臺灣博碩士論文加值系統

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功能的增進也有幫助。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功能變差，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、肺功能和張力之間的關係做一深究。
實驗結果發現，綁帶之張力與肺功能並非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，最佳肺功能的張力大小，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功能都可兼顧的矯具綁帶張力，企盼能給病患更具客觀性和功能性的脊柱側彎矯具治療，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.

Chapter 1 Introduction 1
1.1 Project Motivation 1
1.2 Literature review 2
1.3 Research objectives 15
1.4 Research methods and procedures 16
Chapter 2 Research Method 17
2.1. Experiment protocol 17
2.2. Subjects 18
2.3. Spinal Orthosis 18
2.4. Strap tension 21
2.5. Measurement of pulmonary function 23
2.6. Measurement of vertebral correction 26
2.7. Solution of optimal strap tension 29
Chapter 3 Results 30
3.1. Analysis of subject A 30
3.2. Analysis of subject B 41
3.3. Optimal strap tension 52
Chapter 4 Discussion 56
4.1. Fitting errors 56
4.2. Slow vital capacity and forced vital capacity 58
4.3. Optimal strap tension 59
4.4. Discussion 79
4.5. Clinical application 80
4.6. Disadvantages of method 80
Chapter 5 Conclusions and future work 82
5.1. Conclusions 82
5.2. Suggestion for future work 82
References 83

1. Aubin, C. E.; Labelle, H.; Ruszkowski, A.; Petit, Y.; Gignac, D.; Joncas, J.; and Dansereau, J.: Variability of strap tension in brace treatment for adolescent idiopathic scoliosis. Spine, 24(4): 349-354, 1999.
2. Bergofsky, E. H.; Turino, G. M.; and Fishman, A. P.: Cardiorespiratory failure in kyphoscoliosis. Medicine, 38: 263, 1959.
3. Boas, E. P.: The cardiovascular complications of kyphoscoliosis with a report of a case of paroxysmal auricular fibrillation in patient with severe scoliosis. The American Journal of the Medical Sciences, 166: 89-95, 1923.
4. Bunnell, W. P.: An objective criterion for scoliosis screening. Journal of Bone & Joint Surgery - American Volume, 66(9): 1381-1387, 1984.
5. Caro, C. G.; Butler, J.; and Dubois, A. B.: Some effects of restriction of chest cage expansion on pulmonary function in man: an experimental study. Journal of Clinical Investigation, 39: 573-583, 1960.
6. Cobb, J. R.: Outline foor the study of scoliosis. Instructional Course of Lectures, 5: 261-275, 1948.
7. Duport, G.; Gayet, E.; Pries, P.; Thirault, C.; Renardel-Irani, A.; Fons, N.; Bach, J. R.; and Rideau, Y.: Spinal deformities and wheelchair seating in Duchenne muscular dystrophy: twenty years of research and clinical experience. Seminars in Neurology, 15(1): 29-37, 1995.
8. Flagstad, A. E., and Kollman, S.: Vital capacity and muscle study in one hundred cases of scoliosis. Journal of Bone & Joint Surgery - American Volume, 10: 724-734, 1928.
9. Gayrard, P.; Becker, M.; and Bergofsky, E. H.: The effects of abdominal weights on diaphragmatic position and excursion in man. Clinical Science, 35: 589-601, 1968.
10. Hibbert, M. E.; Lanigan, A.; and Raven, J.: Relation of armspan to height and the prediction of lung function. Thorax, 43: 657-9, 1988.
11. Katsaris, G.; Loukos, A.; Valavanis, J.; Vassiliou, M.; and Behrakis, P. K.: The immediate effect of a Boston brace on lung volumes and pulmonary compliance in mild adolescent idiopathic scoliosis. European Spine Journal, 8(1): 2-7, 1999.
12. Kennedy, J. D.; Robertson, C. F.; Hudson, I.; and Phelan, P. D.: Effect of bracing on respiratory mechanics in mild idiopathic scoliosis. Thorax, 1989(44): 548-553, 1989.
13. Kennedy, J. D.; Robertson, C. F.; Olinsky, A.; Dickens, D. R.; and Phelan, P. D.: Pulmonary restrictive effect of bracing in mild idiopathic scoliosis. Thorax, 42(12): 959-961, 1987.
14. Korovessis, P.; Filos, K. S.; and Georgopoulos, D.: Long-term alterations of respiratory function in adolescents wearing a brace for idiopathic scoliosis. Spine, 21(17): 1979-1984, 1996.
15. Leopando, M. T.; Moussavi, Z.; Holbrow, J.; Chernick, V.; Pasterkamp, H.; and Rempel, G.: Effect of a Soft Boston Orthosis on pulmonary mechanics in severe cerebral palsy. Pediatric Pulmonology, 28(1): 53-58, 1999.
16. Letts, M.; Rathbone, D.; Yamashita, T.; Nichol, B.; and Keeler, A.: Soft Boston orthosis in management of neuromuscular scoliosis: a preliminary report. Journal of Pediatric Orthopedics, 12(4): 470-474, 1992.
17. Lin, K. H.; Chuang, C. C.; Wu, H. D.; Chang, C. W.; and Kou, Y. R.: Abdominal weight and inspiratory resistance: their immediate effects on inspiratory muscle functions during maximal voluntary breathing in chronic tetraplegic patients. Archives of Physical Medicine & Rehabilitation, 80(7): 741-745, 1999.
18. McCarthy, R. E.: Management of neuromuscular scoliosis. Orthopedic Clinics of North America, 30(3): 435-449, 1999.
19. Noble-Jamieson, C. M.; Heckmatt, J. Z.; Dubowitz, V.; and Silverman, M.: Effects of posture and spinal bracing on respiratory function in neuromuscular disease. Archives of Disease in Childhood, 61(2): 178-181, 1986.
20. Olafsson, Y.; Saraste, H.; and Al-Dabbagh, Z.: Brace treatment in neuromuscular spine deformity. Journal of Pediatric Orthopedics, 19: 376-379, 1999.
21. Pehrsson, K.; Danielsson, A.; and Nachemson, A.: Pulmonary function in adolescent idiopathic scoliosis: a 25 year follow up after surgery or start of brace treatment. Thorax, 56(5): 388-393, 2001.
22. Perie, D.; Sales De Gauzy, J.; Sevely, A.; and Hobatho, M. C.: In vivo geometrical evaluation of Cheneau-Toulouse-Munster brace effect on scoliotic spine using MRI method. Clinical Biomechanics, 16(2): 129-137, 2001.
23. Sevastikoglou, J. A.; Linderholm, H.; and Lindgren, U.: Effect of the Milwaukee brace on vital and ventilatory capacity of scoliotic patients. Acta Orthopaedica Scandinavica, 47(5): 540-545, 1976.
24. Stokes, I. A.: Three-dimensional terminology of spinal deformity. A report presented to the Scoliosis Research Society by the Scoliosis Research Society Working Group on 3-D terminology of spinal deformity. Spine, 19(2): 236-248, 1994.
25. Stokes, I. A.; Bigalow, L. C.; and Moreland, M. S.: Measurement of axial rotation of vertebrae in scoliosis. Spine, 16(5): 599-600, 1991.
26. Sybrecht, G. W.; Garrett, L.; and Anthonisen, N. R.: Effect of chest strapping on regional lung function. Journal of Applied Physiology: Respiratory, Environmental & Exercise Physiology, 39(5): 707-713, 1975.
27. Wever, D. J.; Tonseth, K. A.; Veldhuizen, A. G.; Cool, J. C.; and van Horn, J. R.: Curve progression and spinal growth in brace treated idiopathic scoliosis. Clinical Orthopaedics & Related Research, 377: 169-179, 2000.
28. Winter, S.: Preoperative assemment of the child with neuromuscular scoliosis. Orthopedic Clinics of North America, 25(2): 239-245, 1994.
29. Wong, M. S., and Evans, J. H.: Biomechanical evaluation of the Milwaukee brace. Prosthetics & Orthotics International, 22(1): 54-67, 1998.
30. Wong, M. S.; Mak, A. F. T.; Luk, K. D.; Evans, J. H.; and Brown, B.: Effectiveness and biomechanics of spinal orthoses in the treatment of adolescent idiopathic scoliosis (AIS). Prosthetics & Orthotics International, 24(2): 148-162, 2000.