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青少年原發性脊柱側彎無法自行痊癒或矯正,其治療方法取決於不同的因素 [1]:

  • 患者年齡
  • 骨齡
  • 脊柱側彎角度
  • 脊柱側彎位置
  • 月經/青春期狀態
  • 患者性別
  • 相關症狀,例如背痛或呼吸急促

定義脊柱側彎的最小角度為11° (查看更多...),以下是根據嚴重程度和成熟程度不同的常用治療方法 [2]:

 

輕度脊柱側彎 (Cobb angle = 11° - 19°)

cobb 11 19

脊柱側彎角度 (Cobb angle) = 11° - 19°

1. 青春期的患者,需定期檢查以監測脊柱側彎的惡化程度

脊柱側彎患者在青春期間容易惡化,脊柱在發育完成後才會變得穩定 [3]。因此,發育期間患者應加強運動並需接受定期檢查以監測脊柱側彎的惡化程度。如果側彎角度增加至約25°,便可能需要其他治療方法。

 

2. 恆常運動 (查看更多...)

伸展和強化肌肉能保持韌帶和肌腱的柔韌性,從而降低脊柱肌肉失衡的程度。定期運動還可以提高活動能力,從而減少受傷和背痛的機會,有助保持良好的姿勢 [4,5]。

exercise new

伸展運動

 

中度脊柱側彎 (Cobb angle = 20° - 45°)

cobb 20 45

脊柱側彎角度 (Cobb angle) = 20° - 45°

1. 處於青春期的患者需進行矯形治療

矯形治療適用於20°至45°側彎、處於青春期的患者,目的是減慢脊柱側彎的惡化速度。患者需佩帶脊柱矯形器,以在脊柱曲線的凸部施加壓力 (三點壓力系統),同時緩解曲線的凹部 [6]。眾多研究報告指出矯形治療有效減慢脊柱側彎惡化從而減少手術治療機會。矯形師會根據側彎位置、脊柱柔韌性、側彎數量和椎骨旋轉程度為患者設計脊柱矯形器 [7,8]。

3point system1

三點壓力系統 

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常用於治療脊柱側彎的矯形器設計:

全日使用的脊柱矯形

頸胸腰椎矯形器(CTLSO) 適用於是脊柱側彎點在T7或以上的患者。米華基脊柱矯形器 (Milwaukee brace) 是1940年代研發的頸胸腰椎矯形器 (CTLSO) [9]。它具有堅固的金屬結構,需要穿戴在衣服外面。由於其外觀因素和其他脊柱側彎治療方法的發展,如今已較少使用米華基脊柱矯形器,但仍會應用於彎點較高的胸或頸椎側彎 [10]。

milwaukee brace new

CTLSO (米華基脊柱矯形器, Milwaukee brace)

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胸腰椎矯形器 (TLSO) (如脊柱矯形器 (Under-arm brace)、波士頓脊柱矯形器(Boston Brace)和威明頓脊柱矯形器(Wilmington Brace)) 適用對象是脊柱側彎彎點在T7以下的患者,例如低胸側彎、胸腰側彎和單腰椎側彎。脊柱矯形器穿着的位置是腋下和臀部之間,而且由輕質塑料製成。因此,它可以穿在衣服下,比較容易被患者接受。由於人們對胸腰椎矯形器有更高的接受程度及其治療效果顯著,所以是現時最常見的矯形治療方法之一 [11]。

tlso

TLSO

 

夜間脊柱矯形器

查爾斯頓/普羅維登斯脊柱矯形器 (Charleston bending brace / Providence brace): 1979年研發的查爾斯頓胸腰椎矯形器(TLSO),適用對象是脊柱側彎的彎點在T7以下,由輕質塑料製成,特徵是「過度矯正」,把患者的脊椎帶到過度矯正的位置。普羅維登斯脊椎矯形器在側彎處施加壓力,達到矯正的效果。晚間使用的脊柱矯形器須在晚上穿帶8至10小時直至發育完成 [12]。隨著患者的發育成長,矯形器須在四至六個月內覆檢。在某些情況下,夜間脊柱矯形器與日間脊柱矯形器在治療脊柱側彎方面具有相似的效果 [13,14]。

Charleston brace new

TLSO (查爾斯頓脊柱矯形器, Charleston brace)

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Providence brace

TLSO (普羅維登斯脊柱矯形器, Providence brace)

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2. 物理治療

物理治療是脊柱側彎治療中的一個方法,包括伸展和強化肌肉運動以減少肌肉失衡的影響並幫助保持良好姿勢 [15-17]。物理治療在物理治療師指導下進行,在中度脊柱側灣的個案中常配合脊柱矯形器以達致預期的效果。

physio

強化肌肉運動

 

嚴重脊柱側彎 (Cobb angle > 45°)

cobb 45

脊柱側彎角度 (Cobb angle) > 45°

1. 手術治療

脊柱側彎角度大於45°應建議接受手術矯正,防止脊柱側彎繼續惡化。手術治療是在脊柱上植入金屬桿和其他接合材料以矯正脊柱側彎和使脊柱維持在矯正後的位置,使脊柱融合為一體。接受手術治療後,患者需住院3至6天,手術後3至4周後可回到學校學習,3至6個月便可以正常參加活動 [18,19]。

 

參考資料

  1. SRS. "Scoliosis Research Society." https://www.srs.org/patients-and-families/common-questions-and-glossary/frequently-asked-questions/treatment-and-coping.

  2. H.-R. Weiss, S. Negrini, M. Rigo, T. Kotwicki, M. C. Hawes, T. B. Grivas, T. Maruyama, and F. Landauer, "Indications for conservative management of scoliosis (guidelines)," Scoliosis, vol. 1, no. 1, p. 5, 2006.

  3. S. Weinstein and I. Ponseti, "Curve progression in idiopathic scoliosis," The Journal of bone and joint surgery. American volume, vol. 65, no. 4, pp. 447-455, 1983.

  4. A. Gruca, "The pathogenesis and treatment of idiopathic scoliosis: a preliminary report," JBJS, vol. 40, no. 3, pp. 570-584, 1958.

  5. V. Akuthota, A. Ferreiro, T. Moore, and M. Fredericson, "Core stability exercise principles," Current sports medicine reports, vol. 7, no. 1, pp. 39-44, 2008.

  6. R. Fernandez-Feliberti, J. Flynn, N. Ramirez, M. Trautmann, and M. Alegria, "Effectiveness of TLSO bracing in the conservative treatment of idiopathic scoliosis," Journal of pediatric orthopedics, vol. 15, no. 2, pp. 176-181, 1995.

  7. SRS. "Scoliosis Research Society." https://www.srs.org/patients-and-families/conditions-and-treatments/adolescents.

  8. A. Howard, J. G. Wright, and D. Hedden, "A comparative study of TLSO, Charleston, and Milwaukee braces for idiopathic scoliosis," Spine, vol. 23, no. 22, pp. 2404-2411, 1998.

  9. K. J. Noonan, S. L. Weinstein, W. C. Jacobson, and L. A. Dolan, "Use of the Milwaukee brace for progressive idiopathic scoliosis," JBJS, vol. 78, no. 4, pp. 557-67, 1996.

  10. F. C. Wickers, W. H. Bunch, and P. M. Barnett, "Psychological factors in failure to wear the Milwaukee brace for treatment of idiopathic scoliosis," Clinical Orthopaedics and Related Research, no. 126, pp. 62-66, 1977.

  11. J. E. Lange, H. Steen, and J. I. Brox, "Long-term results after Boston brace treatment in adolescent idiopathic scoliosis," Scoliosis, vol. 4, no. 1, p. 17, 2009.

  12. R. S. Fayssoux, R. H. Cho, and M. J. Herman, "A history of bracing for idiopathic scoliosis in North America," Clinical Orthopaedics and Related Research®, vol. 468, no. 3, pp. 654-664, 2010.

  13. A. Simony, I. Beuschau, L. Quisth, S. M. Jespersen, L. Y. Carreon, and M. O. Andersen, "Providence nighttime bracing is effective in treatment for adolescent idiopathic scoliosis even in curves larger than 35," European Spine Journal, vol. 28, no. 9, pp. 2020-2024, 2019.

  14. R. Gepstein, Y. Leitner, E. Zohar, I. Angel, S. Shabat, I. Pekarsky, T. Friesem, Y. Folman, A. Katz, and B. Fredman, "Effectiveness of the Charleston bending brace in the treatment of single-curve idiopathic scoliosis," Journal of Pediatric Orthopaedics, vol. 22, no. 1, pp. 84-87, 2002.

  15. H. Berdishevsky, V. A. Lebel, J. Bettany-Saltikov, M. Rigo, A. Lebel, A. Hennes, M. Romano, M. Białek, A. M’hango, and T. Betts, "Physiotherapy scoliosis-specific exercises–a comprehensive review of seven major schools," Scoliosis and spinal disorders, vol. 11, no. 1, p. 20, 2016.

  16. S. Negrini, C. Fusco, S. Minozzi, S. Atanasio, F. Zaina, and M. Romano, "Exercises reduce the progression rate of adolescent idiopathic scoliosis: results of a comprehensive systematic review of the literature," Disability and rehabilitation, vol. 30, no. 10, pp. 772-785, 2008.

  17. H.-R. Weiss, G. Weiss, and H.-J. Schaar, "Incidence of surgery in conservatively treated patients with scoliosis," Pediatric Rehabilitation, vol. 6, no. 2, pp. 111-118, 2003.

  18. S. Yadla, M. G. Maltenfort, J. K. Ratliff, and J. S. Harrop, "Adult scoliosis surgery outcomes: a systematic review," Neurosurgical focus, vol. 28, no. 3, p. E3, 2010.

  19. E. R. Westrick and W. T. Ward, "Adolescent idiopathic scoliosis: 5-year to 20-year evidence-based surgical results," Journal of Pediatric Orthopaedics, vol. 31, pp. S61-S68, 2011.