動態內固定裝置（ISOBAR）應用於腰椎融合手術之護理

Nursing Care of Lumbar Spine Fusion Surgery Using a Semi-Rigid Device (ISOBAR)

隨著年齡增長，容易引發脊椎退化，當罹患腰椎退化性疾病時，患者易有下背痛、神經性跛行、神經根病變，嚴重時會導致大小便失禁等症狀。當症狀持續惡化且藥物、物理治療或輔助療法等保守治療無效時，則需以脊椎融合手術方式治療，但此術式容易造成前次脊椎手術部位上、下節段產生病變，即所謂鄰近節疾病。為有效降低此合併症，於1997年ISOBAR動態內固定裝置被發明應用於脊椎融合手術中。此裝置已被證實可減輕患者下肢疼痛及背痛，降低失能，提高生活品質，延緩椎間盤退化。對於此項裝置有保留脊椎動態活動的角度，降低脊椎融合手術後鄰近節疾病的發生率之長期成效，則有待更多的研究證實。但在台灣，相關文獻及研究仍欠缺，故本文深入探討腰椎退化性疾病、ISOBAR裝置應用於腰椎融合手術之適應症、禁忌症及術後護理，期望能提供臨床醫護人員照護相關患者之參考依據。

Aging frequently induces degenerative changes in the spine. Patients who suffer from lumbar degenerative disease tend to have lower back pain, neurological claudication, and neuropathy. Furthermore, incontinence may be an increasing issue as symptoms become severe. Lumbar spine fusion surgery is necessary if clinical symptoms continue to worsen or if the patient fails to respond to medication, physical therapy, or alternative treatments. However, this surgical procedure frequently induces adjacent segment disease (ASD), which is evidenced by the appearance of pathological changes in the upper and lower sections of the spinal surgical sites. In 1997, ISOBAR TTL dynamic rod stabilization was developed for application in spinal fusion surgery to prevent ASD-related complications. The device has proven effective in reducing pain in the lower back and legs, decreasing functional disability, improving quality of life, and retarding disc degeneration. However, the effectiveness of this intervention in decreasing the incidence of ASD requires further research investigation, and relevant literature and research in Taiwan is still lacking. This article discusses lumbar degenerative disease, its indications, the contraindications of lumbar spine fusion surgery using ISOBAR, and related postoperative nursing care. We hope this article provides proper and new knowledge to clinical nurses for the care of patients undergoing lumbar spine fusion surgery with ISOBAR.