱ǴՉԖᎩԃǴςࢂӚࣚϦᇡ‫ޑ‬ёՉϐၰϐ΋Ƕ ฅ΋‫ޔ‬аٰǴჹ‫ܭ‬ᓸΚ‫ޑ‬ໆෳБԄǴղᘐ኱ྗǴϝલЮ಍΋ЪϦᇡ‫ޑ‬. -4-.

(18) ኱ྗǴࡺҁࣴ‫ز‬аၸѐϿ‫ޑـ‬ϩ୔ᓸΚෳໆǴҾკ௖૸ӧ၁ಒ୔ϩ‫ى‬ ۭᓸΚ‫ޑ‬БԄΠǴᆶၸѐϐࣴ‫ز‬Кၨ‫ځ‬౦ӕǴаයૈග‫ٮ‬ၸѐ࣬ᜢࣴ ‫่݀ز‬ό΋ठϐёૈှញǴ٠ගрόӕ‫ٳ‬วੱϐᑗֿੰ஻ᓸΚ໣ύϐ ໼ӛǴԖշ‫ܭ‬ᖏ‫׉‬ගԐϟΕ‫ݯ‬ᕍǶ. ಃΒ࿯ʳ ࣴ‫ز‬Ҟ‫ޑ‬ ୷‫زࣴܭ‬ङඳаϷ୏ᐒǴҁࣴ‫ز‬ගраΠୢᚒ຾Չ௖૸Ǻ аઓ࿶ੰᡂᆶ่ᄬᡂ‫׎‬բࣁϩᜪ኱ྗǴஒ཮ϸࢀӧব٤୔ୱǴব ٤‫ۭى‬ᓸΚ‫࣬ޑ‬ᜢୖኧ΢Ƕ ‫ۭى‬ᓸΚࢂցᆶՈᑗࡰ኱ᑗϯՈՅનϐኧॶᡂϯԶр౜ৡ౦‫܄‬Ƕ ຾Չ΢ॊࣴ‫ز‬ୢᚒϐ௖૸ਔǴሡගрҁࣴ‫ز‬ϐଷ೛Ǻ ઓ࿶ੰᡂᆶ่ᄬᡂ‫׎‬ஒ೷ԋ‫ۭى‬Ӛ୔ୱᓸΚදၹ‫܄‬΢ϲǶ ‫ۭى‬ᓸΚஒӢᑗϯՈՅનК‫ٯ‬ගଯԶቚуǶ ҁࣴ‫ز‬ϐЬाҞ‫ޑ‬ӧ‫ܭ‬೸ၸஒ‫ۭى‬ಒϩࣁΜঁ೽ϩϩձ௖૸Ӛ ୔ୱϐӚ໨ᓸΚ࣬ᜢୖኧ(ѳ֡ᓸΚǵѳ֡ॄၩ౗ǵፂໆаϷനεൂ ᗺᓸΚ)ᆶᖏ‫׉‬ᔠࢗၗ਑(ᑗϯՈՅનаϷ໭߻Ոᑗ)໔‫࣬ޑ‬ᜢ‫܄‬Ƕ‫׳‬ё аග‫ٮ‬ᖏ‫׉‬πբ‫ޣ‬аϷ‫ى‬೽ᇶ‫ڀ‬ᇙբ‫ޣ‬բࣁග‫ٮ‬ᑗֿੰ஻‫࡞׳‬྽‫ޑ‬ ᔅշ‫ޑ‬٩ᏵǴаගϲᑗֿੰ஻‫ޑ‬ғࢲࠔ፦Ƕ. -5-.

(19) ಃມകʳ Ў᝘௖૸ ಃ΋࿯ʳ ᑗֿੰᆶ‫ٳځ‬วੱ ᑗֿੰଆӢ‫ܭ‬ી৞નϩ‫ݜ‬ໆό‫ى‬Ǵ‫ک‬բҔफ़եǴᏤठી৞નค‫ݤ‬ ೏҅தճҔԶЇଆଯՈᑗ‫ޑ‬΋ᅿᄌ‫܄‬ཥഋжᖴምᛖ੯ੰǴ٠ЪҞ߻ค ‫ݤ‬ਥ‫ݯ‬ǶਥᏵፁғ࿿಍ीǴԾ҇୯ 72 ԃଆᑗֿੰԋࣁ୯ΓΜεԝӢ ϐ΋ǴԿϞ 20 ൳ԃٰԝΫ౗ᗨฅ‫؂‬ԃଽԖ੃ߏǴՠ୷ҁ΢ᆢ࡭࡭ុ ‫ז‬ೲቚу‫ޑ‬ᖿ༈Ƕ҇୯ 93 ԃӢᑗֿੰԶԝΫ‫ޑ‬Γαኧࣁ 9191 ΓǴၨ ҇୯ 83 ԃԋߏऊ 1.4 ७ǴҞ߻ࣁ୯ΓಃѤεԝӢ(Չࡹଣፁғ࿿, 2004)Ƕ ᑗֿੰ೷ԋ‫ߏޑ‬ය‫܄‬ଯՈᑗǴஒ೷ԋӄ‫ޑ܄ي‬ՈᆅᡂϯǴ຾΋‫؁‬ ೷ԋຎᆛጢǵ๝ํౚǴ߷‫ે୏ރ‬ౢғੰᡂ‫܈‬೷ԋՈਵǶଯᐚࡋՈᑗΨ ཮೷ԋઓ࿶ಒझ‫܌‬Ѹा‫ޑ‬Լᠼᆢᎇค‫҅ݤ‬தឪ‫ڗ‬Ǵ຾΋‫؁‬೷ԋઓ࿶໺ Ꮴ‫ޑ‬૰ଏǶՈనύ‫ޑ‬౲ӭೈқ፦Ψ཮֎ߕဟ๻ᑗǴЪᑗᐚࡋຫଯǴ೭ ٤ೈқ፦ᑗϯ‫ޑ‬К‫ٯ‬൩ຫεǴᑗϯࡕ‫ޑ‬ೈқ፦ஒ཮फ़եচԖ‫ޑ‬բҔਏ ౗Ƕࡺᑗֿੰ൳Яёаӧӄ‫ي‬Їଆ‫ٳ‬วੱǶ. ಃΒ࿯ʳ ᑗֿੰᆶ‫ى‬೽ውᅬ ᑗֿੰ‫܌‬Їଆ‫ٳޑ‬วੱ࣬྽ፄᚇԶᕷӭǴ‫ځ‬ύ‫ۭى‬ውᅬ࿶தࢂᝄ -6-.

(20) ख़ቹៜᑗֿੰ஻ғࢲࠔ፦‫ٳޑ‬วੱϐ΋Ƕӧ୯ѦǴReiber(1996)ගр ΋ঁᑗֿੰ஻Ǵಖ‫ځ‬΋ғεऊԖ 15%‫ޑ‬ᐒ౗Ǵ཮วғ‫ى‬೽ውᅬ‫ޑ‬ୢ ᚒǶԶᕴӝΠަ੯஻Ǵхࡴ‫ڬ‬ᜐՈᆅǵઓ࿶ੰᡂǵ‫ى‬೽ውᅬǵΠަᄒ ަǴ೭٤ୢᚒӧᑗֿੰ஻‫ޑ‬วғ౗ഖࢂคᑗֿੰ‫ٿޑޣ‬७Ǽ ӧऍ୯ǴਥᏵ಍ी(Remsey et al., 1999)Ǵा‫ݯ‬ᕍ΋ঁᑗֿੰ‫ى‬೽ ውᅬǴѳ֡ሡा޸຤ଯၲ 28000 ऍߎǶό໻ӵԜǴനзΓ্‫ࢂޑ܂‬Ǵ ᑗֿੰ஻‫ۭىޑ‬ውᅬ۳۳Ӣࣁค‫ݤ‬౫ᘰ΋ӆགࢉԶᏤठᄒަǶਥᏵ಍ ीǴӕኬࢂ‫ۭى‬ውᅬǴᑗֿੰ஻ᄽᡂࣁᄒަΠ൑‫ޑ‬ᐒ౗ࢂ΋૓Γ‫ޑ‬ 10 ७‫ ډ‬30 ७ϐ໔(Siitonen et al., 1993)Ƕ୯ϣ‫(زࣴޑ‬මቼֵ, 1994)Ψ මࡰрǴ୯ϣεӭኧ‫ޑ‬ᄒަੰ஻ǴଆӢٰԾ‫ܭ‬ᑗֿੰǶԶΒࡋΟࡋᄒ ަǴΨᆶᑗֿੰԖᜢǶзΓᒪᏬ‫ࢂޑ‬Ǵᑗֿੰ஻ᄒަࡕ‫ޑ‬ԝΫ౗Ψၨ தΓٰ‫ޑ‬ଯǶҗ‫ۭىܭ‬ውᅬ৒ܰวғΞόܰ‫ݯ‬ᕍǴӆу΢ਥྍ‫ޑ‬ୢᚒ Ȭᑗֿੰȭҁ‫ي‬ค‫ݤ‬ਥ‫ݯ‬Ǵ‫܌‬аѝा஻‫ޣ‬ᗋࢲ๱Ǵ೭ኬ‫ޑ‬ୢᚒ൩ёૈ ࡭ុόᘐ‫שޑ‬ᑃ஻‫ޣ‬Ƕ‫܌‬аߏයаٰǴ஑ৎॺ΋‫࣬ޔ‬྽ख़ຎᑗֿੰ‫ى‬ ‫ޑ‬ගԐว౜ᆶ‫ݯ‬ᕍǶ. ಃΟ࿯ʳ ‫ى‬೽ውᅬ‫ޑ‬ᔠෳ ӧӃ߻‫زࣴޑ‬Ǵᑗֿੰྣៈ࣬ᜢᙴᕍΓ঩൩ว౜‫ۭى‬ውᅬᆶຼᜐ ઓ࿶ੰᡂǵຼᜐՈᆅੰᡂǵ‫ى‬೽ᡂ‫׎‬฻ӢનԖᜢǶ1990 ԃ Sosenko. -7-.

(21) Кၨ᎜୏⸣ॶаϷྕࡋհ዗‫ک‬ᓸ᝺ෳ၂฻όӕᔠෳБԄǴՖ‫ޣ‬ᆶ‫ۭى‬ ውᅬϐᜢᖄ‫܄‬ၨଯǴ٠ЪКၨόӕෳ၂π‫ڀ‬ϐ໔‫௵ޑ‬ག‫܄‬ᆶ஑΋‫܄‬Ǵ നࡕว౜ᓸ᝺ෳ၂ᆶ᎜୏⸣ॶࣣԖ࣬྽όᒱ‫௵ޑ‬ག‫܄‬Ǵՠӧ௵ག‫܄‬ௗ ߈‫ޑ‬௃‫ݩ‬ΠǴᓸ᝺ෳ၂Ԗ‫׳‬ӳ‫ޑ‬੝౦‫܄‬Ǵ೭ᡉҢΑ‫܈‬೚Кଆ᎜୏ག ᝺Ǵᓸ᝺ౢғ‫ޑ‬ᐒ‫ڋ‬ёૈ‫׳‬ௗ߈‫ۭى‬ውᅬ‫ޑ‬ଆӢǶ ൳ЯӕਔǴԖΓගр‫ۭى‬ᓸΚ‫ޑ‬ෳໆҭૈϸࢀр‫ى‬೽ᜢ࿯ࢲ୏ࡋ ౦த‫(่݀ޑ‬Fernando et al., 1991)Ǵ೭ঁ่݀஥ٰΑཥ‫௴ޑ‬ҢǶ೭ᡉҢ Α‫ۭى‬ᓸΚ‫܌‬ϸࢀ‫ࢂޑ‬΋ঁᕴӝ‫่݀ޑ܄‬Ǵࡽૈϸࢀઓ࿶ੰᡂ‫܌‬೷ԋ ‫่݀ޑ‬Ǵҭૈϸࢀᜢ࿯౦த஥ٰ‫ޑ‬ৡ౦Ƕՠ೭Ψࣁ‫ۭى‬ᓸΚ‫ޑ‬ှ᠐‫׫‬ ΠΑќ΋ঁόዴ‫ۓ‬ӢનǴୖᆶቹៜ‫ޑ‬ӢηຫӭǴ‫ى‬ᓸ൩ຫᜤ‫פ‬рܴዴ ‫ޑ‬ղձ୷ྗǴӢࣁჴᡍύค‫ݤ‬௓‫ޑڋ‬ӢનϼӭΑǶ ߈ԃ‫زࣴޑ‬ӆࡋ᛾ჴ‫ۭى‬ᓸΚ‫ޑ‬ᡂϯёаϸᔈрဌඓΠಔᙃᖓ ϯ‫ׯޑ‬ᡂ(Abouaesha et al., 2001)ǶନԜϐѦǴΨԖࣴ‫ޣز‬ว౜ΠަԼ ԺѨૈӕኬ‫཮ޑ‬ϸࢀӧ‫ۭى‬ᓸΚ‫ޑ‬ᡂϯ΢(Abboud, Rowley & Newton, 2000)Ƕ 2005 ԃ Singh ฻Γ຾ՉΑၸѐ 24 ԃ໔ᜢ‫ۭىܭ‬ውᅬ࣬ᜢࣴ‫ޑز‬ ӣ៝ǴдॺКၨΑӚᅿόӕᔠෳБԄ‫௵ޑ‬ག‫܄‬ᆶ஑΋‫܄‬Ǵдॺ‫่ޑ‬ፕ ගрӃа VPT test аϷ monofiliment fiber ຾Չ touch test ϐࡕӆа‫ى‬ ۭᓸΚዴᇡ٠ຑ՗஻‫ޑޣ‬ᓸΚϩѲǴаዴჴ๏ϒ‫ݯ‬ᕍϷࡌ᝼ǴࢂКၨ. -8-.

(22) ёߞǴ٠ЪБߡ࿶ᔮ‫ޑ‬ບᘐБԄǶ. ಃѤ࿯ʳ ‫ۭى‬ውᅬౢғϐёૈᐒᙯ Ҟ߻ၨࣁቶ‫ݱ‬ௗ‫ۭىޑڙ‬ውᅬౢғ‫ޑ‬ଷᇥǴЬाࢂٰԾ‫ຼܭ‬ᜐઓ ࿶ᆶՈᆅੰᡂǴՔᒿ‫ڙ܍‬ѦΚԶౢғബ໾Ǵ٠Ъӝ‫ٳ‬གࢉ฻຾΋‫؁‬ୢ ᚒ(Boulton, 2004)Ƕ‫ځ‬ύઓ࿶ੰᡂхࡴԾࡓઓ࿶ੰᡂǴག᝺ઓ࿶ੰᡂǴ ၮ୏ઓ࿶ੰᡂΟ‫ޣ‬ǶԾࡓઓ࿶ੰᡂ೷ԋ௨Ԡ౦தǴҜጥଳᔿԶܰ຋Ǵ ԶҜጥΨёૈᡂளૄ১Զ৒ܰ‫ڙ‬໾ǶԶག᝺ઓ࿶ੰᡂ߾Ԗёૈ೷ԋภ ᝺ǵ᎜୏ǵᓸΚǵ᝻᝺ǵྕࡋག‫੃ޑ‬Ѩ‫܈‬όܴᡉǴε൯फ़ե஻‫ޣ‬ҁ‫ي‬ ‫ޑ‬᝾᝺‫܄‬Ǵᝄख़‫׳ޣ‬ёૈр౜౦தག᝺ǴӵഞЕǵ‫ڈ‬ภǶ೭٤ག᝺‫ޑ‬ ౦த೿཮υᘋ஻‫ޣ‬Ǵ٬‫ځ‬ค‫௵ݤ‬᎒‫ޑ‬ჸ᝺‫ى‬೽‫ޑ‬ᡂϯǴаԿ‫ܭ‬ค‫ݤ‬ջ ਔբр҅ዴ‫ޑ‬ϸᔈǶҁᡏག᝺‫੃ޑ‬Ѩஒ೷ԋ஻‫ޣ‬Չ‫و‬ᆶӚᅿՉ୏ύѳ ᑽᐒᙯ‫ׯޑ‬ᡂǴԶ‫؁‬ᄊΨӕਔр౜ಒ༾‫ޑ‬ᡂϯǴ೭ኬ‫ޑ‬ᡂϯࠅ཮೷ԋ ‫ۭى‬ᓸΚϩ೽‫ޑ‬໣ύ(Caselli, et al, 2002)Ƕၮ୏ઓ࿶‫ੰޑ‬ᡂёૈ஥ٰԼ Ժቻє‫ޑ‬લѨǴᇸ‫ޣ‬ԼΚό‫ى‬Ǵख़‫ޣ‬ԼԺ๺ᕭό‫ܭؼ‬ՉǴԶၮ୏ઓ࿶ ‫ޑ‬૰ଏ೷ԋ‫ى‬ϣԼ(intrinsic muscle)‫ޑ‬๺ᕭǴ೭ஒ཮຾΋‫ޑ؁‬೷ԋ‫؁ى‬ ᜢ࿯‫ޑ‬ᡂ‫׎‬ǹԼԺቻє‫ޑ‬૰ଏǴҭёૈ೷ԋ౦த‫؁‬ᄊǴԶ٬‫ֽۭى‬೽ ᓸΚቚуǴᔈΚ‫ޑ‬ᡂϯ࿶ၸಕᑈǴ຾΋‫؁‬ჹ‫ۭى‬೬ಔᙃ೷ԋቹៜǴӵ ߏᛡ‫ࢂ܈‬ӧᜢ࿯ೀቚғମ‫ڈ‬Ƕ. -9-.

(23) ‫ځ‬ԛǴຼᜐՈᆅ੯ੰёૈ೷ԋՈਵǴத‫ܭـ‬ΠަǴӢԜΠަ‫ٮ‬Ո ό‫ى‬Їวό፾ག‫ࢂ܈‬৒ܰੲമǶԶຼᜐൻᕉό‫ࢂ׳ؼ‬फ़եխࣝΚ‫ޑ‬ϡ ӁǴ҃ᆄൻᕉό‫ؼ‬࿶த཮೷ԋ໾αค‫ݤ‬ᘰӝǴаϷ໾α৒ܰགࢉ฻ୢ ᚒǶ ҃ᆄൻᕉό‫ؼ‬ନΑ೷ԋϐຼᜐಔᙃલ਼ѦǴӕਔΨ཮೷ԋҔᛰԋ ϩค‫ݤ‬ᒿՈన‫ډ‬ၲ஻ೀǶԜѦǴ྽ՈᑗၸଯਔǴ೷ԋқՈౚࢲ‫܄‬फ़եǴ ԶଯᐚࡋՈᑗ‫܌‬Їว‫ޑ‬ೈқ፦ᑗϯਏᔈǴ೷ԋံᡏϐ่ӝՏ‫ׯ‬ᡂࠠ ᄊǴቹៜరЃౚտᏘфૈǹጤচೈқ‫ޑ‬ᡂ‫܄‬Ψ཮फ़ե໾αᘰӝ‫ޑ‬ೲ ࡋǴ೭٤ୢᚒ೿཮೷ԋ໾αᜤаᘰӝǴ٠Ъ৒ܰ΋ӆགࢉǴԶനࡕ‫ޑ‬ ่݀۳۳ᏤठᄒަǶ. ಃϖ࿯ʳ ‫ۭى‬ᓸΚᆶ‫ى‬೽ውᅬ ᗨฅࣴ‫ز‬දၹᡉҢ‫ۭى‬ውᅬᆶ‫ۭى‬ᓸΚԖᜢǴவၸѐғ‫ނ‬ΚᏢ‫ޑ‬ ჴᡍύǴࣴ‫ޣز‬ᢀჸ‫ډ‬Πަᄒަ‫ޑ‬஻‫ޣ‬Ǵ۳۳཮ӧՉ‫و‬ύஒख़ໆୃӛ ҂ᄒަୁǶӧՉ‫و‬ύख़Ј‫ޑ‬ό֡ϬϩණǴ౛ፕ΢ஒ೷ԋ‫ۭى‬ᓸΚ‫ׯޑ‬ ᡂǶ‫ࢂܭ‬ԖΓᚶᅪǴӧၸѐ‫ޑ‬ჴᡍύǴ೚ӭઓ࿶ੰᡂ‫ڙޑ‬ෳ‫ޣ‬Ψමᄒ ަǴ‫ز‬ഖࢂᄒަ೷ԋᓸΚ‫ޑ‬ᡂϯǻᗋࢂᑗֿੰҁ‫ي‬Ԗ‫ځ‬дӢન(ӵઓ ࿶ੰᡂ)೷ԋ‫ۭى‬ᓸΚ‫ׯޑ‬ᡂǻ1992 ԃ Veves ฻Γ‫ޑ‬ჴᡍග‫ٮ‬Α΋٤ ጕ઩Ǵдॺ‫زࣴޑ‬ύǴ‫ڙ‬ෳ‫ޣ‬ϩࣁѤಔǺ(1)ӢࣁᑗֿੰԶᄒަ(2)Ӣ. - 10 -.

(24) ࣁ‫ځ‬дѦ໾Զᄒަ(3)ᑗֿੰ஻ЪԖઓ࿶ੰᡂՠคᄒަ(4)คᑗֿੰ‫ޑ‬ ҅தΓǴКၨ‫ۭىځ‬ᓸΚǴ่݀ว౜Ӣᑗֿੰ‫ى‬Їวᄒަϐੰ஻Ǵ‫ځ‬ ‫ى‬ᓸε‫ܭ‬Ӣ‫ځ‬дѦ໾Զӕኬൂୁᄒަ‫ޑ‬஻‫ޣ‬Ƕ٠Ъӕኬࣁᑗֿੰ஻Ǵ ࢂցᄒަϸԶჹ‫ى‬ᓸϐቹៜคᡉ๱ৡ౦Ƕ೭ᡉҢΑ‫܌‬ᢀჸ‫ىޑډ‬ᓸᡂ ϯǴዴჴٰԾ‫ܭ‬ᑗֿੰǴࣗԿёᇥࢂઓ࿶ੰᡂϐቹៜǶ ᒿ๱ࣽ‫ޑמ‬ᄽ຾ǴӚᅿ‫ى‬ᓸ‫ޑ‬ෳໆπ‫ڀ‬аϷෳໆ‫୺ޑ‬ՉБ‫ݤ‬೿೏ уаࣴ‫(ز‬Sarnow et al., 1994; Donaghue et al, 1995; Vijay, 1998; Hughes, Rowland, & McMeekin, 2000)Ǵ೭٤ࣴ‫ز‬᛾ܴΑόӕ‫ޑ‬ჴᡍπ ‫ڀ‬Ǵόӕ‫ޑ‬ჴᡍࢬำǴόӕ‫ڙޑ‬ෳ௼ဂǴջ٬่݀ӧᖿ༈΢Ԗ΋ठ‫܄‬Ǵ ٩ᙑӧኧᏵ΢кᅈΑ‫ݔ‬౦‫܄‬Ƕ 2002 ԃ Caselli ฻Γගр΋ঁཷ‫ۺ‬Ǵдॺஒᑗֿੰ஻٩ྣઓ࿶ੰ ᡂ‫ޑ‬ᝄख़‫܄‬уаϩಔǴ٠Ъஒ‫ۭى‬ᓸΚεठ୔ϩࣁ‫ٿ‬༧Ǵ‫(߻ى‬fore foot)ᆶ‫(ࡕى‬rare foot)Ǵ٠Ъஒ‫ޑࡕى߻ى‬ᓸΚॶ࣬ନǴஒԜКॶ‫ۓ‬က ࣁ F/R ॶǶдॺว౜ჹ‫ܭ‬΋૓‫ޑ‬ᑗֿੰ஻ٰᇥǴ‫ޑࡕى߻ى‬ᓸΚ֡Ԗ ගϲǴՠࢂ‫ࡕى߻ى‬ቚу‫ޑ‬К‫ٯ‬٠ό࣬ӕǴӧઓ࿶ੰᡂനᝄख़‫ٗޑ‬ ಔǴܴᡉ‫ޑ‬р౜ F/R ॶ‫ޑ‬ගଯǴ೭ᡉҢ‫ޑ߻ى‬ᓸΚ΢ϲԖК‫ޑٰࡕى‬ ӭ‫ޑ‬໼ӛǶ 2004 ԃ Pataky ฻Γа‫ۭى‬੝‫ ޑۓ‬5 ঁ୔ୱࣁᢀჸҞ኱Ǵ௖૸ค ઓ࿶ੰᡂҭค‫ڬ‬ᜐՈᆅ੯஻ϐᑗֿੰ஻ᆶ҅தΓ‫ۭى‬ᓸΚԖՖό. - 11 -.

(25) ӕǴ่݀дว౜೭٤Ȩ‫ݩރ‬όᒱȩ‫ޑ‬ᑗֿੰ஻Ǵ٠ߚӄ‫ۭى‬ᓸΚදၹ ‫ޑ܄‬ᓸΚଯ‫҅ܭ‬தΓǴԶࢂӧࢌ٤੝‫୔ۓ‬ୱᓸΚቚуǴࢌ٤୔ୱᓸΚ ϸԶၨեǶ೭ঁࣴ‫่݀ز‬ග‫ٮ‬Α‫ঁٿ‬ख़ा‫ޑ‬སҢǺಃ΋ǵᑗֿੰჹ‫ܭ‬ ‫ۭى‬ᓸΚ‫ޑ‬ቹៜǴёаӧр౜ઓ࿶ੱ‫ރ‬аϷՈᆅੰᡂϐ߻൩೏ँᡉр ٰǹಃΒǵᑗֿੰ஻‫ۭى‬ᓸΚϐගϲǴ٠ߚදၹ‫܄‬ϐӄ‫ى‬ᓸΚ΢ϲǴ Զࢂ೽ϩගଯԶ೽ϩ෧ϿǶ 2005 ԃ Singh ฻Γჹ‫ ܭ‬EBSCOǵMEDLINEǵNational Guideline Clearinghouse database ฻Οঁཛྷ൨‫س‬಍Ǵ٬Ҕᑗֿੰ(diabetes)ᆶ‫ى‬೽ ውᅬ(foot ulcer)аϷགࢉ(infection)‫ک‬Ⴃٛ(prevention)฻բࣁᜢᗖӷ ٰཛྷ൨ 1980 ԃ΋Д‫ ډ‬2004 ԃѤДࣁЗ‫܌‬Ԗ‫ޑ‬ЎകǴдॺКၨΑ೭ 24 ԃٰ‫ޑ‬Ў᝘ࡕ᏾౛р΋٤่ፕǶ‫ځ‬ύӧᖏ‫ޑ׉‬ຑ՗΢Ǵၸѐࣴ‫ز‬ ᡉҢрᑔᔠෳ၂ჹ‫ىܭ‬೽ውᅬаϷЇว‫ޑ‬ᄒަ٠ؒԖܴᡉ‫ޑ‬ਏ݀ǴЬ ा‫ޑ‬চӢԖΒǴಃ΋ঁচӢࣁၸѐ೭Бय़‫ޑزࣴޑ‬ኬҁኧໆၸեǴ‫܌‬ аค‫ݤ‬ϸࢀрᑔᔠ‫ޑ‬ਏ݀ǶಃΒঁচӢࢂӢࣁ‫ى‬೽ᓸΚᔠࢗբࣁ΋ঁ ᑔᔠπ‫ٰڀ‬ᇥǴѬલЮԖΚ‫ୖޑ‬Ե኱ྗǴӢࣁၸѐ೭Бय़‫ࡌ܌زࣴޑ‬ ҥ‫ޑ‬ଯӒᓀᖏࣚॶӭъٰԾ‫ܭ‬ኬҁኧໆ੟λ‫زࣴޑ‬ǴԶЪु‫ޑۓ‬኱ྗ લЮ౛ፕਥᏵǴ೭҅ࢂၸѐ‫ۭى‬ᓸΚ‫زࣴޑ‬നલЮ‫ٿ‬ኬӢનǶ. - 12 -.

(26) ಃϤ࿯ʳ ‫ۭى‬ውᅬϐႣٛ ᑗֿੰ‫ۭى‬ውᅬ‫ޑ‬ႣٛЬाа΢ॊගϷౢғውᅬϐᐒᙯǴᗉխઓ ࿶ੰᡂǴՈᆅੰᡂǴаϷႣٛ‫ى‬೽໾্Ο‫ޣ‬ᄬԋǶ ઓ࿶ੰᡂᆶՈᆅੰᡂ‫ޑ‬চӢٰࣣԾ‫ܭ‬Ոᑗ౦தǴऩૈ௓‫ڋ‬ӳՈ ᑗǴ൩ૈᗉխઓ࿶ੰߡᆶՈᆅੰᡂǶՈᑗ‫ޑ‬௓‫ڋ‬ନΑ᎞໯१ϐѦǴԖ ਼ၮ୏ҭёቚуી৞ન‫ޑ‬բҔਏ౗(୯ৎፁғࣴ‫ز‬ଣ, 2001) 2004 ԃ Armstrong ฻Γჹᑗֿੰ஻ϐВதࢲ୏ໆ຾ՉᅱຎǴдॺ ճҔी‫؁‬ᏔаϷ΋٤ୢ‫ٰڔ‬ፓࢗ΋ဂᑗֿੰ஻ೱុ 25 ຼ‫୏ࢲޑ‬ໆǴ ೭٤‫ڙ‬ෳ‫ޣ‬΋໒‫ۈ‬೿ࢂؒԖ‫ۭى‬ውᅬ‫ޑ‬ᑗֿੰ஻‫ޣ‬Ǵдॺว౜നࡕᜤ ଒‫ۭى‬ውᅬ‫ޑ‬೭٤஻‫ޣ‬Ǵдॺ‫୏ࢲޑ‬ໆ࣬ჹ΢දၹୃեǶ೭ཀ‫ښ‬๱ჹ ‫ܭ‬೭٤ଯӒᓀ௼ဂٰᇥǴ‫܈‬೚եமࡋ࡭ុ‫ޑ܄‬ၮ୏Ԗշ‫ܭ‬Ⴃٛ‫ۭى‬ው ᅬ‫ޑ‬วғǶ ԜѦଞჹ‫ۭى‬ውᅬ‫ޑ‬ଯӒᓀဂǴᇙբ੝ᇙ‫ޑ‬Ꭰ‫ڀ‬ΨૈԖਏफ़ե‫ى‬ ۭᓸΚǶ߈ԃࣗԿԖΓ࠹ᆀдॺ‫܌‬೛ी‫ޑ‬Ꭰ‫ૈڀ‬Ԗਏ‫ޑ‬फ़եനӭ 30% ‫ۭىޑ‬ᓸΚ(van Schie et al, 2005)Ƕՠࢂ೭٤ਏ݀ǴҞ߻࣬ߞ໻ज़‫ܭ‬೭ ٤Ꭰ‫ऀڀ‬ӧဌ΢‫ޑ‬ਔং(Donaghue, 1996)Ǵ‫܌‬аᎠ‫ޑڀ‬ਏҔ༈Ѹᆶ஻ ‫ޣ‬٬ҔᎠ‫୏ޑڀ‬ᐒ৲৲࣬ᜢ(Baumhauer et al, 1997)Ƕ. - 13 -.

(27) ಃΎ࿯ʳ ‫ۭى‬ᓸΚϐᔈҔ ‫ۭى‬ᓸΚ‫ޑ‬ᡂϯନΑբࣁ΋ঁᔠෳπ‫ٰڀ‬ᑔᔠ‫ࢂ܈‬Ⴃෳᑗֿੰ ஻‫ۭى‬ውᅬ‫ޑ‬ёૈ‫܄‬ϐѦǴҗ‫ۭىܭ‬ᓸΚෳ၂ග‫ޔٮ‬ௗ‫ޑ‬ᓸΚኧᏵǴ ёբࣁೕჄ‫ݯ‬ᕍीฝаϷᇙբߥៈ‫ى܄‬೽ᇶ‫ޑڀ‬٩ᏵǶ1994 ԃ Sarnow ฻Γջࡰр‫ۭى‬ᓸΚࢂց‫ׯ‬ᡂǴёаբࣁԵᡍ‫ى‬೽ᇶ‫ޑڀ‬ᇙ բࢂցૈዴჴफ़ե஻‫ޣ‬วғ‫ى‬೽ውᅬ‫ޑ‬ᐒ౗Ƕ1996 ԃ Donaghue ฻Γ ճҔᎠϣᓸΚෳ၂Ǵдॺჹ 52 Տёૈวғ‫ۭى‬ውᅬ‫ޑ‬ᑗֿੰ஻‫ޣ‬຾ Չೱុ 6 ঁД‫ޑ‬ଓᙫǴ٠Ъ٬ҔᎠϣᓸΚགෳᏔϩձෳໆऀᆶόऀ੝ ᇙᎠპਔǴՉ‫و‬ύ‫ۭىޑ‬ᓸΚǴдॺว౜ᗨฅӧග‫ٮ‬੝ᇙᎠ‫߃ޑڀ‬ය ዴჴёа೷ԋᎠϣ‫ۭى‬ᓸΚ‫ޑ‬फ़եǴՠࢂߏයΠ٠ؒԖᒤ‫ޑ܄ុ࡭ݤ‬ ‫ׯ‬๓Ꭰϣ‫ى‬ᓸǶΨԖΓа‫ۭى‬ᓸΚϐᡂϯٰᔠᡍΟᅿόӕ‫ޑ‬Ꭰ‫ڀ‬ჹ‫ܭ‬ ‫ى‬೽ውᅬ‫ޑ‬Ⴃٛਏ݀(Baumhauer et al, 1997)Ǵ‫ࢂ܈‬ោηӧՉ‫و‬ਔჹ‫ى‬ ۭᓸΚ೷ԋ‫ޑ‬ቹៜ(Dai et al, 2006)Ƕӧઓ࿶‫س‬಍‫࣬ޑ‬ᜢ௖૸ύǴ‫ۭى‬ ᓸΚεໆᔈҔӧՉ‫و‬ᆶѳᑽ࣬ᜢ‫ޑ‬੯ੰ΢Ǵ‫ٯ‬ӵӭว‫܄‬ฯϯੱ஻‫ޣ‬ (Ramdharry et al, 2006)аϷ‫ߎۦ‬හМੱ஻‫(ޣ‬Kimmeskamp & Henning, 2001)‫؁ޑ‬ᄊϩ‫݋‬Ƕӧၮ୏Бय़ǴอາᒧЋ‫ۭىޑ‬ᓸΚ‫ޑ‬੝ቻǴ‫܈‬೚ ёаբࣁှញдॺဌඓମੲമ‫܄‬ମ‫ޑש‬วғ౗ଯ‫ܭ‬΋૓Γ‫ޑ‬౛җ (Weist, Eils & Rosenbaum, 2004)ǹ2006 ԃ Mao ฻Γว౜ϼཱུৼၮ୏‫ޑ‬ ၸำύǴಃ΋ඓମᓐаϷ‫߻ۭى‬ϣୁϐ‫ۭى‬ᓸΚᡉ๱ගϲǹӧ୯ϣΨ - 14 -.

(28) ම຾ՉอາᒧЋ‫ى‬ψৡ౦‫܌‬೷ԋ‫ޑ‬ቹៜϐ௖૸(ഋЎ୷, 2003)Ƕ‫ۭى‬ ᓸΚΨ೴ᅌᔈҔӧᡏ፾ૈаϷ଼ந΢‫ޑ‬௖૸Ǵ2004 ԃ Birtane аϷ Tuna ௖૸‫ޥ‬औ‫ޣ‬ᆶߚ‫ޥ‬औ‫ޣ‬ϐ‫ۭى‬ᓸΚϩѲԖՖৡ౦Ƕ‫܈‬೚բࣁ΋ ঁᑔᔠπ‫ڀ‬Զ‫ق‬Ǵ‫ۭى‬ᓸΚ‫௵ޑ‬ག‫܄‬ౣ༮ό‫ى‬ǴԶКଆ᎜୏ག᝺⸣ॶ ‫ࢂ܈‬᝻᝺ෳ၂฻ᙁܰ‫ޑ‬౛ᏢᔠٰࢗᇥǴ‫ۭى‬ᓸΚϐෳໆΨό୼БߡǶ ՠբࣁ΋ঁຑ՗π‫ڀ‬Զ‫ق‬Ǵ‫ۭى‬ᓸΚёග‫ٮ‬ᖏ‫׉‬ന‫ޔ‬ௗ‫ޑ‬᛾ᏵǴ٬ᖏ ‫׉‬πբ‫҅ޣ‬ዴЪ‫ޔ‬ௗ‫ޑ‬๏ϒ஻‫ޣ‬ሡा‫ޑ‬ᔅշǶ. ಃΖ࿯ʳ ϩ୔‫ۭى‬ᓸΚϐ௖૸ ᒿ๱ႝတࣽ‫ޑמ‬຾‫؁‬Ǵ‫ۭى‬ᓸΚ‫ޑ‬ෳໆπ‫ڀ‬В੻Ӄ຾Ǵှ‫ࡋ݋‬ᆶ ᆒஏࡋΨຫٰຫଯǴ΋٤Ꮲ‫ޣ‬໒‫ۈ‬Ҿკᡍ᛾‫ى‬೽‫ڙ‬Κ‫ׯ‬ᡂ‫ޑ‬ଷ೛Ǵ‫ܭ‬ ࢂԖ٤Γஒ‫ۭى‬εౣϩԋ‫߻ى‬೽(fore foot)ᆶ‫ࡕى‬೽(rare foot)‫ٿ‬༧Ǵ ҾკКၨр‫߻ى‬ᆶ‫ࡕى‬ᓸΚ‫ׯޑ‬ᡂ΢ࢂցԖำࡋ΢‫ޑ‬ৡ౦Ǵዴჴ೭ᅿ Б‫ݤ‬КଆൂપѝԖइᒵΠനεᓸΚᗺϐᓸΚॶૈ୼ග‫׳ٮ‬ӭ௃ൔǴΨ ૈ຾΋‫؁‬ග‫ٮ‬ᑗֿੰ‫ޑى‬੝ቻ(Caselli, 2002)ǹԖΓ߾εᖌ‫ޑ‬ஒ‫ۭى‬ϩ ࣁ 10 ঁ୔ୱǴӚձࢂဌၟ(heel)ϣѦୁ‫୔ٿ‬ǵ‫ى‬ύ(mid foot)ϣѦୁ‫ٿ‬ ୔ǵಃ΋ဌඓମ(1st metatarsal bone)ǵಃΒဌඓମ(2nd metatarsal bone)ǵ ಃΟѤϖဌඓମ(3rd, 4th&5th metatarsal bone)ǵεဌ೩(hallux)ǵಃΒဌ ೩(2nd toe)аϷಃΟ‫ډ‬ϖဌ೩(3-5th toe)ǴϩձКၨӚ୔ୱ‫ޑ‬ᓸΚୃ౽. - 15 -.

(29) ॶǴಒϩϐΠ‫่݀ޑ‬ว౜Ǵࢌ٤ௗ߈‫୔ޑ‬ୱ‫ޑ‬ኳԄ࣬྽ᜪ՟Ǵՠࢂࢌ ٤୔ୱᗨฅௗ߈ՠࢂࠅև౜όӕ੝‫(܄‬Prabhu, 2001)ǴԜࣴ‫ز‬ஒಃ΋ಃ Βဌࡰϩࣁ‫୔ٿ‬ǴࢂӢࣁ೭‫୔ঁٿ‬ୱჹ‫ܭ‬ᑗֿੰ஻ٰᇥǴ۳۳ࢂ‫ۭى‬ ውᅬ࿶தр౜‫୔ޑ‬ୱǶӕኬϩࣁ 10 ঁ୔ୱǴBus฻Γӧ 2005 ԃჹ‫ܭ‬ ဌ೩ᜢ࿯ᡂ‫׎‬΢‫زࣴޑ‬ǴࠅԖόӕ‫ޑ‬Б‫ݤ‬Ǵдஒဌࡰ‫ޑ‬೽ϩಒϩࣁ 4 ঁ୔ୱǴԶဌඓᆶဌၟ୔ୱ߾ᙁϯ٠ЪՔᒿMRIᡉቹ‫ೌמ‬Ǵቚуෳໆ ϐᆒዴࡋǶԖ٤ࣴ‫߾ޣز‬ၨߥӺǴафૈ‫܄‬εठஒ‫ۭى‬ϩࣁϖঁ୔ୱ ٰ௖૸λ࠸η‫ޑ‬ϩ୔ᓸΚǴдஒ‫ۭى‬ϩࣁ‫߻ى‬ϣѦୁǵဌၟϣѦୁǴ аϷ‫ى‬ύ(Stebbins et al, 2005)Ǵ‫ۭىޑูٽ‬Ӣࣁᕴय़ᑈλǴᇤৡ‫ޑ‬К ‫࣬߾ٯ‬ჹуεǴၸࡋϩ୔ԖਔϸԶёૈ೷ԋᓸΚ੝ቻ‫ޑ‬షౄǶԶа‫ى‬ ۭᓸΚٰ຾Չઓ࿶‫س‬಍੯ੰ஻‫؁ޑޣ‬ᄊϩ‫݋‬ਔǴࣴ‫ޣز‬٠ό୔ϩ‫ۭى‬ ᓸΚ‫୔ޑ‬༧ǴԶࢂᢀჸᓸΚύЈ(COP)‫ޑ‬౽୏ၡ৩ٰှញ‫ڙ‬ෳ‫ޑޣ‬Չ ‫و‬੝ቻ(Kimmeskamp et al, 2001)Ƕόӕ‫ޑ‬ϩ୔БԄǴ೿ࢂঁձଞჹӚ Ծ‫زࣴޑ‬Ҟ‫ٰޑ‬،‫ۓ‬ǶԐය‫ޑ‬ᑗֿੰ‫ۭى‬ᓸΚࣴ‫ز‬٠όϩ୔Ǵѝ࣮ന εॶǴԶ߈ԃٰ‫ޑ‬ᑗֿੰ‫ۭى‬ᓸΚ࣬ᜢࣴ‫ز‬Ǵӭъаϩ୔ኳԄ௖૸Ǵ ೭ࢂҗ‫ۭىܭ‬ᓸΚ‫ޑ‬ᡂϯǴ٠ߚදၹ‫ޑ܄‬ᓸΚගϲǴԶࢂҗ‫؁ܭ‬ᄊಒ ༾‫ׯޑ‬ᡂ೷ԋ‫ޑ‬Ԝ੃۶ߏǴࡺаϩ୔௖૸ӧ‫؁‬ᄊύόӕਔ໔ᗺΠ‫ޑ‬ᓸ ΚϩѲǴ٠ᆶ஻‫ٳޑޣ‬วੱ‫ރ‬КჹǴԖշ‫ܭ‬ᙶమӧ೭ᅿ‫ٳ‬วੱჹ‫؁ܭ‬ ᄊаϷᓸΚёૈ‫ޑ‬ቹៜǶ‫ۭى‬ᓸΚ‫૸܌‬ፕ‫ୖޑ‬ኧǴΨ٠όѝԖൂપ‫ޑ‬. - 16 -.

(30) ᓸΚ(pressure)΋໨Ǵࣴ‫ޣز‬ӧࣴ‫ޑز‬ၸำύว౜ǴѝԖᓸΚ٠ό‫ى‬а ှញᑗֿੰ‫ى‬ϐ‫܌‬а৒ܰውᅬ‫ޑ‬ᐒᙯǶ΋૓ᓸየ‫ޑ‬ౢғǴନΑᓸΚ‫ޑ‬ ελԖቹៜϐѦǴᓸΚ‫ڙ܍ޑ‬ਔ໔ΨԖख़ा‫ޑ‬ཀကǴ‫ࢂܭ‬ᓸΚ‫܌‬ಕᑈ ‫ૈޑ‬ໆ߾аᓸΚਔ໔ᑈϩॶ(pressure-time integral)‫ࢂ܈‬ፂໆ(impact) уа߄ҢǶՠࢂ೭٩ᙑό‫ى‬ǴӢࣁᗨฅёа࿶җ‫؁‬ᄊ‫ڗޑ‬ኬᆉр΋ԛ ‫؁‬ᄊຼය(gait cycle)‫ޑ‬Ӛ໨ᓸΚୖኧǴՠࢂՉ‫و‬চҁ൩ό཮ࢂൂ΋ൻ ᕉ‫୏ޑ‬բǴ‫܌‬а΋ঁΓ‫܌ۭى‬ಕᑈ‫ૈޑ‬ໆǴ༈Ѹᆶ೭ঁΓВதғࢲύ ࢲ୏‫ޑ‬ำࡋԖᜢǴ‫܌‬аӧᑗֿੰ‫ޑى‬௖૸ύǴΨԖࣴ‫ޣز‬ଓᙫ‫ڙ‬ෳ‫ޣ‬ ‫؂‬ВՉ‫؁و‬ኧٰीᆉрಕᑈᓸΚ‫ࡰޑ‬኱(Donaghue, 1996; Armstrong, 2004)ǶԶӧࡧѳ‫ى‬Бय़‫زࣴޑ‬Ǵ‫ۭى‬ᆶӦय़‫ޑ‬ௗ᝻य़ᑈҭёբࣁ୔ ϩଯψ‫ى‬ᆶࡧѳ‫ىޑى‬ψࡰ኱Ƕ. - 17 -.

(31) ಃୖകʳ ࣴ‫ز‬Б‫ݤ‬ᆶ‫؁‬ᡯ ಃ΋࿯ʳ ࣴ‫ࢎز‬ᄬ ҁࣴ‫ز‬ϐҞ‫ޑ‬ӧ‫ܭ‬௖૸ᑗֿੰ஻‫ۭى‬ᓸΚӧϩ୔ࡕǴӚ୔ӧόӕ ಔձ໔‫ޑ‬ᖿ༈Ǵ‫ز‬ഖԖՖቚ෧Ƕ୷‫زࣴܭ‬Ҟ‫ޑ‬ᆶЎ᝘௖૸ග‫ٮ‬ϐୖ ԵǴҁࣴ‫ز‬ϐࣴ‫ࢎز‬ᄬӵΠკ‫܌‬ҢǶ ஒ‫ڙ‬ෳ‫ޣ‬٩ྣࢂցᑗֿੰϩᜪ. ҅! த! Γ. ! ᑗ. ֿ. ੰ. ಔ. ٩ྣ‫ٳ‬วੱϐԖค. ઓ࿶ੰᡂ. ᜢ࿯ᡂ‫׎‬. ‫ځ‬дӢન. ค! ᑗ! ֿ! ੰ! ‫ޣ‬. ค ‫ٳ‬ ว ੱ ‫ޣ‬. ԏ໣Ӛ໨ᔠࢗၗ਑Ϸ‫ۭى‬ᓸΚ. ่݀ϩ‫݋‬Ϸ૸ፕ. კ 3-1: ࣴ‫ࢎز‬ᄬკ. - 18 -. !.

(32) ‫ځ‬ύᑗֿੰΓ٩Ᏽ‫ۭى‬ውᅬӒᓀӢηуа௨ନǴऩᑗֿੰ஻Ԗ‫ى‬ ೽ઓ࿶ੰᡂǴᜢ࿯ᡂ‫׎‬฻ୢᚒǴ‫ځ܈‬ϩಔচ߾٩ྣࢂցઓ࿶ੰᡂᆶ‫ى‬ ೽ᡂ‫׎‬уа୔ϩǶঁձࢂค‫ٳ‬วੱ‫ځ‬д‫ى‬аቹៜՉ‫ૈو‬Κଫઓ࿶ᚊԺ Ոᆅ࣬ᜢ੯஻‫ޣ‬Ǵ೿ᆶа௨ନǶ. ಃΒ࿯ʳ ࣴ‫ز‬ჹຝ ҁࣴ‫ز‬аБߡ‫ڗ‬ኬᒧ‫ڗ‬Ѡύѱύ୯ᙴᛰεᏢߕ೛ᙴଣǴཥഋжᖴ ࣽᑗֿੰፁ௲ύЈϐ൩ບੰ஻Ӆ 500 ӜǴ‫ځ‬ύᑗֿੰ஻࿶ၸ஑ࣽᙴৣ ບᘐࡕዴᇡǴԏਢచҹӵΠǺ 1. ‫܌‬Ԗୖᆶύ୯ᙴᛰεᏢߕ೛ᙴଣཥഋжᖴࣽᑗֿੰଓᙫྣៈ‫س‬ ಍ϐᑗֿੰ஻‫ޣ‬Ƕՠ໻Ԗဟ๻ᑗѨऐ(IGT)аϷ‫ޜ‬ဎՈᑗ౦த (IFT)‫ޣ‬όᆉӧϣǶ ௨ਢచҹӵΠǺ 1. ъԃϣวғΠަઓ࿶ԼԺମᓝख़ε໾্Ƕ 2. ‫ڀ‬Ԗቹៜၮ୏фૈϐύኰઓ࿶੯஻ੰў(ӵύ॥ǵ‫ߎۦ‬හМੱ฻)Ƕ 3. ค‫ݤ‬ᐱҥՉ‫ و‬10 ϦЁ(คፕࢂց٬ҔՉ‫و‬ᇶ‫)ڀ‬Ƕ 4. Ҟ߻р౜࣬ᜢઓ࿶ᓸॐ(෎໔ዬँр‫܈‬ઓ࿶ਥᓸॐ)Ǵ‫܈‬ҺՖ೷ԋΠ ަག᝺౦தǴၮ୏ૈΚ౦தϐ੯஻Ƕ. - 19 -.

(33) 5. ࿶ᔠࢗዴᇡ‫ځ‬Πަઓ࿶ੰᡂ‫ޣ‬Ƕ 6. ࿶ᔠࢗࡕዴᇡ‫ځ‬Πަᜢ࿯ᡂ‫ޣ׎‬Ƕ ҁჴᡍϐࣴ‫ز‬ጄൎᆶज़‫ڋ‬Ǻ ҁჴᡍϐࣴ‫ز‬ჹຝЬाࣁύ೽Ӧ୔߻۳ύ୯ᙴᛰεᏢߕ೛ᙴଣ൩ ບϐੰ஻Ǵ࿶ၸЬ‫ݯ‬ᙴৣບᘐǴ٠ӕཀୖᆶᑗֿੰፁ௲‫ޣ‬Ƕ ୷‫زࣴܭ‬ጄൎϐज़‫ڋ‬Ǵҁჴᡍϐ่݀ӵᔈҔ‫ډ‬όӕғࢲಞᄍǵό ӕ໯१ಞᄍǵόӕᅿ௼ϐ௼ဂ΢ёૈ཮Ԗज़‫ڋ‬Ƕ. - 20 -.

(34) ಃΟ࿯ʳ ࣴ‫ز‬೛ഢ ΋.ʳ ჴᡍ൑‫܌‬Ǻ ύ୯ᙴᛰεᏢߕ೛ᙴଣཥഋжᖴࣽᑗֿੰፁ௲ύЈ Β.ʳ ჴᡍᏔ‫׷‬Ǻ 1. 5 ϦЁՉ‫؁و‬ၰ ೛࿼‫ܭ‬ύ୯ᙴᛰεᏢߕ೛ᙴଣཥഋжᖴࣽᑗֿੰፁ௲ύЈǴаЕ ݈ᄬԋǴ‫ځ‬ଯࡋᆶ‫ۭى‬ᓸΚ‫س‬಍฻ଯǴаዴߥ‫؁‬ၰϐଯࡋ΋ठǶ 2. Footscan ‫ۭى‬ᓸΚ‫س‬಍ (Footscan plate system, RSscan International., Belgium) Ԝ‫س‬಍х֖Οঁ೽ϩǴFootscan 3D systemǴFootscan 0.5m plateǴ Footscan gait softwareǶ‫ځ‬ೕ਱ӵΠ߄Ǻ ߄ 3- 1:‫ۭى‬ᓸΚ‫س‬಍ೕ਱ಒ໨ Dimensions. Active sensor surface. Amount of ʳ. Sensitivity 2. Max. Frequency. L x B x H (m). L x B (m)ʳ. sensors (#). (N/cm ). (Hz). 0,5 x 0,4 x 0,008. 0,48 x 0,32. 4096. 0,27 - 127. 500ʳ. (ၗ਑ٰྍ: RSscan International., Belgium. ᆛ֟: http://www.rsscan.com/). - 21 -.

(35) კ 3-2: ‫ۭى‬ᓸΚ‫س‬಍Ϸ 0.5m ᓸΚ݈ (კႽٰྍ: RSscan International., Belgium. ᆛ֟: http://www.rsscan.com/). 3. ӀᏢ௟ඔᏔ Astra5400 scanner (maxium technologies inc., TW). ಃѤ࿯ʳ ၗ਑ԏ໣ ҁࣴ‫ز‬Ьाӧ‫ܭ‬௖૸ᑗֿੰ஻ӧѳӦՉ‫و‬ਔǴ‫ۭى‬Ӛϩ୔‫ޑ‬ᓸΚ ࣬ᜢୖኧ‫ޑ‬ᡂϯǴ୺Չ‫ޑ‬ၸำ΋ӅϩࣁΟঁЬा໘ࢤǺ ಃ΋໘ࢤǺᖏ‫׉‬ᔠࢗ(Clinical Examination) ಃΒ໘ࢤǺ‫ۭى‬ᓸΚෳໆ(Plantar pressure measurement) ಃΟ໘ࢤǺੰўԏ໣(History taking) аΠஒϩࢤᇥܴǶ. - 22 -.

(36) 3-4-1 ᖏ‫׉‬ᔠࢗ(Clinical Examination) ᖏ‫׉‬ᔠࢗЬाϩࣁ౛Ꮲᔠࢗ(Physical Examination)аϷჴᡍ࠻ᔠ ࢗ(Laboratory Examinations)‫ঁٿ‬೽ϩǴ‫ځ‬ύ౛Ꮲᔠࢗ‫ޑ‬೽ϩЬाҗ VPT test (Vibration Perception Threshold Test)ǵ10-g Semmes-Weinstein monofilament touch test (Touch-Test Sensory Evaluator; North Coast Medical, Morgan Hill, CA)аϷ᝻ບ(Palpation dorsalis pedis аϷ posterior tibia ‫ેޑ‬ཛ)Ο‫ޣ‬ᄬԋǶ Զჴᡍ࠻ᔠࢗ(Laboratory Examinations)߾ԏ໣໭߻ՈᑗǴ໭ࡕՈ ᑗന߈ΟঁДϣϐѳ֡ॶǴаϷᑗϯՈՅન(HbA1c)߈ΟঁДϐѳ֡ ኧǶа΢ၗ਑ԏ໣ࣣࣁ஻‫ޣ‬൩ᙴਔ‫ٯޑ‬ՉᔠࢗǶ೿཮ӧ໒‫ۈ‬ԏ໣‫ۭى‬ ၗ਑ϐ߻ֹԋǶ. 3-4-2 ‫ۭى‬ᓸΚෳໆ(Plantar pressure measurement) ஻‫ޣ‬ӧ຾Չֹፁ௲ᆶ౛ᏢᔠࢗࡕǴӛ஻‫ޣ‬ᇥܴჴᡍၸำ٠Ъቻ‫؃‬ ‫ځ‬ӕཀǶӃԏ໣ᓉᄊ‫ۭى‬ᓸΚϩѲკǴӆа‫؁ٿ‬Бଞ(2 step protocol) ԏ໣‫ٿ‬ဌ୏ᄊ‫ۭى‬ᓸΚǴ٠ЪаӀᏢ௟ඔᏔ੮Π‫ڙ‬ෳ‫ޣ‬ϐ‫ۭى‬Ѧᢀቹ ႽǴаᢀჸ஻‫߄ۭىޣ‬Ҝ੝ቻǴࢂցр౜౦த‫ރ‬ᄊǴ٠Ъբࣁਠ҅‫ى‬ ۭय़ᑈаϷϩ୔ϐ٩ᏵǶ ‫ځ‬ύ‫ۭى‬ᓸΚෳໆၸำύǴӄำᇘ‫ى‬຾ՉǴ२ӃаӀᏢ௟ඔᏔӕ. - 23 -.

(37) ਔ௟ඔᚈဌ‫ۭى‬ϐҜጥѦᢀаϷጄൎελǶ‫ځ‬ԛǴӧ 5 ϦЁ‫؁‬ၰ΢җ ࡼෳ‫ޣ‬຾ՉҢጄᆶှᇥǴՉ‫و‬ϐाሦࣁᇸ᚞ԾฅǴ‫ܩ‬ᓐ࣮߻БǴ٠Ъ ᡣ‫ڙ‬ෳ‫ޣ‬٩Ңጄግಞ 1-3 ԛǴаዴᇡ‫ڙ‬ෳ‫ޣ‬ዴჴ౛ှჴᡍࢬำǴӕਔ ෳໆ‫؁‬ຯǴᒧ᏷ଆ‫ۈ‬Տ࿼Ǵа಄ӝ‫؁ٿ‬БଞǴаය‫ڙ‬ෳ‫ޣ‬໒‫ۈ‬Չ‫ࡕو‬ ‫ޑ‬ಃΒ‫؁‬ዴჴပӧᓸΚ݈ጄൎϣǶ҅Ԅᘏ‫ڗ‬ၗ਑ਔǴ‫ٰ؂‬ӣ΋ԛ‫؁‬ၰ ջᡣ‫ڙ‬ෳ‫ޣ‬Ҷ৲ 40 ࣾǴ΋Ӆᘏ‫ ڗ‬6-8 ԛၗ਑Ǵ٠ᢀჸ‫ڙ‬ෳ‫ޣ‬Չ‫࠮و‬ ᄊǴаೲࡋǵ࠮༈നᛙ‫ځڗޣۓ‬ύΟԛߥӸइᒵբࣁၗ਑ϩ‫݋‬Ƕ ҁ໘ࢤύ‫܌‬ԏ໣‫ޑډ‬ၗ਑ϩࣁ‫ঁٿ‬೽ϩǺ ΋.ʳ ቹႽၗ਑ ٬ҔӀᏢቹႽ௟ඔᏔёаᕇள‫ڙ‬ෳ‫ىޑޣ‬೽Ѧᢀ୷ҁၗ਑Ǵхࡴ ‫ߏى‬Ǵ‫ى‬ቨǴ‫ۭى‬ჴሞय़ᑈǴҜጥ‫ރ‬ᄊ฻୷ҁၗ਑Ƕ. - 24 -.

(38) კ 3-3: ӀᏢቹႽ(კύ਱ጕ‫ൂ؂‬Տࣁ 1cmǴѳ֡ᇤৡࣁ 0.05mm). Β.ʳ ᓸΚၗ਑ ೸ၸ‫ۭى‬ᓸΚ‫س‬಍‫܌‬ԏ໣‫ޑ‬ၗ਑ǴᕴӅёаεठϩࣁ 4 ঁ೽ϩǴ ϩձ௶ॊӵΠǺ a. ᓉᄊᓸΚϩѲკ ԏ໣‫ڙ‬ෳ‫ޣ‬ᓉЗઠҥਔǴࢌ΋ᛙ‫ۓ‬ᕓ໔‫ޑ‬ᚈဌ‫ۭى‬ᓸΚǶ. - 25 -.

(39) კ 3-4: ᓉᄊ‫ۭى‬ᓸΚϩѲკ b. ୏ᄊᓸΚϩѲკ ԏ໣‫ڙ‬ෳ‫ޣ‬ӧՉ‫و‬ਔǴဌۭௗ᝻Ӧय़ӄำ‫ޑ‬ᓸΚϩѲკǶ. კ 3-5: ୏ᄊ‫ۭى‬ᓸΚϩѲკ. - 26 -.

(40) c. Ӛ୔༧ϐᓸΚୖኧ ҁჴᡍஒ‫ۭى‬ϩࣁΜঁ୔༧Ǵа 500Hz ϐ‫ڗ‬ኬ౗ԏ໣‫ঁ؂‬ᓸΚག ෳൂϡӧ᏾ঁઠҥයύ‫ޑډڙ‬ΚໆǶਥᏵᓸΚགෳൂϡ‫ޑ‬ϩթኳ Ԅٰ،‫ۓ‬Ӛ୔༧ϐՏ࿼ᆶय़ᑈ(area size)Ǵ٠Ъीᆉр᏾ঁ୔ୱӧ ઠҥයύ‫ঁ؂‬ਔ໔ᗺ΢‫ޑ‬ѳ֡ᓸΚ(mean pressure)Ǵ٠Ъ኱૶рന εѳ֡ᓸΚ(max mean pressure)ǵᓸΚр౜ਔ໔(start time)ǵᓸΚ่ ‫״‬ਔ໔(end time)ǵനεᓸΚวғਔ໔(timing of max pressure)฻Ο ໨ୖኧǴฅࡕӆ٩ᏵᓸΚр౜‫ډ‬നεॶวғ೭ࢤය໔ϣ‫ޑ‬ᓸΚቚ уॶीᆉрѳ֡ॄၩ౗(loading rate)ǴനࡕჹᓸΚਔ໔Ԕጕᑈϩी ᆉрፂໆ(impulse)Ǵ٠Ъ኱૶рൂᗺനεᓸΚวғՏ࿼аϷኧॶ (max peak pressure)฻ୖኧǶҁჴᡍаനεѳ֡ᓸΚ(Max P)ǵѳ֡ ॄၩ౗(MLR)ǵፂໆ(Impulse)ǵനεൂᗺᓸΚ(MPP)Ѥ‫ޣ‬բࣁЬा ‫ޑ‬ϩ‫ୖ݋‬ኧǴӚୖኧж߄ϐཀကஒ‫ܭ‬Π࿯௶ॊϐǶ. - 27 -.

(41) d. Ӛ୔༧‫ۓ‬က 1. 2. 3. 4. 5.. Hallux(T1) Toe 2-5(T2-5) 1st Metatarsal bone(MT1) 2nd Metatarsal bone(MT2) 3rd Metatarsal bone(MT3). 6. 7. 8. 9. 10.. 4th Metatarsal(MT4) 5th Metatarsal(MT5) Mid Foot(MFT) Medial Heel(MH) Lateral Heel(LH). კ 3-6: ‫ۭى‬ᓸΚϩ୔კ. 3-4-3 ੰўፓࢗ(History taking) നࡕаୢບ‫ޑ‬БԄԏ໣஻‫ޣ‬ϐ࣬ᜢੰўǴхࡴၸѐύኰઓ࿶ੰᡂ ўǵҞ߻Ҕᛰ௃‫׎‬ǵ࣬ᜢΠަ੯ੰў฻Ƕ. - 28 -.

(42) ಃϖ࿯ʳ ख़ाӜຒញကᆶᏹբࠠ‫ۓ‬က ΋.ʳ ‫؁ٿ‬Бଞ(2 step protocol) ҁࣴ‫ࡰ܌ز‬ϐ‫؁ٿ‬БଞǴཀࡰӧԏ໣‫ڙ‬ෳ‫ޣ‬Չ‫࣬و‬ᜢ௃ൔਔǴа ଆ‫ޑࡕ؁‬ಃΒ‫؁‬໒‫ۈ‬ᘏ‫ڗ‬ၗ਑Ƕӧғ‫ނ‬ΚᏢϷᙴᕍሦୱύǴᆶՉ ‫࣬و‬ᜢϐΚᏢࣴ‫ز‬Ǵ‫؁ٿ‬Бଞς᛾ܴӧ‫ۭى‬ᓸΚϐ߄౜ᆶ Mid Gait Protocal ٠คᡉ๱ৡ౦(Bus & de Lange, 2005)Ǵӆෳߞࡋ‫ؼ‬ ӳǴࡺ௦Ҕ‫؁ٿ‬БଞǶ Β.ʳ ୔ୱѳ֡ᓸΚ(Mean pressure) ൂ΋୔ୱǴӧࢌ΋ᕓ໔‫ൂޑ‬Տय़ᑈ‫ڙ‬ΚॶǶԶ೭ঁѳ֡ॶӧࢌঁ ਔ໔ᗺ΢཮ԖཱུεॶǴҁჴᡍύᆀࣁനεѳ֡ᓸΚ(Max P)ǶӚ ୔ѳ֡ᓸΚࣣᒿਔ໔Ԗ‫܌‬ᡂϯǴௗ᝻‫ޑ‬໩‫ׇ‬ҭό࣬ӕǴࡺ‫୔؂‬ϐ ѳ֡ᓸΚനεॶ٠ό཮р౜ӧӕ΋ਔ໔ᗺ΢ǴൂՏࣁN/cm2Ƕ Ο.ʳ ѳ֡ॄၩ౗(Mean Loading rate) ཀࡰவ၀୔ୱௗ᝻Ӧय़ᕓ໔ଆ‫ډ‬നεॶ‫ޑ‬ቚу౗ǴஒᓸΚჹਔ໔ ଺კǴଆ‫ۈ‬ਔ໔‫ډ‬നεᓸΚр౜‫୔ޑ‬໔ϣϐѳ֡௹౗ǶीᆉБԄ ӵΠǺ LoadingΓ rate. PMAX 0 TMAX T0. ѳ֡ॄၩ౗ёբࣁൂՏਔ໔ϣᓸΚቚуำࡋ‫ࡰޑ‬኱ǴൂՏࣁ.

(43) N/cm2ǸsecǶ Ѥ.ʳ ፂໆ(Imupulse) ҁჴᡍϐፂໆаѳ֡ᓸΚჹਔ໔଺კǴԔጕΠϐय़ᑈж߄ϐǶፂ ໆёբࣁ΋ԛ‫؁‬ᄊຼයύǴ၀୔ୱ‫ڙ܍‬ϐᕴૈໆϐࡰ኱ǴൂՏࣁ NǸsec/ cm2Ƕ ϖ.ʳ ൂᗺനεᓸΚ(Max Peak Pressure) ཀࡰൂ΋୔ୱύ‫܌ޑ‬ԖᓸΚགᔈൂϡǴӧ᏾ঁௗ᝻ਔ໔ύୀෳ‫ډ‬ ‫ޑ‬നεΚໆǴ‫୔ঁ؂‬ୱ೿ӚԾԖ΋ঁനεᓸΚᗺǴ٠Ъό཮р౜ ӧӕ΋ਔ໔ᗺ΢ǴൂՏࣁN/cm2Ƕ. ಃϤ࿯ʳ ၗ਑ϩ‫݋‬Ϸೀ౛ ΋.ʳ ௶ॊ‫܄‬಍ी (descriptive statistic) а௶ॊ‫܄‬಍ीٰඔॊӚಔ‫ڙ‬ෳ‫ޣ‬ϐ୷ҁၗ਑ǴӚ໨‫ۭى‬ᓸΚୖ ኧǴՈᑗෳ၂่݀Ƕ Β.ʳ ൂӢηᡂ౦ኧϩ‫( ݋‬One-way ANOVA) аൂӢηᡂ౦ኧϩ‫݋‬ԵᡍᓸΚ฻ୖኧӧӚ୔ୱϐ໔ࢂցԖᡉ๱ ৡ౦Ƕ Ο.ʳ Ҝᅟහᑈৡ࣬ᜢ (Pearson’ s correlation coefficients) ճҔҜᅟහᑈৡ࣬ᜢ಍ीБ‫ٰݤ‬КၨǴՖᅿୖኧᆶՈᑗᡂϯϐ໔. - 30 -.

(44) ‫ڀ‬Ԗ࣬ᜢ‫܄‬Ƕ. - 31 -.

(45) ಃစകʳ ࣴ‫่݀ز‬ ಃ΋࿯ʳ ‫ڙ‬ෳ‫ޣ‬ ҁࣴ‫ز‬ϐ‫ڙ‬ෳ‫ޣ‬΋Ӆ 500 ӜǴ‫ځ‬ύҗ‫ܭ‬ၗ਑ԏ໣όӄаϷ‫ي‬ᡏ‫ރ‬ ‫ݩ‬ό٫҂ૈֹԋӄ೽ࢬำ‫ޣ‬όӈΕ಍ीǴനࡕᕴԏਢΓኧࣁ 432 ӜǴ ‫ځ‬ύԖ 222 Ӝζ‫܄‬Ǵ210 Ӝ‫܄ت‬Ǵѳ֡ԃស 59.1² 12.6 ྃ(min:18, max:89)Ǵѳ֡‫ي‬ଯ 160.9² 7.9cmǴѳ֡ᡏख़ 66.4² 11.9kgǶ. ߄ 4- 1: ‫ڙ‬ෳ‫୷ޣ‬ҁၗ਑ϐѳ֡ॶᆶ኱ྗৡ(Mean²S.D) ᑗֿੰಔ Γኧ. 432. ‫ي‬ଯ(cm). 160.9² 7.9. ᡏख़(kg). 66.4² 11.9. ԃស(years). 59.1² 12.6. ಃΒ࿯ʳ ‫ۭى‬ᓸΚୖኧ ҁჴᡍԏ໣ 4 ᅿ‫ۭى‬ᓸΚ࣬ᜢୖኧǴϩձࣁനεѳ֡ᓸΚ(Max P)ǵѳ֡ॄၩ౗(MLR)ǵፂໆ(Impulse)ǵനεൂᗺᓸΚ(MPP)Ƕҗ‫ܭ‬ ᄍҔᜐᆶߚᄍҔᜐ‫ۭى‬ᓸΚ࣬ᜢୖኧϐৡ౦ࣣၲᡉ๱኱ྗǴࡺаΠ‫ى‬ - 32 -.

(46) ۭᓸΚ࣬ᜢୖኧࣣϩࣁᄍҔୁ(D’m)ᆶߚᄍҔୁ(ND)ϩձКၨ٠Ъ և౜ϐǶΞǴനεѳ֡ᓸΚΏ၀୔ୱௗ᝻Ӧय़ၸำύǴр౜നεॶ‫ޑ‬ ᕓ໔ᓸΚǴࡺ‫؂‬΋୔༧ϐѳ֡നεᓸΚ٠ߚӕਔр౜Ǵ‫܌‬а‫ځ‬ᕴӝΨ ྽ฅό฻‫ܭ‬ӄ‫ى‬ѳ֡ᓸΚǶ. - 33 -.

(47) ߄ 4-2: ߚᄍҔဌӚ୔ୱᓸΚୖኧѳ֡ॶᆶ኱ྗৡ(Mean±S.D.) MLR Impulse MaxP MPP ND 2 2 2 (N/cm Θs) (NΘs /cm ) (N/cm ) (N/cm2) T1. 11.0̈́3.9ʳ. 42.9̈́22.0ʳ. 2.1̈́1.1ʳ. 37.8̈́16.5ʳ. T2-5. 2.7̈́1.2ʳ. 23.2̈́21.4ʳ. 0.4̈́0.2ʳ. 13.3̈́5.4ʳ. MT1. 10.8̈́4.3ʳ. 40.4̈́19.6ʳ. 2.6̈́1.2ʳ. 26.3̈́12.3ʳ. MT2. 19.3̈́4.7ʳ. 46.4̈́16.8ʳ. 5.2̈́1.3ʳ. 48.0̈́17.1ʳ. MT3. 22.2̈́5.5ʳ. 48.8̈́17.8ʳ. 6.2̈́1.5ʳ. 51.9̈́17.4ʳ. MT4. 14.2̈́3.6ʳ. 34.2̈́11.6ʳ. 4.1̈́1.2ʳ. 35.8̈́10.1ʳ. MT5. 8.1̈́3.1ʳ. 24.9̈́13.2ʳ. 2.2̈́1.0ʳ. 22.3̈́10.8ʳ. MFT. 4.2̈́1.6ʳ. 20.0̈́10.9ʳ. 1.1̈́0.6ʳ. 15.2̈́5.7ʳ. MH. 16.9̈́3.5ʳ. 85.4̈́28.3ʳ. 4.9̈́1.2ʳ. 38.2̈́9.9ʳ. LH. 15.3̈́3.3ʳ. 75.7̈́24.3ʳ. 4.4̈́1.1ʳ. 36.9̈́8.8ʳ. D’m: Domain sideǶND: Non-domain sideǶ. - 34 -.

(48) ߄ 4-3:ᄍҔဌӚ୔ୱᓸΚୖኧѳ֡ॶᆶ኱ྗৡ(Mean±S.D.) MLR Impulse MaxP MPP D’m 2 2 2 (N/cm Θs) (NΘs /cm ) (N/cm ) (N/cm2) T1. 9.9̈́3.5ʳ. 47.4̈́27.3ʳ. 1.9̈́1.1ʳ. 32.9̈́16.8ʳ. T2-5. 3.3̈́1.3ʳ. 24.8̈́20.3ʳ. 0.5̈́0.3ʳ. 13.9̈́5.7ʳ. MT1. 10.5̈́3.6ʳ. 35.1̈́19.3ʳ. 2.6̈́1.0ʳ. 29.9̈́12.6ʳ. MT2. 22.1̈́5.7ʳ. 48.8̈́17.5ʳ. 6.0̈́1.5ʳ. 54.3̈́17.9ʳ. MT3. 21.0̈́5.2ʳ. 44.5̈́16.4ʳ. 5.9̈́1.4ʳ. 50.7̈́15.7ʳ. MT4. 14.1̈́3.7ʳ. 33.6̈́14.2ʳ. 4.3̈́1.4ʳ. 33.0̈́11.5ʳ. MT5. 8.9̈́3.5ʳ. 27.3̈́14.7ʳ. 2.6̈́1.2ʳ. 23.7̈́12.4ʳ. MFT 4.5̈́1.9ʳ. 22.2̈́14.6ʳ. 1.1̈́0.8ʳ. 14.3̈́5.9ʳ. MH. 15.4̈́3.4ʳ. 80.7̈́26.0ʳ. 4.3̈́1.2ʳ. 36.6̈́10.4ʳ. LH. 15.6̈́3.4ʳ. 82.4̈́31.1ʳ. 4.5̈́1.2ʳ. 36.5̈́10.7ʳ. D’m: Domain sideǶND: Non-domain sideǶ. ˠ˴̋ˣ. ˣ̅˸̆̆̈̅˸ʻˡ˂˶̀˅ʼ. ˅ˈ ˅˃ ˄ˈ. ˗ʺ̀ ˄˃. ˡ˗ ˈ ˃ ˧˄. ˧˅ˀˈ ˠ˧˄ ˠ˧˅ ˠ˧ˆ ˠ˧ˇ ˠ˧ˈ ˠ˙˧ ˠ˛. ˟˛. ˔̅˸˴. კ 4-1: ᄍҔᆶߚᄍҔဌѳ֡ᓸΚϩѲКၨკ - 35 -.

(49) ˠ˟˥ ˄˃˃ ˠ˟˥ʻˡ˂˶̀ ˅Θ̆ʼ. ˋ˃ ˉ˃ ˗ʺ̀ ˇ˃ ˡ˗. ˅˃ ˃ ˧˄. ˧˅ˀˈ ˠ˧˄ ˠ˧˅ ˠ˧ˆ ˠ˧ˇ ˠ˧ˈ ˠ˙˧ ˠ˛. ˟˛. ˔̅˸˴. კ 4- 2: ᄍҔᆶߚᄍҔဌѳ֡ॄၩ౗ϩѲКၨკ! ˜̀̃̈˿̆˸ ˊ ˜̀̃̈˿̆˸ʻˡΘ̆ʳ˂˶̀ ˅ʼ. ˉ ˈ ˇ ˆ. ˗ʺ̀. ˅. ˡ˗. ˄ ˃ ˧˄. ˧˅ˀˈ ˠ˧˄ ˠ˧˅ ˠ˧ˆ ˠ˧ˇ ˠ˧ˈ ˠ˙˧ ˠ˛. ˟˛. ˔̅˸˴. კ 4- 3: ᄍҔᆶߚᄍҔဌፂໆϩѲКၨკ ˠˣˣ ˉ˃. ˅. ˠˣˣʻˡ˂˶̀ ʼ. ˈ˃ ˇ˃ ˆ˃ ˗ʺ̀. ˅˃. ˡ˗. ˄˃ ˃ ˧˄. ˧˅ˀˈ ˠ˧˄ ˠ˧˅ ˠ˧ˆ ˠ˧ˇ ˠ˧ˈ ˠ˙˧ ˠ˛. ˟˛. ˔̅˸˴. კ 4- 4: ᄍҔᆶߚᄍҔဌൂᗺനεᓸΚϩѲКၨკ - 36 -.

(50) ᚈဌ‫ۭى‬ϩԋ 10 ঁ୔ୱϩձև౜‫ځ‬ѳ֡നεᓸΚॶ(MaxP)Ǵᡉ Ңӵ߄ 4-2 ᆶ 4-3Ƕ‫ځ‬ύᄍҔဌϐѳ֡ᓸΚനεॶပ‫ ܭ‬MT2 ୔(ಃΒ ဌඓମ)ǴԛଯᓸΚॶ߾‫ ܭ‬MT3 ୔ǹԶߚᄍҔဌ࡞ӳ࣬ϸǴനεॶပ ‫ ܭ‬MT3 ୔ǴԛଯᓸΚॶ߾ပ‫ ܭ‬MT2 ୔(ӵკ 4-1)Ƕ ჹѳ֡ॄၩ౗Զ‫ق‬Ǵനεॶᚈဌ೿р౜ӧဌၟǴՠߚᄍҔဌဌၟ ϣୁε‫ܭ‬ѦୁǴԶᄍҔဌ߾࡞ӳ࣬ϸ(‫ـ‬კ 4-2)Ƕ ፂໆёբࣁӧ᏾ঁઠҥයύ‫ޑډڙ܌‬ӄ೽ૈໆ‫ޑ‬ಕᑈࡰ኱Ǵҁჴ ᡍᡉҢǴᄍҔဌύໆനεॶр౜ӧ MT3 ୔ୱǴԶߚᄍҔဌϐፂໆന εॶр౜ӧ MT2 ୔ୱǶ ऩൂપᢀჸൂᗺനεᓸΚǴߚᄍҔဌ‫ൂޑ‬ᗺനεᓸΚр౜ӧ MT3 ୔ୱǴMT2 ԛϐǴಃΟ߾ࢂεဌ೩ǹՠࢂӧᄍҔဌୁǴനεᓸΚॶ р౜ӧ MT2ǴMT3 ԛϐǴಃΟӕኬࢂεဌ೩(‫ـ‬კ 4-4)Ƕ. - 37 -.

(51) ಃΟ࿯ʳ ᖏ‫׉‬ᔠࢗၗ਑ ҁჴᡍЬाԏ໣ϐჴᡍ࠻ၗ਑(laboratory data)ᑗֿੰ஻ϐᑗϯՈ Յન(HbA1c)аϷ໭߻Ոᑗ(A.C.)Ǵ௓‫ڋ‬ಔ٠คՈᑗ࣬ᜢၗ਑Ƕനࡕ࿶ ၸ᏾౛ǴӅԖ 201 Տ‫ڙ‬ෳ‫ڀޣ‬Ԗֹ᏾ՈᑗइᒵǶՈᑗ࣬ᜢୖኧၗ਑ӵ ߄ 4-4Ƕ ! ߄ 4-4: ᖏ‫׉‬ᔠࢗၗ਑ѳ֡ॶᆶ኱ྗৡ(Mean² S.D.) Γኧ. HbA1c(%). A.C.(mg/dl). 201. 8.0² 1.6. 160.7² 58.0. - 38 -.

(52) ಃѤ࿯ʳ ᖏ‫׉‬ᔠࢗၗ਑ᆶ‫ۭى‬ᓸΚϐ࣬ᜢ‫܄‬ 4-4-1 ᖏ‫׉‬ᔠࢗၗ਑ᆶӚ୔୔ୱѳ֡ᓸΚϐ࣬ᜢ‫܄‬ ӃीᆉрঁΓᓸΚୖԵॶ)ᡏख़ y ख़Κуೲࡋ0‫ۭى‬य़ᑈ*ǴӆҔ ѳ֡നεᓸΚᆶϐ࣬෧‫؃‬рৡॶǴճҔৡॶᆶᑗϯՈՅનीᆉ࣬ᜢ ‫܄‬ǴӚϩ୔࣬ᜢ‫܄‬ᡉҢӵΠ߄Ƕ! ! ߄ 4-5: ᑗϯՈՅનᆶӚ୔ѳ֡ᓸΚ࣬ᜢ߯ኧ߄ ʳ. HbA1c vs. Max P-BW/AREAʳ ND. Area. T1 T2-5 MT1 MT2 MT3 MT4 MT5 MFT MH LH. r. D’m Sig.. r. Sig.. 0.444. >0.001*. 0.406. >0.001*ʳ. -0.021 0.333. 0.784 >0.001*. 0.041 0.396. 0.612ʳ >0.001*ʳ. 0.054 0.075 0.046. 0.469 0.310 0.531. 0.255 0.08 0.053. 0.001*ʳ 0.277ʳ 0.468ʳ. -0.017 -0.003 0.154. 0.817 0.967 0.040*. 0.087 0.106 -0.051. 0.242ʳ 0.164ʳ 0.494ʳ. 0.120. 0.102. 0.072. 0.327ʳ. *: Pearson Correlation, p<0.05Ƕr: correlation coefficient of Pearson CorrelationǶSig.: significantǶD’m: Domain sideǶND: Non-domain sideǶ. - 39 -.

(53) ˆ˃ˁ˃. ˟˄ʳˠ˴̋ʳˣ. ˅˃ˁ˃. ˄˃ˁ˃. ˃ˁ˃. ˥ʳ˦̄ʳ˟˼́˸˴̅ʳːʳ˃ˁ˄ˌˊ. ˀ˄˃ˁ˃. ˉˁ˃. ˊˁ˃. ˋˁ˃. ˌˁ˃. ˄˃ˁ˃. ˄˄ˁ˃. ˄˅ˁ˃. ˄ˆˁ˃. ˛˵˔˄˶. კ 4- 5: ߚᄍҔဌ T1 ୔ᑗϯՈՅનᆶനεᓸΚॶණթკ ˆ˃ˁ˃. ˟ˆʳˠ˴̋ʳˣ. ˅˃ˁ˃. ˄˃ˁ˃. ˃ˁ˃. ˥ʳ˦̄ʳ˟˼́˸˴̅ʳːʳ˃ˁ˄˄˄. ˀ˄˃ˁ˃. ˉˁ˃. ˊˁ˃. ˋˁ˃. ˌˁ˃. ˄˃ˁ˃. ˄˄ˁ˃. ˄˅ˁ˃. ˄ˆˁ˃. ˛˵˔˄˶. კ 4- 6: ߚᄍҔဌ MT1 ୔ᑗϯՈՅનᆶനεᓸΚॶණթკ. - 40 -.

(54) ˆ˃ˁ˃. ˟ˌʳˠ˴̋ʳˣ. ˅˃ˁ˃. ˄˃ˁ˃. ˃ˁ˃. ˥ʳ˦̄ʳ˟˼́˸˴̅ʳːʳ˃ˁ˃˅ˇ. ˀ˄˃ˁ˃. ˉˁ˃. ˊˁ˃. ˋˁ˃. ˌˁ˃. ˄˃ˁ˃. ˄˄ˁ˃. ˄˅ˁ˃. ˄ˆˁ˃. ˛˵˔˄˶. კ 4-7: ߚᄍҔဌ MH ୔ᑗϯՈՅનᆶനεᓸΚॶණթკ ˅˃ˁ˃. ˄ˈˁ˃. ˥˄ʳˠ˴̋ʳˣ. ˄˃ˁ˃. ˈˁ˃. ˃ˁ˃. ˀˈˁ˃ ˥ʳ˦̄ʳ˟˼́˸˴̅ʳːʳ˃ˁ˄ˉˈ. ˀ˄˃ˁ˃. ˉˁ˃. ˊˁ˃. ˋˁ˃. ˌˁ˃. ˄˃ˁ˃. ˄˄ˁ˃. ˄˅ˁ˃. ˄ˆˁ˃. ˛˵˔˄˶. კ 4-8: ᄍҔဌ T1 ୔ᑗϯՈՅનᆶനεᓸΚॶණթკ. - 41 -.

(55) ˆ˃ˁ˃. ˥ˆʳˠ˴̋ʳˣ. ˅˃ˁ˃. ˄˃ˁ˃. ˃ˁ˃. ˥ʳ˦̄ʳ˟˼́˸˴̅ʳːʳ˃ˁ˄ˈˊ. ˀ˄˃ˁ˃. ˉˁ˃. ˊˁ˃. ˋˁ˃. ˌˁ˃. ˄˃ˁ˃. ˄˄ˁ˃. ˄˅ˁ˃. ˄ˆˁ˃. ˛˵˔˄˶. კ 4-9: ᄍҔဌ MT1 ୔ᑗϯՈՅનᆶനεᓸΚॶණթკ. ˇ˃ˁ˃. ˥ˇʳˠ˴̋ʳˣ. ˆ˃ˁ˃. ˅˃ˁ˃. ˄˃ˁ˃. ˥ʳ˦̄ʳ˟˼́˸˴̅ʳːʳ˃ˁ˃ˉˈ. ˃ˁ˃. ˉˁ˃. ˊˁ˃. ˋˁ˃. ˌˁ˃. ˄˃ˁ˃. ˄˄ˁ˃. ˄˅ˁ˃. ˄ˆˁ˃. ˛˵˔˄˶. კ 4-10: ᄍҔဌ MT2 ୔ᑗϯՈՅનᆶനεᓸΚॶණթკ. - 42 -.

(56) ߄ 4-6;!໭߻ՈᑗᆶӚ୔ѳ֡ᓸΚ࣬ᜢ߯ኧ߄ A.C. vs Max P-BW/AREA ND. D’m. Area. r. Sig.. r. Sig.. T1 T2-5 MT1 MT2 MT3 MT4 MT5 MFT MH LH. 0.0974ʳ 0.0738ʳ. 0.1186ʳ 0.2618ʳ. 0.0961ʳ 0.0474ʳ. 0.1273ʳ 0.4829ʳ. 0.0772ʳ. 0.2203ʳ. 0.1094ʳ. 0.0799ʳ. 0.1143ʳ. 0.0657ʳ. 0.1386ʳ. 0.0257*ʳ. 0.1054ʳ 0.0385ʳ. 0.0898ʳ 0.5367ʳ. 0.1558ʳ 0.1036ʳ. 0.0120*ʳ 0.0963ʳ. -0.0664ʳ 0.0330ʳ 0.0389ʳ. 0.2888ʳ 0.6122ʳ 0.5325ʳ. 0.0475ʳ 0.0415ʳ 0.0620ʳ. 0.4495ʳ 0.5205ʳ 0.3202ʳ. 0.1113ʳ. 0.0731ʳ. 0.1076ʳ. 0.0841ʳ. *: Pearson Correlation, p< 0.05Ƕr: correlation coefficient of Pearson CorrelationǶSig.: significantǶD’m: Domain sideǶND: Non-domain sideǶ. ˋ˃ˁ˃˃. ˠ˴̋ʳˣʻˡ˂˶̀˱˅ʼ. ˉ˃ˁ˃˃. ˇ˃ˁ˃˃. ˅˃ˁ˃˃. ˥ʳ˦̄ʳ˟˼́˸˴̅ʳːʳ˃ˁ˃˄ˌ ˃ˁ˃˃ ˄˃˃ˁ˃˃. ˅˃˃ˁ˃˃. ˆ˃˃ˁ˃˃. ˇ˃˃ˁ˃˃. ˈ˃˃ˁ˃˃. ˔˖ʻ̀˺˂˷˿ʼ. კ 4-11: ᄍҔဌ MT2 ୔໭߻ՈᑗᆶനεᓸΚॶණթკ. - 43 -.

(57) ˊ˃ˁ˃˃ ˉ˃ˁ˃˃. ˠ˴̋ʳˣʻˡ˂˶̀˱˅ʼ. ˈ˃ˁ˃˃ ˇ˃ˁ˃˃ ˆ˃ˁ˃˃ ˅˃ˁ˃˃ ˄˃ˁ˃˃ ˥ʳ˦̄ʳ˟˼́˸˴̅ʳːʳ˃ˁ˃˅ˇ ˃ˁ˃˃ ˄˃˃ˁ˃˃. ˅˃˃ˁ˃˃. ˆ˃˃ˁ˃˃. ˇ˃˃ˁ˃˃. ˈ˃˃ˁ˃˃. ˔˖ʻ̀˺˂˷˿ʼ. კ 4-12: ᄍҔဌ MT3 ୔໭߻ՈᑗᆶനεᓸΚॶණթკ. ஒᑗϯՈՅનᆶ໭߻ՈᑗϩձᆶӚ୔ѳ֡ᓸΚ຾ՉҜᅟහᑈৡ ࣬ᜢᔠᡍǶᑗϯՈՅનᆶӚ୔ѳ֡ᓸΚϐ࣬ᜢ߯ኧᆶᡉ๱Нѳӵ߄ 4-5 ‫܌‬ҢǴӧᚈဌ T1 ୔ᆶᑗϯՈՅનԖύࡋ҅࣬ᜢǶԶӧߚᄍҔဌ ‫ ޑ‬MT1 ୔և౜ύࡋ҅࣬ᜢǴဌၟϣୁ߾և౜եࡋ҅࣬ᜢǴ‫ځ‬Ꭹ୔ୱ ֡ௗ߈ค࣬ᜢǴЪ҂ၲᡉ๱НѳǶԶᄍҔဌ߾ӧ MT1 ୔Ԗύࡋ҅࣬ ᜢǴMT2 ୔Ԗեࡋ҅࣬ᜢǶ ໭߻ՈᑗᆶӚ୔ѳ֡ᓸΚϐ࣬ᜢ߯ኧᡉҢӵ߄ 4-6ǴӧᄍҔဌ MT2 ୔(2nd Metatarsal)ǵMT3 ୔(3rd Metatarsal)Ԗեࡋ҅࣬ᜢǴ‫ځ‬Ꭹ୔ ୱࣣ߈Яค࣬ᜢǴЪ҂ၲᡉ๱НѳǶ. - 44 -.

(58) 4-4-2 ᖏ‫׉‬ᔠࢗၗ਑ᆶൂᗺനεᓸΚϐ࣬ᜢ‫܄‬ ߄ 4-7; ᑗϯՈՅનᆶӚ୔ൂᗺനεᓸΚ࣬ᜢ߯ኧ߄ ʳ. HbA1c vs MPP-BW/AREAʳ ND. Area. T1 T2-5 MT1 MT2 MT3 MT4 MT5 MFT MH LH. r. D’m. 0.269ʳ. Sig. >0.001*. -0.049ʳ. r 0.274. Sig. >0.001*ʳ. 0.524. 0.107. 0.183ʳ. 0.231ʳ. 0.002*. 0.189. 0.012*ʳ. 0.116ʳ 0.029ʳ. 0.120 0.690. 0.155 -0.053. 0.040*ʳ 0.477ʳ. 0.035ʳ -0.017ʳ 0.096ʳ. 0.640 0.823 0.210. -0.048 -0.024 0.124. 0.519ʳ 0.745ʳ 0.103ʳ. 0.051ʳ 0.020ʳ. 0.493 0.787. 0.025 0.076. 0.731ʳ 0.301ʳ. *: Pearson Correlation, p<0.05Ƕr: correlation coefficient of Pearson CorrelationǶSig.: significantǶD’m: Domain sideǶND: Non-domain sideǶ!. ! ! !. - 45 -.

(59) ˄˅˃ˁ˃. ˄˃˃ˁ˃. ˟˄ʳˠˣˣ. ˋ˃ˁ˃. ˉ˃ˁ˃. ˇ˃ˁ˃. ˅˃ˁ˃. ˃ˁ˃ ˥ʳ˦̄ʳ˟˼́˸˴̅ʳːʳ˃ˁ˃ˊ˅. ˀ˅˃ˁ˃. ˉˁ˃. ˊˁ˃. ˋˁ˃. ˌˁ˃. ˄˃ˁ˃. ˄˄ˁ˃. ˄˅ˁ˃. ˄ˆˁ˃. ˛˵˔˄˶. კ 4-13: ߚᄍҔဌ T1 ୔ᑗϯՈՅનᆶനεൂᗺᓸΚණթკ ˋ˃ˁ˃. ˟ˆʳˠˣˣ. ˉ˃ˁ˃. ˇ˃ˁ˃. ˅˃ˁ˃. ˃ˁ˃. ˥ʳ˦̄ʳ˟˼́˸˴̅ʳːʳ˃ˁ˃ˈˆ. ˉˁ˃. ˊˁ˃. ˋˁ˃. ˌˁ˃. ˄˃ˁ˃. ˄˄ˁ˃. ˄˅ˁ˃. ˄ˆˁ˃. ˛˵˔˄˶. კ 4-14: ᄍҔဌ MT1 ୔ᑗϯՈՅનᆶനεൂᗺᓸΚණթკ. - 46 -.

(60) ˄˅˃ˁ˃. ˄˃˃ˁ˃. ˥˄ʳˠˣˣ. ˋ˃ˁ˃. ˉ˃ˁ˃. ˇ˃ˁ˃. ˅˃ˁ˃. ˃ˁ˃ ˥ʳ˦̄ʳ˟˼́˸˴̅ʳːʳ˃ˁ˃ˊˈ. ˀ˅˃ˁ˃. ˉˁ˃. ˊˁ˃. ˋˁ˃. ˌˁ˃. ˄˃ˁ˃. ˄˄ˁ˃. ˄˅ˁ˃. ˄ˆˁ˃. ˛˵˔˄˶. კ 4-15;!ᄍҔဌ U2 ୔ᑗϯՈՅનᆶനεൂᗺᓸΚණթკ ˄˃˃ˁ˃. ˋ˃ˁ˃. ˥ˆʳˠˣˣ. ˉ˃ˁ˃. ˇ˃ˁ˃. ˅˃ˁ˃. ˃ˁ˃ ˥ʳ˦̄ʳ˟˼́˸˴̅ʳːʳ˃ˁ˃ˆˉ. ˀ˅˃ˁ˃. ˉˁ˃. ˊˁ˃. ˋˁ˃. ˌˁ˃. ˄˃ˁ˃. ˄˄ˁ˃. ˄˅ˁ˃. ˄ˆˁ˃. ˛˵˔˄˶. კ 4-16;!ᄍҔဌ NU2 ୔ᑗϯՈՅનᆶനεൂᗺᓸΚණթკ. - 47 -.

(61) ˄ˈ˃ˁ˃. ˥ˇʳˠˣˣ. ˄˃˃ˁ˃. ˈ˃ˁ˃. ˃ˁ˃ ˥ʳ˦̄ʳ˟˼́˸˴̅ʳːʳ˃ˁ˃˅ˇ. ˉˁ˃. ˊˁ˃. ˋˁ˃. ˌˁ˃. ˄˃ˁ˃. ˄˄ˁ˃. ˄˅ˁ˃. ˄ˆˁ˃. ˛˵˔˄˶. კ 4-17;!ᄍҔဌ NU3 ୔ᑗϯՈՅનᆶനεൂᗺᓸΚණթკ ! ߄ 4-8;!໭߻ՈᑗᆶӚ୔ൂᗺനεᓸΚ࣬ᜢ߯ኧ߄ A.C. vs MPP-BW/AREA ND. D’m. Area. r. Sig.. r. Sig.. T1 T2-5 MT1 MT2 MT3 MT4 MT5 MFT MH LH. 0.0433ʳ 0.0982ʳ 0.0603ʳ. 0.4890ʳ 0.1341ʳ 0.3398ʳ. 0.0504ʳ 0.0447ʳ 0.0651ʳ. 0.4250ʳ 0.5087ʳ 0.2995ʳ. 0.0090ʳ 0.0060ʳ. 0.8857ʳ 0.9231ʳ. 0.0567ʳ 0.0928ʳ. 0.3653ʳ 0.1372ʳ. 0.0819ʳ -0.0813ʳ. 0.1880ʳ 0.1956ʳ. 0.1061ʳ 0.0458ʳ. 0.0901ʳ 0.4670ʳ. 0.0936ʳ 0.0672ʳ. 0.1491ʳ 0.2814ʳ. 0.1010ʳ 0.0321ʳ. 0.1209ʳ 0.6111ʳ. 0.0221ʳ. 0.7228ʳ. 0.0753ʳ. 0.2269ʳ. r: correlation coefficient of Pearson CorrelationǶSig.: significantǶD’m: Domain sideǶND: Non-domain sideǶ. !. - 48 -.

(62) ஒᑗϯՈՅનᆶ໭߻ՈᑗϩձᆶӚ୔ൂᗺനεᓸΚ຾ՉҜᅟහ ᑈৡ࣬ᜢᔠᡍǶᑗϯՈՅનᆶӚ୔ൂᗺനεᓸΚϐ࣬ᜢ߯ኧᆶᡉ๱Н ѳӵ߄ 4-7 ‫܌‬ҢǴӧߚᄍҔဌT1 ୔ǵMT1 ୔(1st Metatarsal)аϷᄍҔ ဌToe1 ୔ǵMT1 ୔аϷMT2 ୔ᆶᑗϯՈՅનԖեࡋ҅࣬ᜢǴЪၲᡉ ๱኱ྗǶ‫ځ‬Ꭹ୔ୱࣣௗ߈ค࣬ᜢǴ‫܈‬҂ၲᡉ๱НѳǶ ໭߻ՈᑗᆶӚ୔ѳ֡ᓸΚϐ࣬ᜢ߯ኧᡉҢӵ߄ 4-8Ǵ‫܌‬Ԗ୔ୱࣣ ߈Яค࣬ᜢǴ‫܈‬҂ၲᡉ๱НѳǶ. - 49 -.

(63) ಃҴകʳ ૸ፕ ೸ၸϩ୔௖૸‫ۭى‬ᓸΚǴёаว౜‫ى‬೽ᓸΚ੝ձ໣ύӧࢌ٤೽ ՏǴҁകஒ೴໨૸ፕ‫ۭى‬όӕ୔ୱӚև౜ব٤όӕϐᖿ༈Ǵ٠Ъব٤ ೽ϩஒᒿՈᑗଆҷԶᡂϯǶ. ಃ΋࿯ʳ ୔ୱѳ֡ᓸΚ ӧԐය‫زࣴޑ‬ύǴԏ໣‫ޑ‬ᓸΚӭъѝࢂ΋᏾ঁઠҥයύࢌ΋ᕓ໔ р౜‫ޑ‬ᓸΚനεॶǴ໻З‫ܭ‬΋ঁλ୔༧ǴԶЪόᆅ೭΋ᗺр౜ӧဌ΢ ҺՖ΋ঁ೽ՏǴၨϿࣴ‫ز‬ଞჹ΋᏾ঁ୔༧‫ޑ‬ѳ֡ᓸΚ຾Չ௖૸Ƕ߈ԃ ߾ၨӭԜᜪ‫ޑ‬ϩ୔௖૸Ƕᆕᢀ᏾ঁ‫؁‬ᄊၸำǴѳ֡ᓸΚ‫࣬ޑ‬ჹཱུεॶ р౜ӧ‫ঁٿ‬೽ϩǺ‫߻ى‬аϷဌၟǶᄍҔဌѳ֡ᓸΚനεॶр౜ӧMT2 ୔(22.1²5.7N/cm2)ǵMT3 ୔(20.9²5.3 N/cm2)Ǵဌၟ‫ޑ‬ѦୁࣁಃΟ(15.6 ²3.4 N/cm2)ǶߚᄍҔဌୁനεॶр౜ӧMT3(22.2²5.5 N/cm2)୔ǴMT2 ୔ԛϐ(19.3²4.7 N/cm2)ǴဌၟϣୁಃΟ(16.9²3.5 N/cm2)Ƕऩஒҁჴᡍ ᆶ 2005 ԃPataky฻Γϐჴᡍ࣬КǴൂаኧᏵԶ‫ق‬Ǵ၀ჴᡍѓဌᆶҁ ჴᡍᄍҔဌኧᏵ࣬КǴεဌࡰϩձࣁ 20.5 N/cm2ᆶ 11.0 N/cm2Ǵৡ౦ ၨεǶಃ΋ဌඓମϩձࣁ 13.7 N/cm2ᆶ 10.8 N/cm2ǴԶಃΟဌඓମϩ ձࣁ 20.5 N/cm2ᆶ 22.2 N/cm2Ǵ࣬྽ௗ߈Ƕಃϖဌඓମϩձࣁ 16.0. - 50 -.

(64) N/cm2ᆶ 8.1 N/cm2Ǵৡ౦ሥεǶဌਥ೽ϩ߾ࣁ 18.7 N/cm2Ǵᆶҁჴᡍ ϐ 16.9 N/cm2(ϣୁ)ᆶ 15.3 N/cm2 (Ѧୁ)࣬ѐόᇻǶ ҁჴᡍीᆉᑗϯՈՅનᆶѳ֡ᓸΚϐ໔೽ϩԖᜢᖄ‫܄‬ǶӧߚᄍҔ ဌୁǴT1 ᆶ MT1 ୔ᆶᑗϯՈՅનև౜ύࡋ҅࣬ᜢ(r=0.44 аϷ r=0.33)ǴЪၲᡉ๱Нѳǹဌၟϣୁ‫ ޑ‬MH ୔ᆶᑗϯՈՅનԖեࡋ҅࣬ ᜢ(r=0.15, p=0.04)ǹ‫ځ‬Ꭹ୔༧ϐᓸΚᆶᑗϯՈՅન൳ЯคᜢǶԶᄍҔ ဌୁϐ T1ǵMT1 ୔ᆶᑗϯՈՅનև౜ύࡋ҅࣬ᜢ(r=0.41 аϷ r=0.40)ǹMT2 ୔և౜եࡋ࣬ᜢ(r=0.26, r=0.001)Ƕҁჴᡍ่݀ᡉҢǴ ӧ࿶ၸᡏख़኱ྗᓸΚൂՏϐਠ҅ࡕǴᑗϯՈՅનஒ཮ᆶεဌࡰаϷಃ ΋ဌඓମΠѳ֡ᓸΚԖጕ‫܄‬ᜢ߯ǴᡉҢ຾ΟঁДϣϐՈᑗऩ௓‫ڋ‬ό ‫ؼ‬ǴԖёૈ཮ϸࢀӧ‫ۭى‬ᓸΚ΢Ƕՠჹ‫ܭ‬Ոᑗϸᔈၨόᆒዴϐ໭߻Ո ᑗǴѝᆶᄍҔဌ MT2 ୔ǵMT3 ୔ǴཀջಃΒဌඓମᆶಃΟဌඓମԜ ᓸΚၨεॶр౜ϐ୔ୱᓸΚԖ҅࣬ᜢ‫܄‬ǴЪࣁեࡋ҅࣬ᜢ(r=0.14 а Ϸ r=0.16)ǶՈᑗϐᡂϯዴჴᆶ‫ۭى‬ᓸΚ࣬ᜢǴՈᑗ௓‫ڋ‬ό‫ؼ‬ำࡋ‫ޑ‬ ගଯǴӧΓᡏ‫ۭى‬ᓸΚനε‫୔ঁٿޑ‬ୱ‫ޑ‬ᓸΚΨ཮ᒿϐගଯǶҁჴᡍ Ψᢀჸ‫ډ‬Ǵ٠ߚӄ‫ى‬ϐᓸΚ೿ᒿՈᑗගϲԶԖܴዴ‫ޑ‬ᡂϯǴ೭ӆࡋᡍ ᛾ၸѐჴᡍύǴ‫ۭى‬ᓸΚ٠ߚӄ‫܄ى‬ගϲϐ่ፕǶ. - 51 -.

(65) ಃΒ࿯ʳ ѳ֡ॄၩ౗ ӧၸѐ‫زࣴޑ‬ύǴᗲϿԖࣴ‫ޔز‬ௗ૸ፕѳ֡ॄၩ౗‫ޣ‬Ǵѳ֡ॄၩ ౗ϐ‫ނ‬౛ཀကӧ‫߄ܭ‬౜‫ۭى‬ᓸΚගଯ‫ޑ‬ቚуำࡋǴ‫܈‬ቚуೲࡋǶ‫܈‬ӧ Չ‫ޑو‬ၸำύǴӧ initial contact ਔલЮԼԺ௓‫ڐڋ‬ፓԶҺҗަᡏԾҗ ပΠǴၨ৒ܰр౜ၨε‫ॄޑ‬ၩ౗Ǵ‫ۭى܈‬ௗ᝻य़લЮ጗ፂǴ‫ۭى‬ಔᙃ ᖓϯǴ೷ԋᓸΚགෳᏔᕓ໔ε൯ࡋ‫ڙ‬ΚǴԶߚൻ‫ׇ‬ᅌ຾ਔр౜ၨεϐ ॄၩ౗Ƕ‫ൂ܈‬પՉ‫و‬ೲࡋၨ‫ޣז‬Ǵ‫ॄځ‬ၩ౗ΨёૈၨεǶ ӧӚ୔ѳ֡ॄၩ౗ύǴЬाаဌၟϐMHǵLH‫୔ٿ‬ϐॄၩ౗ࣁന εǴᄍҔᆶߚᄍҔୁϐৡ౦٠όܴᡉǴѳ֡ॄၩ౗ϐനεॶࣁᄍҔဌ 82.4²31.1 N/cm2ǸsǴߚᄍҔဌ 85.4²28.3 N/cm2ǸsǶҗ‫ܭ‬ҁჴᡍ٠҂ ଞჹՉ‫و‬ೲࡋ຾Չ኱ྗϯǴёૈࢂෳໆॶϩණ‫ޑ‬౛җǶΞஒѳ֡ॄၩ ౗ᆶՈᑗ฻ᖏ‫׉‬ᔠෳ຾ՉҜᅟහᑈৡ࣬ᜢϐԵᡍǴ٠คև౜࣬ᜢ‫܄‬Ƕ ёૈࢂҗ‫ ܭ‬3 ঁДϣ‫ޑ‬Ոᑗᡂϯ΋ٰό‫ى‬а೷ԋ‫ۭى‬ಔᙃᖓϯǴΒٰ Ψό‫ى‬а೷ԋՉ‫و‬ೲࡋ‫ޑ‬εୋᡂ୏Ǵࡺ‫࣬ܭ‬ᜢ‫܄‬ᄊ૸ύѸคܴዴϐᖿ ༈Ƕ. ಃΟ࿯ʳ ፂໆ ፂໆࣁᓸΚ-ਔ໔ԔጕΠϐᑈϩǴж߄‫ى‬೽ӧ᏾ঁௗӦय़‫ޑ‬ၸำ ύǴᕴӅ‫ૈޑډڙ‬ໆࡰ኱Ƕӧၸѐ೚ӭࣴ‫ز‬ύ֡ԖගϷҁୖኧǴ‫܈‬а - 52 -.

(66) pressure-time integral ϐ‫׎‬Ԅ߄ၲ(Kanade, 2006)Ƕ җҁჴᡍள‫ޕ‬ǴߚᄍҔဌፂໆനεॶပ‫ ܭ‬MT3 ୔Ǵ‫ځ‬ԛ߾ࣁ MT2 ୔ǴᡉҢ೭‫୔ٿ‬ӧ᏾ঁ‫؁‬ᄊύ‫ڙ܍‬നεૈໆǴಃΟ߾ࢂဌၟϣୁǶჹ ᄍҔဌԶ‫ق‬Ǵനεॶр౜ӧ MT2 ୔Ǵ‫ځ‬ԛࣁ MT3 ୔ǴಃΟ߾ࣁဌၟ ѦୁǶᆶၸѐ Pataky ฻Γӧ 2005 ԃଞჹคᑗֿੰ௓‫ڋ‬ಔᆶᑗֿੰඤ ϐჹྣჴᡍύǴෳໆрѓဌ PTI(pressure-time integral)ϐനεॶՏ‫ܭ‬ ಃϖဌඓମǴಃΟဌඓମԛϐǴಃΟࣁဌၟϐ่݀ౣԖόӕǴҁჴᡍ ಃϖဌඓମϐፂໆӧ‫ٿ‬ဌܴ֡ᡉၨեǶ‫܈‬೚ࢂӢࣁ၀ჴᡍჹ‫ ܭ‬PTI ϐीᆉБԄᆶҁჴᡍόӕǶԶ௦ኬ‫ޑ‬௼ဂҁ‫ي‬όᄊԖ‫܌‬ৡ౦ϐࡺǶ ߈ԃϐࣴ‫ز‬ൔ֋ᡉҢ(Armstrong, 2004)Ǵҗ‫ܭ‬Չ‫و‬ೲࡋ཮‫ޔ‬ௗ೷ ԋ‫؁‬ᄊύᓸΚ‫ޑ‬ᡂϯǴ‫ޑو‬ຫᄌ‫ޑ‬ΓᓸΚຫλǴՠࢂঃऩीᆉ pressure-time integralǴ‫و‬ளᄌ‫ޑ‬ΓёૈϸԶ཮Ԗၨε‫ޑ‬ፂໆॶǶ Զӧჴᡍ࠻ᔠࢗၗ਑Бय़ǴᑗϯՈՅનᆶ໭߻Ոᑗ‫ޣٿ‬ჹ‫ܭ‬ፂໆ ϐ࣬ᜢ‫܄‬ीᆉॶࣣ҂ၲᡉ๱኱ྗǶ. ಃѤ࿯ʳ ൂᗺനεᓸΚ ൂᗺനεᓸΚॶࣁၸѐ 20 ԃ໔Ǵᑗֿੰ‫ۭى‬ᓸΚ࣬ᜢࣴ‫ز‬നத ᔈҔϐჴᡍၗ਑Ǵҗ‫ܭ‬ၸѐ‫ޑ‬ෳໆπ‫ڀ‬٠όӵϞВวၲǴᜤаᆒಒ୔ ϩ΋᏾ঁ୏ᄊၸำύ‫ޑ‬ϩ୔ᓸΚǴᒿ๱ႝတࣽ‫ޑמ‬ว৖ǴቹႽೀ౛‫מ‬. - 53 -.

(67) ೌ‫ޑ‬ᄽ຾Ǵ‫ۭى‬ᓸΚϐࣴ‫ز‬Бૈᖿ‫ܭ‬ӭኬϯǶൂᗺനεᓸΚࡰ‫ࢂޑ‬ӧ ᏾ঁઠҥයύǴ‫ۭى‬ௗ᝻‫܌ޑ‬ԖᓸΚགෳᏔ‫܌‬ௗ‫ޑډڙ‬ᕓ໔നεॶǶ Զҁჴᡍஒ‫ۭى‬ϩࣁ 10 ঁ୔ୱǴࡺൂᗺനεॶΨࢂ‫୔؂‬Ӛ΋ঁǶ ӧ‫߻ى‬೽ǴMT2 ୔(54.3²17.9 N/cm2)ᆶMT3 ୔(51.9²17.4 N/cm2) ϩձࣁᄍҔဌᆶߚᄍҔဌϐൂᗺനεॶϐനεॶǶԶεဌࡰ߾ࣁᚈဌ ൂᗺനεॶಃΟଯ‫୔ޑ‬ୱǶ1991 ԃFernado฻Γ‫ޑ‬ჴᡍǴஒᑗֿੰ஻ ٩ྣઓ࿶ੰᡂᆶ‫ى‬೽ᜢ࿯ࢲ୏‫ڙ‬ज़ϩಔǴ‫ځ‬ᓸΚനεॶр౜ӧঋ‫ڀ‬ᜢ ࿯ࢲ୏‫ڙ‬ज़аϷઓ࿶ੰᡂ‫ޣ‬Ƕ2001 ԃPeter฻Γ‫ޑ‬ჴᡍύǴஒઓ࿶ੰ ᡂǵຼᜐՈᆅੰᡂǵ‫ى‬೽ᡂ‫׎‬ǴаϷࢂցԖ‫ۭى‬ውᅬੰў฻ӭӢનٰ ஒᑗֿੰ஻ϩᜪǴঋ‫ڀ‬ӭᅿ‫ٳ‬วੱϐಔձǴ‫ۭى‬ᓸΚΨၨεǶऩᆶ 2005 ԃPataky฻Γ‫ޑ‬ჴᡍ࣬КၨǴόᆅӧѰѓဌǴдॺ‫ޑ‬ჴᡍ೿ࡰр εဌࡰᆶಃΟဌඓମЍൂᗺനεॶ࣬߈Ǵՠࢂҁჴᡍࡐܴᡉёаว ౜ǴεဌࡰϐൂᗺനεॶεऊѝԖMT2 ୔‫܈‬MT3 ୔‫ޑ‬ΟϩϐΒѰѓǶ ӧჴᡍ࠻ᔠࢗၗ਑Бय़Ǵҁჴᡍว౜ᑗϯՈՅનᆶߚᄍҔဌ T1 ୔аϷ MT1 ୔Ԗեࡋ҅࣬ᜢ(r=0.27 аϷ r=0.23)ǴЪၲᡉ๱኱ྗ (p>0.001 аϷ p=0.002)ǶԶᄍҔဌϩձࢂ T1ǵMT1ǵMT2 ೭Οঁ୔ ୱ(r=0.27, r=19, r=0.16)ǴᆶൂᗺനεᓸΚॶԖեࡋ҅࣬ᜢǴЪၲᡉ๱ Нѳ(p>0.001, p=0.01, p=0.04)Ƕࡺёᘜયрᑗֿੰ஻ऩߏය‫܄‬Ոᑗ௓ ‫ڋ‬ό‫(ؼ‬ᑗϯՈՅનᆶ 3 ঁДϣՈᑗѳ֡ॶև౜ጕ‫܄‬ᜢ߯)Ǵ߾ёૈᏤ. - 54 -.

(68) ठ‫ى‬೽ᓸΚനεॶ‫ޑ‬΢ϲǴՠᖿ༈٠҂ӵѳ֡നεᓸΚॶܴᡉǶ. - 55 -.