129~144 방출성 요추 골절

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1 129 DOI : /KPI Received : Accepted : Case study of Oriental Medicine Treatment with Mae-sun therapy of the spinal cord injury due to lumbar burst fracture Key Words: traumatic lumbar burst fracture, spinal cord injury, mae-sun therapy, TUG, SCIM, CIC. Kwon Gi-sun Park Jung-ah Noh Ju-hwan Kim Cheol-hong Department of Acupuncture & Moxibution College of Oriental Medicine, Dong-Eui University ABSTRACT Objective : Traumatic lumbar burst fracture causes significant spinal cord injury. This report is intended to estimate the efficacy using oriental treatment on a patient with lumbar burst fracture and spinal cord injury. Methods : From 21th December, 2009 to 5th February, 2010, 1 female inpatient diagnosed with lumbar burst fracture and spinal cord injury was treated with general oriental medicine therapy : mae-sun therapy ; acupuncture ; moxibustion ; pharmacopuncture ; physical therapy and herbal medication. TUG, SCIM and VAS were used for evaluation of gait disturbance and pain in both feet. Measurement of self voiding amount and remaining amount through CIC was used for evaluation of neurogenic vesical dysfunction. Results : The patient showed a certain degree of improvement in gait disturbance, pain in both feet and neurogenic vesical dysfunction through above evaluation methods. Conclusion : Oriental treatments such as mae-sun therapy, acupuncture and moxibustion therapy, pharmacopuncture therapy and herbal medication can be effective for spinal cord injury due to traumatic lumbar burst fracture. I conusmedullaris Corresponding author : Kim Cheol-hong, Department of Acupuncture & Moxibution College of Oriental Medicine, Dong- Eui University, San 45-1, Yangjung 2-Dong, Busanjin-Gu, Busan, Korea, Tel : (82) , Fax : (82) , kmdkch@deu.ac.kr This research was supported by Dong-Eui University Research Fund(2009AA127)

2 T12-L CVA, DM stratch car T12-L1 burst Fx. and spinal cord injury, both calcaneus Fx H/R II /2 /1 3

3 /day CIC Clean Intemittent Catheterization 6-7 self voiding Abdomne & pelvis-gastrografin CT : T12-L1 compression fracture and burst fracture, Sacrum burst fracture L-spine CT : L1 compression fracture with anterior thecal sac indentation caused by fractured fragment. Sacral body burst fracture.(fig1-2) Ankle AP both : both calcaneal frature (Fig3-4) 2 EKG Normal ECG. Sinus rhythm. 3 chest X-ray N-S 4 LAB Cl 112mmol/L, U. LEU Hg 80 Hg 2 77 min min G 6.0 GV1 B56 B57 G34 S36 B36 B37 B25 Sp12 G29 Liv12 23G 4.0 B60 Table mm stainless steel 8-20mm K5 G34 Liv3 SI G31 G34 Liv3 SI3 GV K5 G34 Liv3 SI3 GV

4 CV12 CV :1 0.5 T12-L5 G31 G34 S36 G39 K6 Liv4 S41 G40 B62 B60 G41 Liv :1 2.0 Table G20 G ~ Table 3 5 FES Opalmon TAB Mucoran Forintestin Klebsiella Cravit Loxonin Stillen 4 Stillen, Septrin( Visual Analogue Scale VAS 0 10 VAS 2 CIC Table4 3 Timed Up and Go test TUG Timed Up and Go test TUG 3m TUG functional mobility TUG 3m 5m Table5 4 SCIM Spinal Cord Independence Measure SCIM SCIM 3 16

5 133 SCIM Appendix SCIM VAS10 1 VAS CIC self voiding ~ VAS10 1 VAS TUG Test SCIM SCIM VAS VAS3

6 TUG 2 3m m m m 36.2 SCIM SCIM 71 3 VAS6 3 2 CIC 500~ cc VAS VAS10 VAS2 4 3 TUG 3 SCIM VAS3 VAS UA U.LEU 500 U.WBC25-50 U.RBC10-25 U.NIT Klebsiella pneumoniae Cravit Loxonin, Stillen 4 Stillen, Septrin TUG 5m

7 135 SCIM VAS5 5 Cravit Septrin 4 VAS6 VAS3 CIC 4 VAS2-3 III Denis three column concept conusmedullaris

8 T12-L1 Fx. spinal cord injury, both calcaneus Fx GV1 B56 B57 G34 S36 B36 B37 B25 Sp12 G29 Liv12 G34 Liv3 SI3 G31 K5 CV12 CV4 G20 G21 5 FES 3-5

9 137 SCIM m TUG 3m m m VAS10 VAS5 CIC CIC VAS3 4 VAS6 VAS3 1 IV T12- L1, 1 TUG, SCIM VAS CIC V : 670~ Atlas SW, Regenbogen V, Rogers LF et al:the Radiographic characterization of Burst Fractures of the Spine ; AJR 147 : : 724, Kim Hyung-Jee, Sohng In-Ho, Lee Geun-Ho. High Risk Urodymamic Factors of Neuropthic Bladder in Spinal Cord Injury Patients : Hwang Min-Seob, Kim Kap-Sung, Yoon Jong- Hwa, Sohn Sung-Chul. A Case of Spinal Cord Injury Due to Spinal Arterio-Venous malformation. The Journal of Korean Acupuncture and Moxibustion Society : Kim Ki-Young, Hwan, Woo-Joon, Lee Geon- Mok, Cho Ki-Yong. The Effects of Aqua-acupuncture with Radix aconiti on the Contraction of Rat's Spinal Cord Injury. The Journal of Korean Acupuncture and Moxibustion Society : Kim Kyung-Sik, Lee Keon-Mok, Cheon Mi- Na, Lee Byung-Cheol, Kim Jong-Hwan. Long

10 term Effects of Electrical Acupuncture treatment on Rat's Spinal Cord Injury and Allodynia. The Journal of Korean Acupuncture and Moxibustion Society ;14(1) : Kim Jong-Hwan, Kim Kyung-Sik, Hwang Woo-Joon, Lee Geon-Mok, Cheon Mi-Na. Long term Effects of Acupuncture treatment on the Contraction of Rat's Spinal Cord Injury. The Journal of Korean Acupuncture and Moxibustion Society ; 14(1) : Sul Jae-Uk, Chu Min-kyu, Kim Sun-Jong, Choi Jin-Bong, Shin Mi-Suk, Kim Soo-Ik. Effects of Yanghyuljanggeungunbo-tang and Electrical Accupuncture on the spinal nerve injury and the Motor Function. J Oriental Rehab Med ; 19(2) : : Pharmacopunctur-ology : , : Morris S, Morris ME, Iansek R. Reliability of measurements obtained with the Time Up & Go test in people with Parkinson disease. Phys Ther. 2001;81(2); Catz A.,Itzcovich M.,& Agranove E. SCIMspinal cord independent measure; A new disablility scale for patients with spinal cord lesions. Spinal Cord : 35, Kim Chan M.D, Lee Seung-Myung M.D. Modified transpedicular approach with laminoplasty in thoracolumbar burst fracture : 343~6, : , : 70, Journal of Oriental Rehabiliration Medicine ; 7(2) : : 144-7, Lee Kyoung-hee, Noh Ju-hwan, Youn Hyounmin, Jang Kyung-jeon, Ahn Chang-beohm, Kim Cheol-hong. Oriental clinical study on a case of the sequelae of spinal SAH. The Journal of Korean Pharmacopuncture Institute ; 12(4) : : , , : Ahn Koang-Hyun, Kim Kee-Hyun, Hwang Hyeon-Seo, Soon Ho-Sueb, Kwo Soon-Jung, Lee Seong-No, Byun Im-Jeung, Kang Mi-Suk. The Effect of Bee-venom Acupuncture on Heel Pain. The Journal of Korean Acupuncture and Moxibustion Society ; 19(5) : : Kang Kyung-Hwa, Youn Hyoun-min. Study on Anti-Allergic Effecst of Ganoderma lucidum Herbal Acupuncture and Ganoderma lucidum Extract. The Journal of Korean Pharmacopuncture Institute ; 11(4) : ; 10(3) :

11 139 Table 1. Clinical chart of Mae-sun therapy Date Place ( ) ( ), ( ), ( ) ( ) ( ),, ( ), ( ), Count Date Place ( ),, ( ) 1.5 ( ), ( ) ( ),, Count Table 2. Clinical chart of bee venom acupuncture therapy Date Density 10000: :1 5000:1 5000:1 3000:1 2000:1 Dose Date Density 1000:1 1000:1 1000:1 1000:1 1000:1 1000:1 Dose Date Density 1000:1 1000:1 1000:1 1000:1 1000:1 500:1 Dose Date Density 500:1 500:1 500:1 500:1 Dose Table 3. Herbal medicine prescription / 8g 6g 6g 6g 4g 4g ~ / 10g 8g 6g 6g 6g 4g g ~ / 8g 6g 6g 6g 4g ~ / 10g 8g 6g 6g 6g 4g 90g ~ / 50g 6.6g 6g ~ / 8g 6g 6g 6g 4g ~ g 8g 8g??8g 4g ~ g 5g 5g 4g 4g 4g ~ g 8g 6g 6g 6g 5g 5g ~ / 15g 10g 10g 6g 4g 4g ~ / 8g 6g 6g 6g 4g

12 Table 4. frequency of urination and self voiding amount and remained amount frequency( / ) self voiding amount( ) remained amount( ) 1 period period period period period Table 5. Time Up and Go test (TUG test) walker 3m walker 5m Stick 3m Stick 5m S.W3m S.W5m 2 period period period period Table 6. SCIM (Spinal Cord Independence Measure ) period SCIM total point(max=100, min=0) 1 period 62 2 period 68 3 period 71 4 period 74 5 period 76 Table 7. Visual Analogue Scale(VAS) of painful urination and pain of both foot period painful urination pain of both foot 1 period VAS3 VAS7 2 period VAS3 VAS8 3 period VAS3 VAS6 4 period VAS6 VAS6 5 period VAS3 VAS5

13 141 Fig L-spine CT Fig L-spine CT Fig Calcaneous X-ray Fig Calcaneous X-ray

14 Appendix 1. SCIM (Spinal Cord Independence Measure ) Self-care 1. (,,, ). 0 :. 1 :. 2 : : (,,, ) (, ) (,,,, ). 0. ( :.) 1. :

15 cc : cc : cc : /3. 0.( : ). ( ). 5..( 1 ) (,, ) 0. :. 1. : /. 2 : /. 3 ( : bars) 4 ( ) : (push-up). 5 : ( - ) (,,,, ) ( - - ) ( :, :,,,, ) ( ) 12. (10m ) ( ). 3 (swing). 4 (reciprocal waking). 5

16 (10-100m) ( ). 3 (swing). 4 (reciprocal waking) (100m ) ( ). 3 (swing). 4 (reciprocal waking) ,, : - (,,,, ) (max=100, min=0)

012임수진

012임수진 Received : 2012. 11. 27 Reviewed : 2012. 12. 10 Accepted : 2012. 12. 12 A Clinical Study on Effect of Electro-acupuncture Treatment for Low Back Pain and Radicular Pain in Patients Diagnosed with Lumbar