Journal of Korean Medicine Rehabilitation Vol. 25 No. 4, October 2015 pissn 1229-1854 eissn 2288-4114 http://dx.doi.org/10.18325/jkmr.2015.25.4.105 Original Article 척추세움근매선침치료가만성요통환자에미치는효과 유덕주 정재영 정석희경희대학교한의과대학한방재활의학과교실 Effects of the Embedding Acupuncture Treatments for Chronic Low Back Pain Patients Duk-Joo Yoo, K.M.D., Jae-Young Jung, K.M.D., Seok-Hee Chung, K.M.D., Ph.D. Department of Korean Rehabilitation Medicine, College of Korean Medicine, Kyung-Hee University RECEIVED September 16, 2015 REVISED October 5, 2015 ACCEPTED October 12, 2015 CORRESPONDING TO Seok-Hee Chung, Department of Korean Rehabilitation Medicine, Kyung-Hee University Medical Center, 23, Kyungheedae-ro, Dongdaemungu, Seoul 02447, Korea TEL (02) 958-9299 FAX (02) 963-4983 E-mail omdchung@khu.ac.kr Copyright 2015 The Society of Korean Medicine Rehabilitation Objectives To investigate clinical effects of needle embedding acupuncture treatments for chronic low back pain patients. Methods 30 patients with chronic low back pain were recruited and randomized into two groups-the embedding acupuncture group or the placebo. At baseline, the age, height, weight, visual analogue scale (VAS), Oswestry disability index (ODI) scores were measured. And surface electromyography (SEMG) data of both erector spinae at L2, L4 level were also measured on both groups and asymmetry index (AI) were calculated. The embedding or placebo acupuncture treatment was performed on the erector spinae according to SEMG values; immediately after the first evaluation and 48 hours after the first visit. After 96 hours of intervention, the VAS, ODI score and SEMG of both erector spinae were measured again. Statistical significance was determined using the Wilcoxon signed ranks test or the Wilcoxon rank sum test. Results The mean VAS, ODI score after treatment was decreased significantly compared with baseline on both groups. And the VAS, ODI score and AI of the embedding acupuncture group was more decreased significantly than the placebo (p<0.05). Conclusions The results suggest that embedding acupuncture for chronic low back pain patients was effective on the VAS pain score, ODI score and AI of the erector spinae. (J Korean Med Rehab 2015;25(4):105-112) Key words Low back pain, Needle embedding acupuncture, Visual analogue scale, Oswestry disability index, Surface electromyography, Asymmetry index 서론»»» 2014년 10월보건복지부의실태조사에따르면허리통증은한방의료기관에내원하는질병의 14.3% 를차지 1) 하고있으며, 더불어요통의치료기전연구, 임상실험및문헌고찰등이국제적인학술지에발표되고있는등요통의한의학적치료에대한관심은더욱높아지고있는추세이다 2,3). 이러한한방치료행위중하나인매선침치료는혈위매 장요법또는약실자입요법으로도불리며, 증상의원인이되는부위에약실을삽입하여매몰시켜지속적인자극을주는치료법이다 4). 이렇게체내에매입된약실은근처부위의근육, 인대또는건등의조직을자극하고이에따른면역반응을유도하여항상성을증대시켜치료하는데 5), 약화된근육, 인대등으로인한각종질환에응용이가능하다. 매선침치료의최근국내연구동향은안면, 성형, 비만 www.e-jkmr.org 105
유덕주 정재영 정석희 치료에관한연구가대부분 6,7) 으로, 근골격계통증치료를기술한문헌은드물었다. 최근발표되었던매선침치료의연구현황에의하면근골격계질환에매선을이용한사례는 4편이었으며, 그마저도모두증례보고형태로작성되었고 8), 다만매선을요추추간판탈출증환자 4례에기존치료에병행적용하여효과를나타낸연구보고가있었다 9). 다만매선침치료가약화되고늘어진근육을강화시킨다는연구들이있었는데, 예로요실금증상을가진환자들에게골반저근육에매선을시술하여근수축을강화시킨연구 10) 가있었고, 또다른보고로는안면마비환자들에게매선을시술하여안면근육을강화시켜회복을촉진시켰던사례들이있었다 6,11). 그렇다면체간이나사지의근골격계질환에도이를응용할수있겠고, 요통환자들에게서표면근전도상의좌우비대칭이나타났다는연구 12) 를근거로하였을때요통환자에서낮은수축력을나타내는쪽에매선을적용한다면비대칭을줄일수있을것이라예상할수있다. 저자는요통을호소하는환자에게양측척추세움근 (Erector spinae) 의표면근전도검사를통해낮은근수축력을나타낸척추세움근을선택하여매선침치료혹은거짓매선침치료를실시하고, 이에대해서시각적상사척도 (visual analogue scale, VAS), 요통기능장애점수 (oswestry disability index, ODI) 및표면근전도 (surface electromyography, SEMG) 값의비대칭도 (asymmetry index, AI) 의변화를살펴본결과약간의지견을얻었기에보고하는바이다. 대상및방법»»» 1. 연구대상 1) 개요 2015년 1월 1일부터 2015년 3월 31일까지원내및원외모집공고를통해자원한 18세이상 65세미만의만성요통을가진환자를대상으로하였다. 본연구에서의만성요통은요통이주소증이면서 3개월이상지속된경우 13) 를말한다. 대상자중연구기간중다른치료를받지않기로서면으로동의한자를선정하였으며, 아래기술한제외기준에해당하는자를제외하고총 30명을선정하였다. 본연구는피험자의안전및권익에대한보호를위해 경희대학교한방병원기관생명윤리위원회의심의 (IRB 승인번호 : KOMCIRB-140718-HR-001-03) 를거쳐진행되었다. 2) 제외기준모집된자중연구대상에서제외한기준은다음과같다. 1 특정한질병의진단으로요통증상이나타날개연성이있는자 ; 척추골절 (vertebral fracture), 염증성척추염 (Inflammatory spondylitis), 척추감염 (spinal infection), 악성종양 (metastatic cancer) 등 2 척추수술의과거력또는연구기간내에수술이예정된경우 3 신경학적검진시이상이나타나거나신경근통증이있는자 4 심한요통으로인하여검사에필요한기립자세및요추의굴곡, 신전이어려운자 5 치료효과나결과의해석을방해할수있는다른내과, 부인과적만성적인질환이있는경우 6 임신또는수유중인자 7 심한인지저하로인해연구에동의와협조가어려운경우 8 요통으로인한소송혹은보상과관련된경우 9 현재요통치료를위한약물혹은한약을복용중이거나기타연구자가부적합하다고고려되는약품을복용한경우 10 스크리닝시 100 mm 시각적상사척도상 40 mm 미만인자 11 피부알러지반응과민자인경우 12 기타임상연구에참여또는치료를받는것이어려운경우 ( 약물중독을포함한심각한심리적혹은정신적이상, 치매, 마비, 중대한청각이나시각의이상, 통원이불가능한경우, 한국어로읽고쓰기가안되는경우등 ) 2. 연구방법 1) 대상본연구는피험자들에게매선침을시행한실험군과거짓매선침을시행한대조군으로나누어진행하였다. 군배정은 Microsoft Excel 2010 R version 14.0 프로그램내의무작위함수를이용하여진행되었으며, 연령에의한차이를최대한배제시키기위하여 18 33세, 34 49세, 50 106 J Korean Med Rehab 2015;25(4):105-112
척추세움근매선침치료가만성요통환자에미치는효과 65세로나누어연령별층화무작위배정방법을이용하였다. 군간의피험자수차이를최소화하기위해블록무작위배정을함께적용하여각군당 15명이모집되도록하였다. 2) 치료방법 스크리닝이후첫방문시매선침시술이전에연구대상자의 VAS 측정, ODI 설문지작성과함께 SEMG를측정하였고, SEMG 측정시전극은제2번과 4번요추극돌기의좌우척추세움근에부착하였다. 처음평가가끝난직후실험군의경우매선침 (Miracu, 바늘 (0.350 mm 30 mm), 매선실 (0.08 mm 30 mm), 동방침구제작소 ) 을시술하게되는데이는 SEMG 결과를바탕 9) 으로좌측또는우측중보다낮은 root mean square (RMS) 값을나타낸쪽의척추세움근에적용시켰다. 매선침은 2개를족부에서두부방향으로피부와 15도의각도를이루도록평자하여자입하여약실이근육천층에위치하게끔하였다. 대조군의경우에는실험군과동일한과정을거치지만실제매선약실을삽입하지않는방식으로이루어졌다. 이때시술과정을보지못하게하여대상자맹검이이루어질수있도록한다. 48시간이경과한후연구대상자는재방문하여이상반응여부를확인받고각군별로처음방문과같은치료과정을통해 2차시술이시행되었다. 2차시술이후 48시간이경과한다음의마지막방문시에는시술없이 VAS, ODI 설문지및 SEMG의측정만이루어졌고이상반응여부확인후연구를종료하였다. 3) 평가방법치료에대한평가는처음매선침혹은거짓매선침의시술직전과 2차시술이후 48시간이경과한다음모두 2회에걸쳐시행되었다. 평가지표로는 VAS와 ODI와함께표면근전도 (Surface electromyography, SEMG) 의값이사용되었다. 표면근전도 (LXM3208-RF, ( 株 )Laxtha, Korea) 측정시이용된표면전극 (Ag/AgCl 일회용전극, 3M Company) 은기준전극과기록전극으로구성되었는데, 대상자의경추 7번극돌기아래에기준전극 1개를부착하였으며, 척추세움근 ( 제2번, 4번요추극돌기의좌우측약 3 cm지점 ) 에기록전극 4개를부착하였다 14) (Fig. 1). 대상자는바로선후양발을어깨너비정도로자연스 Fig. 1. Measuring surface electromyography values of the erector spinae during repetitive trunk flexion and extension. 럽게벌린자세에서위에기술한부착지점에전극을부착하고서측정이이루어졌다. 측정시연구대상자는가볍게허리를 45도구부려 5초간허리를굽히도록시킨후다시중립자세로돌아오고바로신전을 20도시킨후 5초간유지한다음다시중립자세로돌아오는과정을한주기로하였고, 총 5회씩실시하였다. 이때, 전극을통해척추세움근의전기적활동전위를구하였다 15). 측정이끝난후양측의근긴장도와근수축력을나타내는 RMS (root mean square) 값을통해비대칭분율 (asymmetry index, AI) 을계산하였다. 비대칭분율값은좌우양측의 RMS 값차이의절대값을좌우양측의 RMS 값의합으로나누어구하였다 15-17). 이때, 시술자와평가자는서로다른사람을두고, 낮은 RMS를나타내는쪽이어느쪽인지에대한사항외에는서로의사소통하지못하게함으로써평가자맹검이이루어질수있도록하였다. 3. 통계처리 통계처리는 SPSS 18.0 R for Windows를사용하였고, 각측정값들은평균 ± 표준편차 (mean±standard deviation) 로표시하였다. 대상자각군에서치료전후의통증강도, ODI 결과및좌우척추세움근의 RMS 비대칭분율의변화의유의성여부를측정하기위하여대응표본의비모수검정에이용되는 Wilcoxon signed ranks test가이용되었고, 양쪽군의치료효과차이의유의성여부를비교하기위하여독립표본의비모수검정에이용되는 Wilcoxon rank sum test를이용하였다. 통계결과 p<0.05 인경우를유의성이있는것으로간주하였다. www.e-jkmr.org 107
유덕주 정재영 정석희 결과»»» 1. 대상분석및초기평가 의성있게 VAS 가감소하였다 (Table II). 3. 요통기능장애점수의변화 실험군과대조군각각 15명의분석및초기평가가이루어졌다. 중도탈락은없었으며, 연구대상자의기본정보를평균 ± 표준편차 (Mean±SD) 형식으로기술하였다. 전체대상자의평균나이는 37.93±14.29세였으며, 키와몸무게를이용한평균체질량지수 (body mass index, BMI) 는 23.08±2.49kg/m 2 의분포를보였다. 나이, BMI에서실험군과대조군간의통계적으로유의한차이는발견되지않았다. 치료시작전요통에대한 VAS에있어실험군의경우 4.99±1.12, 대조군의경우 5.33±0.85이며군간의유의한차이는발견되지않았다. ODI를이용한요통기능장애점수에있어실험군의경우 23.05±9.70, 대조군의경우 23.88±10.36이며군간의유의한차이는발견되지않았다. 표면근전도값의 AI에대한결과는실험군의경우 1.14±0.71, 대조군의경우 1.06±1.09이며군간의유의한차이는발견되지않았다 (Table I). 2. 시각적상사척도를이용한요통정도의변화실험군과대조군의치료전과후의평균 VAS 를비교해본결과, 실험군에서는 4.99±1.12에서 3.13±1.05로, 대조군도 5.33±0.85에서 4.83±1.30으로모두유의성있게감소하였다. 또한, 치료전에는군간의 VAS의유의성있는차이가없었으나치료후에는실험군이대조군에비해좀더유 실험군과대조군의치료전과후의평균 ODI를비교해본결과, 실험군에서는 23.05±9.70에서 11.42±8.73로, 대조군도 23.88±10.36에서 19.81±11.19으로모두유의성있게감소하였다. 또한, 치료전에는군간의 ODI 점수의유의성있는차이가없었으나치료후에는실험군이대조군에비해좀더유의성있게 ODI 점수가감소하였다 (Table III). 4. 표면근전도값비대칭분율의변화 실험군과대조군의치료전과후의평균 AI 를비교해본 Table II. VAS Comparison between Before and After Treatment EA (n=15) PEA (n=15) p-value VAS before treatment 4.99±1.12 5.33±0.85 0.126 (1st visit) VAS after treatment 3.13±1.05 4.83±1.30 <0.001* (3rd visit) p-value 0.001 0.021 *p<0.05, VAS was significantly decreased between two groups. p<0.05, VAS was significantly decreased between before and after treatment. EA: embedding acupuncture group, PEA: placebo embedding acupuncture group, VAS: visual analogue scale. Values are represented by mean±sd. Significance between groups was calculated by Wilcoxon rank sum test. Significance between before and after treatment was calculated by Wilcoxon signed ranks test. Table I. General Characteristics and Baseline Evaluation of the Subjects (n=30) Total EA PEA p-value The number of subjects 30 15 15 Age (years) 37.93±14.29 37.93±15.13 37.93±13.94 0.967 BMI (kg/m 2 ) 23.08±2.49 22.31±2.56 23.86±2.25 0.081 VAS 5.16±0.99 4.99±1.12 5.33±0.85 0.126 ODI 23.46±9.87 23.05±9.70 23.88±10.36 0.285 AI 1.10±0.90 1.14±0.71 1.06±1.09 0.539 EA: embedding acupuncture group, PEA: placebo embedding acupuncture group, BMI: body mass index, VAS: visual analogue scale, ODI: Oswestry disability index, AI: asymmetry index. Values are represented by mean±sd. Significance was calculated by Wilcoxon rank sum test. 108 J Korean Med Rehab 2015;25(4):105-112
척추세움근매선침치료가만성요통환자에미치는효과 Table III. ODI Comparison between Before and After Treatment EA (n=15) PEA (n=15) p-value ODI before treatment 23.05±9.70 23.88±10.36 0.285 (1st visit) ODI after treatment 11.42±8.73 19.81±11.19 0.023* (3rd visit) p-value 0.001 0.016 *p<0.05, ODI was significantly decreased between two groups. p<0.05, ODI was significantly decreased between before and after treatment. EA: embedding acupuncture group, PEA: placebo embedding acupuncture group, ODI: Oswestry disability index. Values are represented by mean±sd. Significance between groups was calculated by Wilcoxon rank sum test. Significance between before and after treatment was calculated by Wilcoxon signed ranks test. 결과, 실험군에서는 1.14±0.71에서 0.42±0.25로유의성있게감소한것으로나타났다. 반면, 대조군은 1.06±1.09 에서 0.85±0.58로평균은감소하였으나, 검정결과유의성은나타나지않았다. 또한, 치료전에는군간의 AI 점수의유의성있는차이가없었으나치료후에는실험군이대조군에비해좀더유의성있게 AI 점수가감소하였다 (Table IV). 고찰»»» 매선침치료는약실을피부속으로자입하는매침의원리와지속적으로자극을주는유침의원리를근거로형성된치료법으로신침요법중하나에속한다 18). 처음매선이사용될당시에는안면마비등비교적장시간의유침을필요로하는질환에만제한적으로사용되었으나 19), 최근에는급성기치료에도응용되는등그범위가확장되고있으며, 이와관련한연구들이진행되고있다. 현재밝혀진매선침치료의기전으로는약실의무균성염증반응을통한지속적자극을통해탄력을잃고이완된근육의탄력을회복하여주는것 20) 으로설명되고있으며, 따라서약해진근육에이를응용할수있다고판단된다. 실제로매선을골반저근육에적용하여강화시켜증상의개선을보여준연구 10) 가있었고, 특히안면마비에있어서는약해진안면근육에매선을시술하여안면비대칭감소효과를보았던연구 11,12) 도있었다. 하지만최근까지의매선침치료는주 Table IV. Asymmetry Index Comparison between Before and After Treatment EA (n=15) PEA (n=15) p-value AI before treatment 1.14±0.71 1.06±1.09 0.539 (1st visit) AI after treatment (3rd visit) 0.42±0.25 0.85±0.58 0.023* p-value 0.006 0.460 *p<0.05, AI was significantly decreased between two groups. p<0.05, AI was significantly decreased between before and after treatment. EA: embedding acupuncture group, PEA: placebo embedding acupuncture group, AI: asymmetry index. Values are represented by mean±sd. Significance between groups was calculated by Wilcoxon rank sum test. Significance between before and after treatment was calculated by Wilcoxon signed ranks test. 로안면부위에만국한되어많은연구가진행이되었고, 이를체간이나사지의근골격계에응용한사례는드물었다 8). 이에본연구에서는치료적응증의범위를확장시켜요통환자에있어양측근육기능의차이가있음 21) 에착안하여약해진쪽의척추세움근에약실을자입하여약해진근육을강화시키려는의도로진행되었다. 그리하여약실자입으로이러한차이를줄여주면서동시에요통의호전효과를함께기대하였고, 실제피험자들에게실시한결과비대칭분율의유의한감소를나타내면서통증강도역시줄어듦을확인할수있었다. 이처럼매선침치료는근육기능의불균형을나타내는다양한질환에응용할수있지만, 실제이물질이몸속에지속적으로들어가있는만큼감염에의한부작용역시간과할수없는부분이다. 대표적으로매선침치료의조직괴사, 비정형마이코박테리움감염, 육아종염증등의가능성에대해언급하며특히이물육아종으로진단된 2례에대해보고한문헌 20) 이있었으며, 염증등의이물반응을보고 22) 한사례도있었다. 따라서감염, 염증에대한철저한소독등을통해부작용을미연에방지할수있는권고사항혹은장치들이필요하며, 문제발생이후에발생할수있는사후조치에대한가이드라인이필요할것으로생각된다. 이번연구의 30명의피험자에게서는상기설명된부작용등은나타나지않았다. 본연구에서는매선침치료의효과를검증하는데있어시각적상사척도 (visual analogue, scale, VAS) 와요통기 www.e-jkmr.org 109
유덕주 정재영 정석희 능장애점수 (oswestry disability index, ODI), 그리고표면근전도의비대칭분율 (asymmetry index, AI) 을이용한평가지표가사용되었다. 이중 VAS 와 ODI 는일반적으로요통연구에서많이사용된다. 하지만이둘은환자의주관적느낌과경험이섞여객관적인평가가부족하다는단점이있다. 그리하여기존평가방식에더하여좀더객관적인수치로확인할수있는평가를위해표면근전도를대안으로선택하였다 21). 표면근전도는근육으로부터나오는전기신호를피부에표면전극을부착하여통증없이감지하여측정하는방식이다. 따라서한개의개별근육만을평가하는침근전도방식과는다르게특정운동시반응하는모든근육군에대한기능을종합적으로측정하고수치화하여나타낼수있다. 이러한표면근전도는근골격계질환관련재활분야의평가에있어서새로운가능성을열어주고있다 23). 표면근전도의주요한결과값으로 RMS (root mean square) 와 MEF (median edge frequency) 가있다. RMS값은근육들로부터측정된전기적파형에서양수값과음수값을취하여제곱한후그평균을낸값에제곱근을하여계산하는방식 15) 으로일반적으로값이높아질수록근수축력과긴장이있음을의미한다. MEF는근육의피로도를나타내주는값 15) 으로값이낮아질수록피로도가높음을나타낸다. 이번연구에서는표면근전도의결과값중 RMS 값을이용하여진행되었는데, 양쪽의척추세움근의 RMS 값의차이가크다면양쪽의근긴장도가다름을나타내는것이고, 결국이는비특이적만성요통과연결시킬수있을것이다. 표면근전도에대한기존연구에서요통은주로표면근전도값의좌우비대칭의정도와비교가많이되었는데대표적으로요통환자에서표면근전도값을이용해좌우비대칭을도식화하여평가하는데응용할수있다고발표한연구 12) 가있었으며, 그외에요통환자들에있어표면근전도를통한복부근육의좌우비대칭이나타남을보고한문헌 24) 이있었다. 최 15) 역시이러한점을들어척추세움근기능의비대칭분율을통한임상연구 16) 를진행하였고, 본연구에서도이를바탕으로응용하였다. 본연구에서는매선침치료군과거짓매선침치료군으로나누어치료전후로통증강도, 일상생활기능장애정도와함께표면근전도상의비대칭분율을조사하였다. 세가지의평가결과모두매선침치료군에서치료전보다 치료후에유의한감소를확인할수있었으며, 군간비교에서도매선침치료군이거짓매선침치료군에비해더유의한감소가나타난것으로확인되었다. 또한연구결과를살펴보면거짓매선침치료군에서도치료전보다치료후에 VAS, ODI의유의한감소효과가나타났는데이는크게두가지관점에서해석해볼수있다. 첫째로거짓매선침치료에있어서도눈가림을위한단자가시행되었기때문에이에의한위약효과가나타난것으로생각되고, 둘째로는단자로인한근육과근막자극으로실제로어느정도의효과가났을가능성을생각해볼수있었다. 실제로이두가지원인이같이작용한것으로생각되며, 다만위의첫번째요인을어느정도배제시킬수있는표면근전도분석에서는거짓매선침치료군에서치료전후로유의한효과가관찰되지않았기때문에실제단자에의한효과보다는위약효과가더크게작용한것으로판단된다. 위약효과에대해고찰해보았을때이전의일부연구 25) 에서는요통환자의침치료전후를평균 VAS 를통해분석한결과최대 65% 정도의비율로위약효과에의한통증감소가있었다고보고된반면, 본연구를 VAS 를통해살펴보았을때는약 27% 의위약효과로인한통증감소가나타났다. 이는단시간유침시키는침과는달리매선실은장기간삽입되어있어상대적으로긴시간동안근막에작용하여실제치료의효과가크게작용하였기때문으로판단된다. 또한실험군의 ODI의감소에대하여세부항목에따른고찰이이루어졌는데, 상대적으로 앉기 항목에대해서평균 1.73점의감소를보여가장큰점수의감소폭을보였다. 그리고 통증정도 나 수면 에대한항목역시평균 1.47점의큰감소폭을보였다. 따라서매선침치료를시행하였을때안에들어간약실이근육을강화시키고지지하는효과가있어조금더오래앉아있을수있게해주었고, 동시에지속적으로통증제어를해줌으로써수면의질을향상시킨다고판단된다. 이번연구로만성요통환자들에게서매선침치료는양척추세움근의비대칭분율을줄여주고, 이로써요통의정도를감소시켰다는것을확인할수있었다. 아직까지는매선침의근골격계질환에의적용이나표면근전도를이용한평가에대한연구가많이이루어져있지않은상태이다. 하지만본연구를초석으로이에대한연구가활발히진행된다면임상에서보다널리사용되면서한의학에서 110 J Korean Med Rehab 2015;25(4):105-112
척추세움근매선침치료가만성요통환자에미치는효과 사용되는치료및평가에있어그지평을더욱더넓혀갈수있을것이라기대한다. 결론»»» 본연구는만성요통을주소증으로하는환자 30명을매선침치료군혹은거짓매선침치료군으로나누어 5일간총 2회의치료를실시한다음시각적상사척도 (visual analogue scale, VAS), 요통기능장애점수 (oswestry disability index, ODI) 및표면근전도값의비대칭분율 (asymmetry index, AI) 을분석한결과다음과같은결론을얻었다. 1. 시각적상사척도를이용한요통의통증강도는매선침치료군과거짓매선침치료군모두유의한감소를보였으나매선침치료군에서보다나은통증강도의개선이나타났다 (p<0.05). 2. 요통기능장애점수는매선침치료군과거짓매선침치료군모두유의한감소를보였으나매선침치료군에서보다낮은기능장애점수를보였다 (p<0.05). 3. 표면근전도를이용한양쪽척추세움근의비대칭분율은매선침치료군에서만유의한감소를보였고, 매선침치료군에서대조군보다낮은비대칭분율을보였다 (p<0.05). 이상의결과를종합하였을때, 만성요통환자에게매선침치료와거짓매선침치료모두효과가나타났지만매선침치료군이유의성있게보다나은효과를보여주었다. References»»» 1. Ministry of Health & Welfare. Surveys about the use of Korean medicine and the herbal medicine consumption. Sejong:HumanCultureArirang. 2014. 2. Liu L, Skinner M, McDonough S, Mabire L, Baxter GD. Acupuncture for low back pain: an overview of systematic reviews. Evidence-based complementary and alternative medicine : ecam. 2015;2015:1-18. 3. Cho YJ, Song YK, Cha YY, Shin BC, Shin IH, Park HJ, Lee HS, Kim KW, Cho JH, Chung WS, Lee JH, Song MY. Acupuncture for chronic low back pain: a multicenter, randomized, patient-assessor blind, sham-controlled clinical trial. Spine. 2013;38(7):549-57. 4. Korean Acupuncture & Moxibustion Medicine Society. Acupuncture and Moxibustion Medicine. Gyeonggi : Jipmoondang. 2012. 5. Park YU. The Thread-embedding Therapy. Seoul: Hanglimseowon. 2003. 6. Lee CW, Lee SM, Jeon JH, Kim JI, Kim YI. Effects of Needle-Embedding Therapy on Sequelae of Peripheral Facial Palsy : A Case Series Objectives. The Journal of Korean Acupuncture & Moxibustion Society. 2011;28(4): 93-103. 7. Song MY, KIM HJ. Review on Clinical Trials of Catgut Embedding for Obesity Treatment. Journal of Society of Korean Medicine for Obesity Research. 2012;12(2):1-7. 8. Kwon K. The Analysis on the Present Condition of Thread-embedding Therapy Papers Published in Journal of Korean Medicine. J Korean Med Ophthalmol Otolaryngol Dermatol. 2014;27(4):16-44. 9. Lee HG, Lim JG, Jung DJ, Yuk TH, Kim JW. Case Report on 4 Patients with Lumbar Disc Herniation Treated with Concurrent Embedding Therapy under Conventional Korean Medical Treatments. Korean journal of oriental physiology & pathology. 2013;27(1):124-9. 10. Kim YJ, Kim MC, Lee CH, Kim JU, Yook TH. The Effect of Needle-embedding Therapy and Pharmacopuncture Therapy on Patients with Urinary Incontinence. Journal of Acupuncture and Meridian Studies. 2011;4(4):220-4 11. Li L. Acupuncture combined with catgut embedding therapy for treatment of 158 cases of facial paralysis. Zhongguo Zhen Jiu. 2005 Mar;25(3):167-8 12. Reger SI, Shah A, Adams TC, Endredi J, Ranganathan V, Yue GH, Sahgal V, Finneran MT. Classification of large array surface myoelectric potentials from subjects with and without low back pain. Journal of electromyography and kinesiology : official journal of the International Society of Electrophysiological Kinesiology. 2006;16(4):392-401. 13. Dekker-van Weering MG, Vollenbroek-Hutten MM, Hermens HJ. A pilot study - the potential value of an activitybased feedback system for treatment of individuals with chronic lower back pain. Disability and rehabilitation. 2015:1-7. 14. Stevens VK, Bouche KG, Mahieu NN, Coorevits PL, Vanderstraeten GG, Danneels LA. Trunk muscle activity in healthy subjects during bridging stabilization exercises. BMC musculoskeletal disorders. 2006;7:75. 15. Choi JS, Ahn JM, KIM CY, Lee JH, Park DS, Jeong SH, Kim SJ. The Clinical Study of Muscle Energy Techniques (MET) in Elector Spinae Muscle on Low Back Pain Patients-Through Meridian Electromyography. J Korean Rehab Med. 2013;23(1):15-23. 16. Visser A, McCarroll RS, Oosting J, Naeije M. Masticatory electromyographic activity in healthy young adults and myogenous craniomandibular disorder patients. Journal of oral rehabilitation. 1994;21(1):67-76. 17. Cho DI, Park DS, Jeong SH, Kim SJ. The Effects of MET and ICT in Patients with Lumbago by Meridian Muscle www.e-jkmr.org 111
유덕주 정재영 정석희 Electrography. J Korean Rehab Med. 2014;24(3):121-30. 18. Noh SH, Kim YR, Kim KH, Yang GY, Kim JK, Lee BR. Effects of Catgut-embedding Acupuncture Therapy on Plantar Fasciitis:Case Report. The Journal of Korean Acupuncture & Moxibustion Society. 2013;30(5):227-33. 19. Han JM, Yoon JW, Kang NR, Ko WS, Yoon HJ. The Clinical investigation studies in early stage of intractable peripheral facial paralysis using Needle-Embedding Therapy. The Journal of Korean Oriental Medical Ophthalmology & Otolaryngology & Dermatology. 2012;25(3): 113-28. 20. Baek JH, Chun JH, KIM HS, Lee JY, Kim HO, Park YM. Two cases of facial foreign body granuloma induced by needle-embedding therapy. Korean J Dermatol. 2011; 49(1):72-5. 21. Yoo DJ, Cho JH, Chung SH. A Review of Studies Comparing of Surface Electromyography Values between the Low-back Pain Group and Healthy Controls. J Korean Rehab Med. 2013;23(4):83-93. 22. Lee J, Seo HM, Hwang SH, Lee HJ, Kim YH, Min JH, Yang YJ, Lee SJ, Park JH, Choi JW. Foreign body reaction after gold-string embedding therapy. Korean J Dermatol. 2012;64(1):134. 23. Cho JH, Lee JS, Kim SS. A study of the Meridian Muscle Electrography for the Clinical Application. J Korean Rehab Med. 2005;15(4):89-104. 24. Jung JY, Lee JH, Nam KB, Kim SS. Meridian-Electromyograph Analysis on Features of Abdominal Muscles in Chronic Low Back Pain Patients. J Korean Rehab Med. 2008;18(4):203-15. 25. Leibing E, Leonhardt U, Koster G, Goerlitz A, Rosenfeldt JA, Hilgers R, Ramadori G. Acupuncture treatment of chronic low-back pain - a randomized, blinded, placebocontrolled trial with 9-month follow-up. Pain. 2002; 96(1-2):189-96. 112 J Korean Med Rehab 2015;25(4):105-112