神經肌肉性脊柱側彎矯具之綁帶張力調整的臨床要領

Abstract

脊柱側彎矯具是目前咸認對於脊柱側彎病患最普遍也最有效的非侵入式治療。除了脊柱的矯正效果之外，長期使用脊柱側彎矯具對病患肺弁鄋獐W進也有幫助。然而若是對因本身呼吸肌衰弱造成胸廓運動及換氣機制不正常的神經肌肉性脊柱側彎病人來說，脊柱側彎矯具在穿戴時，會限制原本即已孱弱的呼吸運動機制，病患馬上就會感到影響程度不一的不舒適感，進而降低穿戴脊柱側彎矯具的意願。 綁帶張力大小會左右脊柱矯正的效果。若綁帶使用不當造成張力不足，矯正的成效會大打折扣；矛盾的是太大的張力又會立即使病患的肺弁鉣飫t，加重病患的不舒適感，病患穿戴的意願也就跟著下降。本研究即是探討這幾項因素之間的關連性，我們從量化綁帶張力開始，並且從脊柱矯正、肺弁鄔M張力之間的關係做一深究。 實驗結果發現，綁帶之張力與肺弁鄖禱D呈現單純之線性關係，其關係近似二次曲線，存在一廣義最大值。該最大值並非出現在綁帶張力最低或是未穿戴背架時，而是出現在特定之綁帶張力處，但亦非最鬆或最緊之處；此外，最佳肺弁鄋滷i力大小，會隨著不同的病患而呈現不同的結果。至於在脊椎的Cobb angle或是側彎頂點的旋轉角度方面，綁帶張力有截然不同的影響：在病患能忍受的範圍內，當綁帶張力越大時，角度的矯正效果就會越大。由此可驗證我們最初綁帶張力在治療時的確有其矛盾之處，也因此我們將實驗數據進行最佳化的處理，並且藉由改變目標函數中各部分的權重值，針對不同需求、不同病況的病患做個別化的考量。 依據上述之結果，我們可依個別的狀況，為神經肌肉性脊柱側彎病患矯正效果和肺弁鈳ㄔi兼顧的矯具綁帶張力，企盼能給病患更具客觀性和弁鄔坁滲嶈W側彎矯具治療，藉以提升病患長期配合脊柱側彎矯具療程的意願，而能早日達成既定的矯正目標。

The orthotic management has become a trend of nonoperative treatment of the scoliotic patients in recent decades. In addition to the correction of spinal deformity, many studies reported that long-term use of spinal orthosis would benefit on not only reduction of spinal deformity but improvement of pulmonary function. However, individuals with neuromuscular scoliosis are thought to have respiratory muscle weakness causing a restrictive pattern, abnormal compliance of the chest wall and lung, and mismatched ventilation and perfusion. Hence, spinal orthosis, using a rigid supporting jacket, led to restriction of chest expansion immediately. And it usually lowers patients’ compliance for orthotic treatment. Strap tension has an influence on pulmonary function; on the other hand, strap tension also affects the correction of spinal deformity. The effectiveness of the spinal orthosis will therefore depend on how tightly its strap is adjusted and fastened. If the patient does not apply enough force on straps, the effective correction of spinal deformity will be reduced. As to our results, we found that there was a certain strap tension that made the pulmonary function highest. However, the maximum of pulmonary function didn’t occur at the loosest strap tension even without spinal orthosis. It exited between the tightest and loosest strap tension and the values would fluctuate among different patients. In the contrast, Cobb angle and apex rotation decreased with the increasing strap tension and increased with the decreasing strap tension. The controversy we hypothesized was proven so we dealt with by optimization and sought for optimal value to achieve the best correction of spinal deformity but least compromise of pulmonary function. Consequently, we hope the application of optimal strap tension would improve the patients’ willingness and compliance of orthotic treatment program.