척추손상에 관한 임상적 연구

Abstract

[영문]

[한글]

척추손상은 손상기전에 따라 손상부위 및 정도가 다양하며 이러한 환자에 대하여는 조

기 진단으로 적절한 치료방침을 세워야하고 이에 따라 예후가 결정되는 것이다.

척추손상 환자의 치료목적은 신경손상 정도를 취소한 줄이고 해부학적 정복으로 안정도

를 높혀 속히 재활활동을 허용시키는데 있는 것이다. 저자는 지난 만 7년간 연세대학교

의과대학부속 원주 기독병원에서 치험한 157예의 척추손상 환자를 대상으로 임상적 연구

를 하여 다음과 같은 결과를 얻었다.

1. 발생빈도를 보면 남녀비가 6.1:1이었고 호발연령층은 20∼50세로 전체의 84.7%를 차

지하였으며 사고원인은 탄광업소에서 일어난 산업재해로 인한 것이 52.2%로 가장 많았다.

2. 골절부위별로는 경추 24예, 흉추 64예, 요추 89예로 요추, 흉추, 경추순으로 발생분

포를 나타냈으며 흉요추부가 전 척추손상환자의 71.8%를 차지하였다.

3. 척추손상환자를 형태별로 분류하였던 바 경추에서는 50%에서 골절탈구가 동반되었고

12.5%에서는 순수탈구가 나타났다. 흉요추부에서는 단순전방 및 측방 설상골절이 66.6%

로 가장 높은 빈도를 나타냈으며 경추에서 호발하는 신전손상으로 인한 순수탈구는 1예도

관찰하지 못하였다.

4. 경추 손상환자 중 62.5%에서 척수마비 소견을 보였으며 특히 신전탈구 및 회전성 골

절탈구 환자에서 주로 나타났다. 한편 흉요추 손상환자 중 31.6%에서 신경마비를 동반하

였으며 그 중 회전성 골절탈구가 73.8%를 차지하였다. 부위별로는 제 12흉추와 제 1요추

에서 가장 높은 빈도를 보였다.

5. 치료는 경추손상 환자 중 37.5%에서 그리고 흉요추손상 환자 중 30.8%에서 관혈적

정복술을 시행하였다.

6. 경추손상 환자 중 입원 당시 완전 마비로 입원한 15예에서는 치료방법에 관계없이

회복된 예는 1예도 없었다, 흉요추환자에 있어서는 입원당시 완전신경마비 환자의 10.5%

그리고 불완전 신경마비 환자의 62.5%에서 각각 부분 회복을 보였다.

7. 경추손상 환자를 치료한 후 엑스선 추후관찰에서 점진적 전위 및 재탈구는 관찰하지

못하였으나 흉요추부에서는 단순압박골절시 6.6˚ 감압 후궁절제술 시행 후 8.7˚ 관혈

정복 및 골유합 시행시 2.9˚의 후방만곡도 증가를 보였다.

8. 흉요추부의 불안정 골절탈구 환자의 치료는 Harrington instrumentation사용이 좋을

것으로 기대되며 아울러 무분별한 후궁 절제술은 불안정성을 초래하여 신경 증상이 진행

될 수 있으므로 정확한 적응증이 되어야 실시하는 것이 좋다고 생각한다.

9. 11예의 하반신 마비환자를 간혈적 뇨관도뇨법 및 방광훈련을 통하여 전 예에서 3개

월 이내에 반사배뇨를 나타내는 것을 관찰할 수 있었다.

A clinical study of the spine injury

Jae In Ahn M.D.

Department of Medicine Science, The Graduate School, Yonsei University

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

In recent years the rate of the spine injury tends to be on the increase year by

year as the rate of traffic and industrial accidents are increased.

During industrial, sports and automobile accidents are occured, the various

forces were exerted by the mechanism, "flexion, extension, flexion-rotation,

vertical compression and shearing".

These exercise their effects on the vertebral bodies, the neural arches and

intervertebral disc and the contents of the spinal cord, depending on directionand

intensity of the trauma, and the posture and muscular attitude existent at the

movement.

Once the neurological lesion has been diagnosed and the type of vertebral injury

has been established and particularly after a decision has been made as to whether

the spinal injury is stable or unstable, a rational method of treatment can be

decided upon.

Our treatment consists of providing the best conditions for recovery from the

spine injury, preventing further neurological damage in theunstable area, achieving

stable bone and ligament healing in satisfactory position, preventing metabolic

complications from being fatal, mobilizing the patient early, and rehabilitating to

provide maximum functional independence with the remaining muscle power available

to the cord injury patient.

One hundread and fifty seven spine fracture and dislocation patients were

clinically observed and evaluated from Jan. 1972 to Dec. 1978 in our study.

The reesults of this study may be summarized as follows:

1. Out of the 157 patients, there were 135 male and 22 female cases. The ratio

between male and female was 6.1:1. The majority (84.7%) of the spine injuries was

found in the age of 20 to 50 years. Fifty-two per cent of the cases was caused by

industiral accidents.

2. The most common site of the lesion occurred between T-11 and L-2 vertebrae

(71.8%).

3. In cervical injury, fracture dislocation type was most common (50%), and

especially, pure dislocation by extension mechanism was 12.5% but in thoracolumbar

injury, simple anterior wedge compression fracture was most common (66.6%) and

there were no pure dislocations just like cervical spine injury cases.

4. Fifty seven cases of the total were complicated by paraplegia, of which 62.5%

in cervical region and 31.6% in thoracolumbar region were noticed. the most

frequent type of the injury in which paraplegia developed was the fracture

dislocation (73.8%) and the most common site of the lesion was between the T-12 and

the L-2 vertebrae.

5. Open reduction was performed in 9 cases out of 24 cervical spine injury

patients and in 41 cases out of 133 thoracolumbar injury patients.

6. Prognosis of neurologic recovery in initially complete legion was poor,

regardness of treatment. In the cervical lesion cases there were no patients who

were recovered. But in the other sites about 10.5% of initially complete lesion

showed partial neural recovery comparing to 62.5% of initially incomplete lesions.

7. Progressiv edeformity is often noted as a complication of spine fracture or

dislocation with fusion fails to develop.

The incrment of kyphosis after treatment is as follows:

Simple wedge fracture 6.6°

Laminectomy cases 8.7°

Open reduction and fusion 2.9°

8. Harrington instrumentation is an excellent armament for stabilization of spine

fracture dislocation except for the cervical spine.

9. All 11 patients on bladder training with intermittent catheterization became

catheter free within 3 months.