探討在三種不同方向的單腳跳躍落地時前十字韌帶傷害的危險因子

Risk Factors Related to Anterior Cruciate Ligament Injury During Single Leg Jump Landing Among Three Different Directions

前言：前十字韌帶(ACL)傷害通常與落地動作有關，以往的研究著重於討論不同的落地高度及男女性別動作上的差異，藉由施作跳躍落地測試，來探討相關的生物力學因子。然而可能造成ACL傷害的危險因子在不同落地方向的探討仍然未知，故本研究的目的旨在探討施作三種不同方向(前跳、斜跳、側跳)的跳躍單腳落地時，可能對於ACL造成傷害的危險因子。方法：本研究招募12名健康的男性受試者，進行單腳跳躍落地，受試者必須雙腳起跳，使用支撐腳單腳落地，各跳躍方向以三次成功的測試進行分析。統計方法使用相依樣本單因子變異數分析(one way ANOVA with repeat measured)，比較不同跳躍落地方向對下肢關節運動學及動力學的影響，以最小平方差異法(LSD)進行事後比較，各項統計考驗的顯著水準之α值定義為.05。結果：不同方向的跳躍單腳落地測試得到不同程度的ACL傷害危險因子的風險，在膝屈曲角度方面，前跳及斜跳方向的數值均顯著大於側跳，p值分別為.001及.017；脛前剪力亦是前跳與斜跳的數值顯著大於側跳，其p值均為.001；膝外翻力矩方面，與側跳比較，前跳(p<.01)；髖伸展力矩方面，前跳及斜跳也是顯著大於側跳的數值。結論與建議：側向跳躍單腳落地結果顯示屬於較硬式的落地策略，可能會有較高ACL的傷害風險，未來研究必須著重於探討較佳的落地策略及探討落地時下肢各關節緩衝能力的分析，以降低非接觸性ACL傷害的風險。

Purpose: Anterior cruciate ligament (ACL) injury is often associated with jump landing tasks. Studies were focused on the effects of landing height and gender differences associated with ACL injury while performing jump landing. The relationship between ACL risk factors and single leg jump landing among different directions were still unknown. The purpose of this study was to investigate risk factors related to anterior cruciate ligament injury during single leg jump landing among three different directions (forward， diagonal， lateral). Methods: Twelve healthy male subjects were recruited in this study. All subjects were asked to perform 3 successful trials at each directions (forward， diagonal， lateral). While jumping， subjects were asked to take off with both legs and landing with single supporting leg. One way ANOVA with repeated measures were used to compare biomechanical factors of the supporting leg among three different directions. LSD test was used for post hoc comparison. A significance level of 0.05 was set for all statistical tests. Results: The result showed that during single leg jump landing with different directions could result in different biomechanical factors to cause different ACL injury risk level. The peak knee flexion angles of forward and diagonal directions were significantly greater than lateral direction (p = .001 and p = .017). The peak anterior tibial shear forces of forward and diagonal directions were significantly greater (p = .001) than lateral direction. The data of peak knee valgus moments showed significantly difference (p < .01) among three landing directions. The peak hip extension moments of forward and diagonal directions were significantly greater (p < .01) than lateral direction. Conclusions: While landing at the lateral direction， a stiffer landing strategy could cause higher ACL injury rate. Future studies should be focus on investigating the best jump landing strategy， and analyzing better way to coordinate lower extremity joints while landing to reduce non-contact ACL injury risks.