KISEP Clinical Research J Korean Neurosurg Soc , 1999 요추간반탈출증에서적외선체열촬영과통증척도와의상관관계 장호열 진동규 조용은 김영수 = Abstract = Correlation between Pain Scal

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1 KISEP Clinical Research J Korean Neurosurg Soc , 1999 요추간반탈출증에서적외선체열촬영과통증척도와의상관관계 장호열 진동규 조용은 김영수 = Abstract = Correlation between Pain Scale and Infrared Thermogram in Lumbar Disc Herniations Ho-Yeol Zhang, M.D., Dong-Kyu Chin, M.D., Yong-Eun Cho, M.D., Young-Soo Kim, M.D. Spine Center, Department of Neurosurgery, Yongdong Severance Hospital, Yonsei University College of Medicine, Seoul, Korea KEY WORDS 서론 J Korean Neurosurg SocVolume 28February,

2 요추간반 탈출증에서 적외선 체열 촬영과 통증 척도와의 상관 관계 검사상 탈출의 정도가 심하지 않아도 통증이 심한 환자를 하는 데에 많은 도움을 주고 있다3). 자주 관찰하게 된다. 따라서 통증의 위치와 통증의 정도를 본 연구는 적외선 체열 촬영이 요추간반 탈출증 환자의통 객관적으로 알아내는 것이 요추간반 탈출증 환자의 진단과 증 정도와 좌우 하지의 온도차와의 상관 관계가 있나를 보 진료에 도움이 될 것이다. 고자 하는 것이다. 피부는 피하의 많은 혈관과 말초 신경을 가지고 있으며 이들의 변화에 의하여 심부 체온을 일정하게 유지하는 데 대상 및 방법 21) 중요한 역할을 한다. 피하 수mm이내의 혈관들에 의한 피 부 온도의 조절은 자율신경계에 의하여 조절된다2)6)21). 최 1996년 1월부터 1996년 12월까지 본원에 입원하였던 초의 피부 온도에 대한 검사는 히포크라테스가 시작하였는 요추간반 탈출증 환자 중에서 한 부위의 요추간반 탈출이 데, 그는 젖은 진흙을 환자의 몸에 도포한 뒤 비대칭적으로 빨리 건조되는 부위를 찾아 열이 나는 곳을 쉽게 찾았다. 즉, 국소적이고 비대칭적인 피부 온도의 변화는 히포크라테스 시대에서부터 진단에 이용되었다12). 적외선 체열 촬영은 1956년 유방암 환자에 대한 촬영을 최초로 보고하면서13) 현대 의학에서 사용되기 시작하였다. 컴퓨터화된 적외선 체열 촬영기가 보급되면서 그 학문적 성 과가 여러 곳에서 보고되기 시작하였고 요추간반 탈출증에 서도 적외선 체열 촬영이 민감도가 높으며 유용한 것으로 되어있다2)3)10)11)15)19)22). 적외선 체열촬영은 요추간반 탈출 에 의한 방사통이 체온절(thermatome)의9)11) 온도 변화로 나타내어 주는 것으로 해부학적 검사가 아닌 생리학적 검사 기계이다. 또한 환자의 주관적인 증상을 객관적으로 보여줌 으로써10) 환자와 의사간의 신뢰를 구축하게 하며 치료 효과 의 분석 및 다발성 요추간반 탈출의 경우 현 증상의 위치를 보여줌으로써 환자의 증상이 있는 부위만을 수술 혹은 처치 Fig. 2. Painful areas were drawn with color pens and pointed numeric scale at the pain chart. 8 points is included Group Ⅲ(severe) pain. Lumbar CT shows that L4/5 disc herniation is included in moderate disc protrusion group. DITI shows severe right leg hypothermia especially right calf. Thermal difference between the point A and B(A 24.75, B ) is Fig. 1. Patients demographics shows 174 consecutive patients who underwent operation or chemonucleolysis for single level unilateral disc protrusion with ipsilateral leg pain(mean age 43.4 years, range of age years, 72 males and 102 females). 254 J Korean Neurosurg Soc/ Volume 28 / February, 1999

3 장호열 진동규 조용은 김영수 1. 적외선체열촬영및온도측정 1) 적외선체열촬영 2) 온도측정 2. 환자의주관적통증에따른분류 3. CT 혹은 MRI 소견에따른분류 Table 1. Thermal difference with subjective painp0.01 Group No. of patients Thermal differences meansd, Group Group Group Group Total 증상의기간에따른분류 5. 분석 결 1. 온도차와환자의주관적통증 Fig. 3. Thermal differences with subjective pain. These data show that the discogenic pain is the more severe, the thermal difference between the both legs is the more significantly prominent. These were statistically significantp0.01. Table 2. Thermal difference with degree of disc protrusion p0.01 Thermal differences Disc protrusion No. of patients meansd, Mild protrusion Moderate protrusion Severe protrusion 과 J Korean Neurosurg SocVolume 28February,

4 요추간반탈출증에서적외선체열촬영과통증척도와의상관관계 3. 온도차와증상의기간 Fig. 4. Thermal differences with degree of disc protrusion. These data show that the disc herniation is the more protruded, the thermal difference between the both legs is the more significantly prominent. These were statistically significantp0.01. Table 3. Thermal difference with duration of symptoms Duration months No. of patients Thermal differences meansd, Fig. 5. Thermal differences with duration of symptom. These data show that the symptom duration is the shorter, the thermal difference between the both legs is the more significantly prominent. These were statistically significantp0.01. 고찰 256 J Korean Neurosurg SocVolume 28February, 1999

5 장호열 진동규 조용은 김영수 J Korean Neurosurg SocVolume 28February,

6 요추간반탈출증에서적외선체열촬영과통증척도와의상관관계 결 론 References 1) Boden SD, Davis DO, Dina TS, et alabnormal magneticresonance scans of the lumbar spine in asymptomatic subjects. A prospective investigation. J Bone Joint SurgAm , ) Cho J, Moon CT, Nah JH, et alpostoperative evaluation of lumbar disc herniation using digital infrared thermographic imaging. Journal of Korean Neurosurgical Society , ) Cho YE, Kim YS, Zhang HYClinical efficacy of digital infrared thermographic imaging in multiple lumbar disc herniations. Journal of Korean Neurosurgical Society , ) Duus PTopical Diagnosis in Neurology. Translated Lindenberg R. New YorkGeorge Thieme Verlag, 1983, pp ) Fields HL, Basbaum AICentral nervous system mechanisms of pain modulation, in Wall PD, Basbaum AIedsTextbook of pain, ed 2. Edinburgh, Churchill Livingstone, 1994, pp ) Gandhavadi B, Rosen JS, Addison RGAutonomic pain. Features and methods of assessment. Postgrad Med , ) Holt EP JrThe question of lumbar discography. J Bone Joint SurgAm , ) Hooshmand HChronic PainRefex Sympathetic Dystrophy. Prevention and Management. CRC Press, 1993, pp ) Jinkins JR, Whittemore AR, Bradley WGThe anatomic basis of vertebrogenic pain and autonomic syndrome associated with lumbar disk extrusion. Am J Roentgenol , ) Kim YS, Cho YEPre- and postoperative thermographic imagings in lumbar disc herniations. Journal of Korean Neurosurgical Society , ) Kim YS, Cho YE, Zhang HYThermatomes of the Lumbosacral Nerve Roots. Journal of Korean Neurosurgical Society , ) Lawson CThe validation of thermology. The American Chiroprator 21-6, ) Lawson RImplications of surface temperatures in the diagnosis of the breast cancer. Canad M Ass J , ) Lindblom KDiagnostic puncture of intervertebral disc in sciatica. Acta Orthop Scand , ) Mills GH, Davis GK, Getty CIM, et althe evaluation of liquid crystal thermography in the investigation of nerve root compression due to lumbosacral lateral spinal stenosis. Spine , ) Mooney VWhen is surgery appropriate for patients with low back pain? J Musculoskel Med , ) Mooney V, Saal JA, Saal JSEvaluation and treatment of low back pain, in Moore TH, Bean KJedsClinical Symposia 48 4, Ciba-Geigy Co., 1996, vol 484, pp17 18) Oh SJClinical electromygraphynerve conduction studies, ed 2. Williams and Wilkins, 1993, pp ) Pochaczevsky R, Wexler CE, Meyers PHLiquid crystal thermography of the spine and extremities. Its value in the diagnosis of spinal nerve root syndromes. J Neurosurg , ) Saal JA, Saal JSNonoperative treatment of herniated lumbar intervertebral disc with radiculopathy. An outcome study. Spine , ) Snellen JWMean body temperature and the control of thermal sweating. Acta Physiol Pharmacol Neer I , ) Takahashi Y, Takahashi K, Moriya HThermal deficit in lumbar radiculopathy. Correlations with pain and neurologic signs and its value for assessing symptomatic severity. Spine , ) Uematsu SThermography, in YoumannsedNeurological Surgery, ed 3. Saunders, 1990, pp ) Walsh TR, Weinstein JN, Spratt KF, et allumbar discography in normal subjectsa controlled prospective study. J Bone Joint SurgAm , J Korean Neurosurg SocVolume 28February, 1999

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