소아마비 후유변형에 관한 통계학적 연구

Abstract

[한글]

STATISTICAL STUDY ON RESIDUAL DEFORMITIES OF THE LATE EFFECTS OF POLIOMYELITIS

Soo Bong Hahn

Department of Medical Science The graduate School Yonsei University

(Directed by Professor In Hee Chung, M.D.)

Poliomyelitis was first described in medical literature in 1789 by Underwood, an

English physician.

In 1909, Landsteiner and Popper confirmed the etiology of the poliomyelitis from

a virus.

Thereafter with clinical application of Salk and Sabin vaccinations, and marked

improvements in control of poliomyelitis, the incidence of this disease has

markedly decresed in developed nations.

In Korea, Miyoshi was the first to report an epidemic of poliomyelitis in Dae Goo

in 1939.

Statistical analysis is presented of 752 cases of the late effects of the

poliomylitis who were admitted to Orthopedic Department of the Severance Hospital

during the ten year period from Jan. 1961 to Dec. 1971.

Results of this study are as follows:

1. The incidence in males was greater than in females(males 59.3%, females

40.7%).

2. 95.3% of the 752 cases were found to occur under the age of four years, and

highest peak by age occurred between 12 and 24 months (38.7%).

3. The peak duration of deformities was from 3 years to 5 years (29.1%).

4. Difference between the incidences of the city and of the rural areas was not

determined. There was no difference between the age distribution of the onset in

Seoul, in the medium-sized cities and in rural areas.

5. Paralytic poliomyelitis was observed even in vaccinated children 2.5% of total

cases after one injection of Salk vaccine, 1.6% after two injections of Salk

vaccine, and 1.3% after three injections of Salk vaccine, and 0.2% followed a

combination of Salk and Sabin vaccination.

6. Deformity of the upper extremity was only 1.2% of that of the total body. But

deformity of the lower extremity was 93.9% of the total. There was no difference

between the deformities in both sides. In deformities of the lower extremities,

deformities of the foot were most common(29.3% of the total), those of the knee

21.3%, those of the hip 10.9%, those of the toes 8.6%, and those of the legs were

8.9%. Deformities of the spines were 4.4% and those of the pelvis were 0.5%.

In individual deformities, discrepancy in leg length was most common (15.8% of

the total), equinovalgus 7.9%, external tibial torsion 7.7%, claw toe 6.8%,

equnovarus 6.2%, knock knee 5.6% and combination of flexion, abduction and external

rotation of the hip was 5.4%.

7. The locations of the paralyses were found to be 90.7% in the lower

extremities, 7.6%in the upper extremities, 1.5% in the trunk and 0.2% in the neck.

In involvement of the upper extremities, the most frequent were in the Triceps

brachii (0.5% of involvements of the total body muscles), Deltoideus (0.5%) and

Biceps brachii (0.4%). in the involvement of the lower extremity, Tibialis anterior

was found to be the most frequent (6.1% of involvements of the total body muscles),

Iliopsoas 6.1%, Quadriceps 6.1% and Tibialis posterior was 6.0%.

Generally, the muscles of the upper extremity were more frequently affected in

mild involvement than in severe involvement except that the Opponens pollicis was

slightly more frequently affected in severe involvement than in mild involvement.

However the muscles of the lower extremities were slightly more frequently

affected in severe involvement.

Especially the Tibialis anterior, Quadriceps, Tibialis posterior, and hip

adducters were more frequently affected in severe involvement than in mild

involvement.

Generally in the muscles of the upper and lower extremities, the proximal muscles

were involved more frequently than that of the distal. There was no difference

between the frequencies of the involvements of right and left sides.

8. Taking associated paralysis into account it was shown that certain muscles

that receive nerve supply from the same segment were paralysis or weakened

together.

Tibialis anterior and Tibialis posterior, Quadriceps and hip adductors,

Quadriceps and hip flexors were the most numerous combination of the associated

paralysis.

9. Looking at spinal segment innervation in relation to mild affection of

muscles, the highest incidence was found in the first lumbar segment. In segment

incidence of severe paralysis the highest incidence was found in the second and

third lumbar segments.

[영문]

Poliomyelitis was first described in medical literature in 1789 by Underwood, an English physician.

In 1909, Landsteiner and Popper confirmed the etiology of the poliomyelitis from a virus.

Thereafter with clinical application of Salk and Sabin vaccinations, and marked improvements in control of poliomyelitis, the incidence of this disease has markedly decresed in developed nations.

In Korea, Miyoshi was the first to report an epidemic of poliomyelitis in Dae Goo in 1939.

Statistical analysis is presented of 752 cases of the late effects of the poliomylitis who were admitted to Orthopedic Department of the Severance Hospital during the ten year period from Jan. 1961 to Dec. 1971.

Results of this study are as follows:

1. The incidence in males was greater than in females(males 59.3%, females 40.7%).

2. 95.3% of the 752 cases were found to occur under the age of four years, and highest peak by age occurred between 12 and 24 months (38.7%).

3. The peak duration of deformities was from 3 years to 5 years (29.1%).

4. Difference between the incidences of the city and of the rural areas was not determined. There was no difference between the age distribution of the onset in Seoul, in the medium-sized cities and in rural areas.

5. Paralytic poliomyelitis was observed even in vaccinated children 2.5% of total cases after one injection of Salk vaccine, 1.6% after two injections of Salk vaccine, and 1.3% after three injections of Salk vaccine, and 0.2% followed a combination of Salk and Sabin vaccination.

6. Deformity of the upper extremity was only 1.2% of that of the total body. But deformity of the lower extremity was 93.9% of the total. There was no difference between the deformities in both sides. In deformities of the lower extremities, deformities of the foot were most common(29.3% of the total), those of the knee 21.3%, those of the hip 10.9%, those of the toes 8.6%, and those of the legs were 8.9%. Deformities of the spines were 4.4% and those of the pelvis were 0.5%.

In individual deformities, discrepancy in leg length was most common (15.8% of the total), equinovalgus 7.9%, external tibial torsion 7.7%, claw toe 6.8%, equnovarus 6.2%, knock knee 5.6% and combination of flexion, abduction and external rotation of the hip was 5.4%.

7. The locations of the paralyses were found to be 90.7% in the lower extremities, 7.6%in the upper extremities, 1.5% in the trunk and 0.2% in the neck.

In involvement of the upper extremities, the most frequent were in the Triceps brachii (0.5% of involvements of the total body muscles), Deltoideus (0.5%) and Biceps brachii (0.4%). in the involvement of the lower extremity, Tibialis anterior was found to be the most frequent (6.1% of involvements of the total body muscles), Iliopsoas 6.1%, Quadriceps 6.1% and Tibialis posterior was 6.0%.

Generally, the muscles of the upper extremity were more frequently affected in mild involvement than in severe involvement except that the Opponens pollicis was slightly more frequently affected in severe involvement than in mild involvement.

However the muscles of the lower extremities were slightly more frequently affected in severe involvement.

Especially the Tibialis anterior, Quadriceps, Tibialis posterior, and hip adducters were more frequently affected in severe involvement than in mild involvement.

Generally in the muscles of the upper and lower extremities, the proximal muscles were involved more frequently than that of the distal. There was no difference between the frequencies of the involvements of right and left sides.

8. Taking associated paralysis into account it was shown that certain muscles that receive nerve supply from the same segment were paralysis or weakened together.

Tibialis anterior and Tibialis posterior, Quadriceps and hip adductors, Quadriceps and hip flexors were the most numerous combination of the associated paralysis.

9. Looking at spinal segment innervation in relation to mild affection of muscles, the highest incidence was found in the first lumbar segment. In segment incidence of severe paralysis the highest incidence was found in the second and third lumbar segments.