129~144 방출성 요추 골절

129 DOI : 10.3831/KPI.2010.13.1.129 Received : 10. 03. 08 Accepted : 10. 03. 13 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 50 40 20 10 2 3 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, 614-710. Tel : (82)51-850-8613, Fax : (82)51-867-5162, E-mail : kmdkch@deu.ac.kr This research was supported by Dong-Eui University Research Fund(2009AA127)

130 13 1 2010 3 1 T12-L1 2009 12 21 2010 2 5 1 3 2008 11 1 4 2009 12 21 5 6 CVA, DM 7 8 2009 12 21 2010 2 5 9 29 2008 11 1 2 stratch car T12-L1 burst Fx. and spinal cord injury, both calcaneus Fx 2009 1 2009 1 2009 10 H/R II 1 29 10 1 2 1 2-3 2 1/2 /1 3

131 4 1 /day 5 6 3-4 2008 12 5 7 50 3-4 8 CIC Clean Intemittent Catheterization 6-7 self voiding 100 300 9 10 11 12 13 35-40 4-5 11 1 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 2009 12 23 Normal ECG. Sinus rhythm. 3 chest X-ray 2009 12 23 N-S 4 LAB 2009 12 23 Cl 112mmol/L, U. LEU 10 5 1 130 Hg 80 Hg 2 77 min 3 36.2 4 20 min 12 1 23G 6.0 GV1 B56 B57 G34 S36 B36 B37 B25 Sp12 G29 Liv12 23G 4.0 B60 Table 1 2 1 0.20 30mm stainless steel 8-20mm 30 2009 12 2010 1 2 K5 G34 Liv3 SI3 2010 1 3 G31 G34 Liv3 SI3 GV20 2010 1 4 2010 2 1 K5 G34 Liv3 SI3 GV20 2009 12 2010 1 2 2010 1 3 2010 2 1

132 13 1 2010 3 2 CV12 CV4 1 3 1 10000:1 0.5 T12-L5 G31 G34 S36 G39 K6 Liv4 S41 G40 B62 B60 G41 Liv3 2009 12 21 3-4 500:1 2.0 Table 2 2 2009 12 22 2010 1 4 G20 G21 0.01~0.05 0.2 2010 1 26 0.2 0.1 3 4 Table 3 5 FES 2009 12 29 2010 1 15 5 2010 1 18 2010 2 5 3 6 Opalmon TAB Mucoran Forintestin Klebsiella 2010 2 1 Cravit Loxonin Stillen 4 Stillen, Septrin( 5 13 1 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

133 SCIM Appendix 1 14 5 1 2009 12 21 2009 12 29 1 9 1 9 20-30 SCIM 62 3-4 2008 12 9 VAS10 1 VAS7 50 5 50 50 6 1 2 CIC 6-7 1-2 self voiding 100 300 20~30 2009 12 27 1 100 150 9 VAS10 1 VAS3 2 2009 12 30 2010 1 5 10 16 2 2 2 2009 12 31 TUG Test 2010 1 0-1 SCIM 1 62 68 SCIM VAS8 2 6 129 146 1 20-30 VAS3

134 13 1 2010 3 2 50 3 2010 1 6 2010 1 21 17 32 3 3 1-2 3 TUG 2 3m 52.1 3 3m 31.6 2 5m 57.7 3 5m 36.2 SCIM SCIM 71 3 VAS6 3 2 CIC 500~600 30-50cc 3 8 110 136 2 VAS3 4 2010 1 22 2010 1 30 33 41 4 4 2 4 VAS10 VAS2 4 3 TUG 3 SCIM 4 74 4 4 VAS3 VAS6 4 9 66 178 2010 2 1 UA U.LEU 500 U.WBC25-50 U.RBC10-25 U.NIT Klebsiella pneumoniae 2010 2 1 Cravit Loxonin, Stillen 4 Stillen, Septrin 5 3 5 2010 1 31 2010 2 5 42 47 5 5 5 1 10 TUG 5m 27.4 2 40.8

135 SCIM 76 62 5 3-4 5 0-1 5 5 VAS5 5 Cravit Septrin 4 VAS6 VAS3 CIC 4 VAS2-3 III Denis three column concept conusmedullaris

136 13 1 2010 3 3 29 2 T12-L1 Fx. spinal cord injury, both calcaneus Fx 2009 12 21 2010 2 5 GV1 B56 B57 G34 S36 B36 B37 B25 Sp12 G29 Liv12 G34 Liv3 SI3 G31 K5 CV12 CV4 G20 G21 5 FES 3-5

137 SCIM 62 76 10m TUG 3m 2 22.9 21.7 3m 2 43.3 20.4 3m 2 52.1 20.3 3-4 0-1 5 VAS10 VAS5 CIC 2 129 146 13 303 85 198 150 100 CIC VAS3 4 VAS6 VAS3 1 IV 2009 12 21 2010 2 5 T12- L1, 1 TUG, SCIM VAS CIC V 1. 5 2001 : 670~78. 2. Atlas SW, Regenbogen V, Rogers LF et al:the Radiographic characterization of Burst Fractures of the Spine. 1986 ; AJR 147 : 575-82. 3. 3 2003 : 724, 673-5. 4. Kim Hyung-Jee, Sohng In-Ho, Lee Geun-Ho. High Risk Urodymamic Factors of Neuropthic Bladder in Spinal Cord Injury Patients. 1998 : 1. 5. 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. 2002 : 247-57. 6. 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. 1999 : 283-96. 7. Kim Kyung-Sik, Lee Keon-Mok, Cheon Mi- Na, Lee Byung-Cheol, Kim Jong-Hwan. Long

138 13 1 2010 3 term Effects of Electrical Acupuncture treatment on Rat's Spinal Cord Injury and Allodynia. The Journal of Korean Acupuncture and Moxibustion Society. 1997 ;14(1) : 287-302. 8. 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. 1997 ; 14(1) : 273-86. 9. 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. 2009 ; 19(2) : 27-49. 10. 2003 : 19-66. 11. Pharmacopunctur-ology. 2008 : 115-48, 134. 12. www.druginfo.co.kr 13. 6 2006 : 333-4. 14. 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);810-18. 15. Catz A.,Itzcovich M.,& Agranove E. SCIMspinal cord independent measure; A new disablility scale for patients with spinal cord lesions. Spinal Cord. 1997 : 35, 850-6 16. Kim Chan M.D, Lee Seung-Myung M.D. Modified transpedicular approach with laminoplasty in thoracolumbar burst fracture. 2002. 17. 2006 : 343~6, 353. 18. 2000 : 76-289, 510-2. 19. 2003 : 70, 262. 20. Journal of Oriental Rehabiliration Medicine. 1997 ; 7(2) : 154-61. 21. 2006 : 144-7, 624. 22. 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. 2009 ; 12(4) : 97-104. 23. 2000 : 210-44, 384-434, 753-8. 24. 2008 : 136-245. 300-6. 25. 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. 2002 ; 19(5) : 149-60. 26. 15 1999:498-9. 27. 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. 2008 ; 11(4) : 79-86. 2007 ; 10(3) : 37-46.

139 Table 1. Clinical chart of Mae-sun therapy Date 09. 12. 22 09. 12. 30 10. 1. 2 10. 1. 6 10. 1. 11 Place ( ) ( ), ( ), ( ) ( ) ( ),, ( ), ( ), Count 1 4 6 5 6 Date 10.1.16 10.1.20 10.1.22 10.1.29 10.2.1 Place ( ),, ( ) 1.5 ( ), ( ) ( ),, Count 6 4 6 2 4 Table 2. Clinical chart of bee venom acupuncture therapy Date 09.12.21 09.12.23 09.12.25 09.12.27 09.12.29 10.1.1 Density 10000:1 10000:1 5000:1 5000:1 3000:1 2000:1 Dose 0.50 0.50 0.30 0.50 0.50 0.50 Date 10.1.2 10.1.4 10.1.6 10.1.8 10.1.10 10.1.12 Density 1000:1 1000:1 1000:1 1000:1 1000:1 1000:1 Dose 0.50 0.50 1.00 1.00 1.00 1.00 Date 10.1.14 10.1.18 10.1.20 10.1.22 10.1.25 10.1.27 Density 1000:1 1000:1 1000:1 1000:1 1000:1 500:1 Dose 1.00 1.00 1.50 2.00 1.00 1.50 Date 10.1.29 10.2.1 10.2.3 10.2.5 Density 500:1 500:1 500:1 500:1 Dose 2.00 2.00 2.00 2.00 Table 3. Herbal medicine prescription 2009.12.21 / 8g 6g 6g 6g 4g 4g 2009.12.22~2009.12.29 / 10g 8g 6g 6g 6g 4g 80-100g 2009.12.30~2010.1.5 / 8g 6g 6g 6g 4g 2010.1.6~2010.1.10 / 10g 8g 6g 6g 6g 4g 90g 2010.1.11~2010.1.12 / 50g 6.6g 6g 2010.1.13~2010.1.19 / 8g 6g 6g 6g 4g 2010.1.20~2010.1.21 10g 8g 8g??8g 4g 2010.1.22~2010.1.24 8g 5g 5g 4g 4g 4g 2010.1.25~2010.1.28 12g 8g 6g 6g 6g 5g 5g 2010.1.29~2010.1.30 / 15g 10g 10g 6g 4g 4g 2010.1.31~2010.2.5 / 8g 6g 6g 6g 4g

140 13 1 2010 3 Table 4. frequency of urination and self voiding amount and remained amount frequency( / ) self voiding amount( ) remained amount( ) 1 period 7 13 303 2 period 6 129 146 3 period 8 110 136 4 period 9 66 178 5 period 9 85 198 Table 5. Time Up and Go test (TUG test) walker 3m walker 5m Stick 3m Stick 5m S.W3m S.W5m 2 period 22.9 33.9 43.3 57.7 52.1 3 period 30.7 36.9 25.9 36.2 31.6 40.8 4 period 21.7 27.5 23.6 33 34.7 39.7 5 period 21.7 29.3 20.4 30.1 20.3 27.4 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

141 Fig.1. 2008.11.1 L-spine CT Fig.2. 2009.12.16 L-spine CT Fig.3. 2008 11 1 Calcaneous X-ray Fig.4. 2009 5 Calcaneous X-ray

142 13 1 2010 3 Appendix 1. SCIM (Spinal Cord Independence Measure ) Self-care 1. (,,, ). 0 :. 1 :. 2 : :. 3. 4 2. (,,, ). 0. 1. 2. 3. 0. 1. 2. 3 3. (, ). 0. 1. 2. 3. 0. 1. 2. 3 4. (,,,, ). 0. ( :.) 1. :. 2. 3 5.. 0. 2. 4. 6. 8. 10 6. - 0

143 100cc :. 4 100cc :. 8 12 100cc :. 15 7. - 1 /3. 0.( : ). ( ). 5..( 1 ). 10 8. (,, ) 0. :. 1. : /. 2 : /. 3 ( : bars) 4 ( ). 5 9.. 0. 1. 2. 3. 4 : (push-up). 5 :. 6 10. ( - ) (,,,, ). 0. 1. 2 11. ( - - ) ( :, :,,,, ). 0. 1. 2 ( ) 12. (10m ). 0. 1. 2 ( ). 3 (swing). 4 (reciprocal waking). 5

144 13 1 2010 3. 6. 7. 8 13. (10-100m). 0. 1. 2 ( ). 3 (swing). 4 (reciprocal waking). 5. 6. 7. 8 14. (100m ). 0. 1. 2 ( ). 3 (swing). 4 (reciprocal waking). 5. 6. 7. 8 15.. 0 3. 1,, 3. 2 3. 3 16. : - (,,,, ). 0. 1. 2. 3 (max=100, min=0)