曲轉的人生－－論青少年特發性脊柱側彎之背架治療

Bracing in Adolescent Idiopathic Scoliosis

特發性脊柱側彎佔所有脊柱側彎的80%，發生率約為0.47%–5.2%且病程橫跨青春發育期。隨著發育成長，患者的脊柱曲轉除造成外觀改變，也容易產生負向生活經驗。若沒有接受妥善的治療，患者可能會出現軀幹畸形、神經併發症、慢性疼痛與心肺功能衰竭等問題。目前治療方式包括保守療法以及外科手術，保守療法以背架治療最為常見，目的乃利用背架的外力限制脊柱側彎的進展，惟背架運用非矯正側彎脊柱，僅避免進一步的側彎惡化衍生更多異常。然而在臺灣背架預防性療效，因家長與患童經濟與實務執行困難的考量，因而忽略。本文旨在透過介紹青少年特發性側彎及各國背架治療的研究，探討背架治療的成效，希望藉此喚醒國人對此疾病預防性照護和護理的重視。尤其護理師在治療早期向患童及家屬提供正向支持，例如幫助他們進行適當的運動和正確支架佩戴，持續促進有效支撐；再者引導患者如何面對自我身體的感覺認知，學習自我身體的調整與背架的運用，與側彎肢體形成有機共處非強制壓擠限制，更是患者疼痛避免和預防惡化的重要因素，也是護理指導的獨特貢獻。

Scoliosis is a common medical problem, with an incidence of between 0.47% and 5.2% in the general population globally. Adolescent idiopathic scoliosis (AIS) accounts for nearly 80% of all scoliosis. Young people with AIS often experience negative social consequences in association with their condition. Without proper and timely treatment, the potential resulting disabilities range from trunk deformity, pain, and neurological complications to compromised cardiopulmonary function, all of which may cause lifelong suffering. Scoliosis may be treated either conservatively or surgically, based on the severity of the disease. Bracing is the most widely adopted method of conservative treatment. However, the main goal of bracing is to inhibit the progression of the spinal curvature rather than to cure scoliosis. The clinical effectiveness of bracing in Taiwan has often been underutilized as a result of financial or other factors such as the availability of the treatment. The purpose of the present review is to clarify the effectiveness of bracing for AIS by elucidating the pathophysiology of scoliosis and examining the recent clinical evidence. The importance of preventative care and the unique contribution of nursing care to treatment has to date been under-recognized. The positive support that nurses provide to the families of the patients during the early phases of treatment as well as to the patients themselves, including helping them exercise appropriately and wear the brace correctly, is an essential component of effective treatment. Learning how to work with and to adapt to the brace being part of the body is an important part of the treatment as well as a way to avoid pain. Nurses are in an ideal position to facilitate this learning process and, overall, to provide health education.