軀幹側支撐對脊髓損傷個案脊柱與骨盆曲線影響之探究

Abstract

目的：探討軀幹側支撐對脊髓損傷個案脊柱與骨盆曲線的影響。 背景：臨床上特殊擺位系統廣泛地被用來改善脊髓損傷個案的坐姿，但軀幹側支撐對脊柱側彎及臀部壓力的影響，卻少有相關文獻之驗證。 方法:共有8位脊柱側彎的男性脊髓損傷個案參與本研究。受試者坐於實驗用椅上，在有/無軀幹側支撐兩種情況下，分別量測脊柱及骨盆的位置與形狀。首先照射X光，然後三維脊柱骨盆曲線及臀部壓力利用動作分析系統 (Vicon 512, Oxford Metrics, U. K.) 及壓力量測系統 (Tekscan Advanced Clinsear, U. S. A.) 同步測量。脊柱側彎的嚴重度分別在X光影像上用科布角度 (Cobb angles)，脊突角度 (spinous process angles) 及側彎指數 (scoliotic index) 來表示。利用配對-t檢定來比較上述X光影像取得之三種角度及由三維立體脊柱骨盆曲線投影在冠狀面 (coronal plane) 之脊突角度在兩種擺位情況的差異。二維X光影像與三維脊柱骨盆曲線投影在冠狀面影像的相關性；及三維脊柱骨盆曲線與壓力中心位移的相關性用皮爾森相關(Pearson’s correlation )作分析。 結果：X光影像的結果顯示，有軀幹側支撐的座位，受試者的科布角度，脊突角度及側彎指數都明顯較小(p = 0.005 ~ 0.043)。科布角度，脊突角度及側彎指數的改善比率分別為31.38％，31.69％及23.71％。從X光影像與三維脊柱骨盆曲線投影在冠狀面影像所得的脊突角度二者間有明顯的相關性(r = 0.624, p = 0.010)。但軀幹各部分與骨盆間的相對移動角度在兩種座位間的差異卻不顯著。有軀幹側支撐時，所有受試者的臀部最高壓力值都降低，但是壓力中心位移並沒有明顯改變。脊柱各區段及骨盆的相對角度與壓力中心位移比率也沒有發現明顯的相關性存在。 結論：藉由X光影像分析可知，利用有側支撐的坐姿擺位系統達到靜態矯正脊柱側彎的作用。但在三維脊柱骨盆運動分析中卻沒有顯示相同的現象，可能是因為計算方法的不同。此議題仍待未來研究的進一步驗證。有側支撐時臀部最高壓力值降低，但是對稱指數及壓力中心位移卻沒有同時降低。此結果隱喻臨床上，脊柱與骨盆在給予脊髓損傷個案輪椅特殊擺位處方時，需要視為一體，不可偏廢。

Objective. To investigate the effects of lateral trunk supports (LTSs) on spinal and pelvic alignment for the spinal cord injured (SCI) persons with scoliosis. Background. Special seating has been widely used in clinic to improve sitting postures of SCI persons. However, little has been known about the effects of LTSs on the scoliotic curve and buttock pressures. Methods. Eight male SCI subjects with scoliosis participated in this study. The shapes of the spine and pelvis were measured with subjects sitting on an experimental chair in two seating configurations. Radiographs were taken first and then 3-dimensional (3-D) spine-pelvis curve and buttock pressures were measured simultaneously using a motion analysis system (Vicon 512, Oxford Metrics, U. K.) and a pressure plate (Tekscan Advanced Clinseat, U.S.A.). The severity of scoliosis was described by Cobb angles, spinous process angles, and scoliotic index calculated from the radiographic images. Paired-t test was used to compare differences of the Cobb angles, spinous process angles and scoliotic index as well as the corresponding angles calculated from the coronal projection of the 3-D spine-pelvis curve between two seating configurations. Relationships between the results from 2-D radiographs and coronal projection of the 3-D spine-pelvis curves, and between the results from 3-D spine-pelvis curves and COP movements were analyzed by Pearson’s correlation. Results. The results of the radiographic data revealed that Cobb angles, spinous process angles, and scoliotic index with LTSs were all significantly smaller than those without LTSs (p = 0.005 ~ 0.043). The scoliosis correction rate in terms of Cobb angles, spinous process angles, and scoliotic index from the radiographs were 31.38% (14% ~ 50%), 31.69% (-7% ~ 69%), 23.71% (-27% ~ 54%) respectively. Spinous process angles on A-P radiographs and coronal projection of the 3-D spine-pelvis curves were obviously correlated (r = 0.624, p = 0.010). But there was no significant difference in relative positions of the 3-D spine-pelvis curves between the two seating configurations. With LTSs, peak pressures at the buttock were smaller than those without LTSs for all subjects, but symmetry index and center of pressure displacement (COPd) did not change significantly. None of the relative movements among the spinal segments and pelvis were related to the movement of center of pressure percentage (COPp) on the pressure plate. Conclusions. Significant static correction of the scoliotic spine could be achieved by special seating with lateral trunk supports as shown by radiographic analysis results. But kinematic analysis of 3-D spine-pelvis movements did not show the same phenomenon, which could be related to the calculated methods. Further study on this issue is necessary. Peak pressures at the buttock were decreased after using LTSs. Nevertheless, symmetry index and COPd were not reduced accordingly. The results implied that spine and pelvis should be regarded as a whole when prescribing the special seating for SCI persons with scoliosis.