脊柱矯具對於自發性脊柱側彎女性患者之動態表現

Abstract

背景 少有研究探討背架對青春期自發性脊柱側彎女性病人動靜態的效應。 目的 1) 比較青春期自發性脊柱側彎女性病人和健康人的動靜態表現差異; 2) 研究背架治療對青春期自發性脊柱側彎女性病人在立即和四個月後，跟治療前比 較，在動靜態表現差異; 3) 探討背架治療對青春期自發性脊柱側彎女性病人是 否帶來四個月的動作適應能力。 研究設計 前瞻性研究設計 受試者 15 位青春期自發性脊柱側彎女性病人，Cobb 角度介於20 到50 度，和健 康女孩15 位。 治療介入 為每位青春期自發性脊柱側彎女性病人量身訂製胸腰薦椎矯具 方法 測量走路時運動學資料及收集站姿時足底壓力軌跡。健康人僅測量一次， 病人則測量四次，分別是 治療前、背架立即治療後、治療四個月後沒有穿背架， 和治療四個月後有穿背架。 測量參數 動態參數包括: 行走時的時空參數、行走韻律及流暢性(諧波比值)、 行走身體旋轉偏置角度；靜態參數包含: 站姿足底壓力軌跡分佈、站姿時身體旋 轉偏置角度、頭部偏離身體中心線的距離。 結果 用諧波比值來測量行走時的韻律及流暢性，發現青春期自發性脊柱側彎女性 病人的表現較健康人不好，以絕對空間來看，是發生在上下的運動方向，以相對 空間來看，則是發生在前後的運動方向。四個月的背架效應，影響青春期自發性 vii 脊柱側彎女性病人頭部的左右運動的流暢性有變差，但從相對空間來看，從骨盆 看頭及從骨盆看肩膀的運動韻律，則是沒有影響。此外，背架限制了骨盆和從骨 盆看肩膀，行走中在冠狀面的運動。在四個月動作適應上，從相對空間來看，背 架治療有改善上下運動的走路流暢性，但從絕對空間看，頭部左右的行走韻律有 變差。 總論 青春期自發性脊柱側彎女性病人在背架治療前的行走韻律及流暢性有比健 康人差。病人在行走及站姿，身體存在旋轉偏置角度。背架治療四個月後，雖然 背架限制了身體的活動角度，從相對空間來看，並不干擾走路時的韻律及流暢性。 在背架治療4個月後，從相對空間來看，有發現動作的適應能力。

Background. Few studies have discussed the dynamic effects of spinal orthotic intervention on patients with adolescent idiopathic scoliosis (AIS), nor have they investigated the motion adaptation on them. Objectives. The objectives of this study is three-fold: 1) To evaluate dynamic and static balance between AIS patients and normal subjects; 2) to investigate the dynamic and static balance effects of spinal orthotic intervention in the AIS patients during investigative periods of immediate in-brace wearing and after four-month in-brace treatment; 3) to evaluate the motion adaptation after four-month brace treatment in the AIS patients. Design. A prospective cohort study was performed for this investigation. Participants. Fifteen adolescent females with AIS with Cobb angle of 20 to 50 degrees and fifteen age-matched healthy females participated in this study. Interventions. The intervention treatment for the females with AIS was a custom-made total contact thoracolumbar spinal orthosis. Methods. The gait kinematic data and the standing centre of pressure (COP) data were collected. For each AIS patient, data were collected for the following four conditions—pre-brace, immediate in-brace, after four-month of brace treatment data without the brace, and after four-month of brace treatment data in the brace. Normal iv subjects acted as the control and participated in gait analysis just one time. Main outcome measures. The dynamic variables of temporal-distance parameters, walking smoothness with harmonic ratios, and torsional offset of central segments during gait were calculated. The static variables included COP sway, postural orientation and head decompensation in static standing were also calculated for all subjects and conditions. Results. The walking smoothness measured by harmonic ratios was reduced in AIS patients compared with healthy teenagers, especially in the vertical direction on the head (p=.001), trunk (p=.001) and pelvis (p=.005) as well as the antero-posterior direction on the segments of the head on pelvis (p=.025) and the trunk on pelvis (p=.01). For the four-month effect of bracing, bracing negatively affected the smoothness in the medio-lateral direction on the head (p=.001), in the global reference, but the smoothness was not changed on the body reference in AIS patients. Moreover, the effect of bracing restricted the pelvis motion during gait in the frontal plane causing the limited motion on the trunk on pelvis. For the four-month motion adaptation, brace treatment promoted the walking rhythm and smoothness in the vertical direction on the segment of the head on pelvis (p=.026), but decreased in the medio-lateral direction on the head (p=.018). Conclusion. AIS patients before the brace treatment exhibited significantly poor v walking symmetry compared with age-matched girls. AIS patients had abnormal segmental offset during gait and abnormal segmental orientation in standing posture. Bracing stiffened the range of motion on the body but did not disturb walking rhythm in on the body reference in the four-month brace intervention. Brace treatment yielded motion adaptation for walking rhythm in the body reference in the four-month brace intervention.