章良渭2006-07-262018-06-292006-07-262018-06-292005-12-31http://ntur.lib.ntu.edu.tw//handle/246246/22394Background: 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. Therefore, a spinal orthosis, a rigid supporting body jacket, leads to restriction of chest expansion and significant reduction in vital capacity immediately. Strap tension has an influence on pulmonary function; on the other hand, strap tension also affects the correction of spinal deformity. If the patient does not apply enough force on straps, the effective correction of spinal deformity will be reduced. The tension adjustment of straps on spinal orthoses is clinically significant for neuromuscular scoliosis. The overall effectiveness of the spinal orthosis will therefore depend on how tightly its strap is adjusted and fastened. Objectives: To quantify the strap tension and find an optimal value to achieve the best correction of spinal deformity but least compromise of pulmonary function. Setting: Orthotic services, National Rehabilitation Engineering Research Center, Taipei , Taiwan. Participant: A seven-year-old girl with spinal muscular atrophy, presenting a scoliotic curve. The curve was a left lumbar C curve and the apex was at L1. Intervention: A custom molded co-polymer anterior-opening Thoracic-Lumbar-Sacral Orthosis (TLSO) with three adjustable straps. Optimal strap tension solution: An objective function was chosen as the weighted sum of two indexes, i.e., an index of the pulmonary function and an index of vertebral correction. Main Outcome Measures: Strap tensions, slow vital capacity (SVC) for the pulmonary function index, Cobb angle and apex rotation for the vertebral correction index. Results: Optimal strap tensions all lie in between 60% to 70% of the tightest tension which the subject can tolerate. Conclusions: In the past, clinicians had no idea to adjust objectively the tightness of the straps on TLSO for individuals with neuromuscular scoliosis. This study provided a systematic approach to find an optimal strap tension where both pulmonary function and vertebral correction were taken into consideration at the same time.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，我們會從量化綁帶張力 開始，並且試圖從脊柱矯正、肺功能和張力之間的關係做一深究，最後將找出一組對神經肌 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。application/pdf878355 bytesapplication/pdfzh-TW國立臺灣大學醫學工程學研究所reporthttp://ntur.lib.ntu.edu.tw/bitstream/246246/22394/1/932213E002075.pdf