요추간판탈출증의 임상 및 근전도학적 연구

Abstract

[영문]

[한글]

임상-신경학적 검사소견과 척추조영술로도 요추신경근압박부위를 진단할 수 있으나, 근

전도 검사가 요추간판탈출증의 진단에 큰 도움을 주는 경우가 종종 있다

1974년 3월부터 1979년 2월까지 연세대학교 의과대학 부속 세브란스병원 정형외과에 입

원한 요추간판탈출증 환자 52명을 대상으로, 수술소견과 임상-신경학적 검사, 척추조영술

및 근전도 소견을 비교, 관찰하여 다음과 같은 결과를 얻었다.

1. 임상-신경학적 검사에선 71.2%에서, 척추조영술에선 78.8%, 그리고 근전도 검사에선

73.1%에서 수술소견과 일치하였다.

2. 술개건반사의 감소가 있는 경우에는 60%에서 족모지신전근의 약화 또는 마비가 있는

경우에는 94.1%에서, 그리고 Achilles 건반사의 감소 또는 소실이 있을 시에는 58.9%에

서 수술시에 일치하는 부위에서의 요추간판탈출이 있었다.

3. 척추조영술상 병변이 발견됐을 경우에는 전예에서 그 부위에서의 요추간판탈출이 수

술 시에 확인되었다.

4. 근전도 소견상 제 4요추신경근의 탈 신경을 보인 경우에는 전 예에서, 제 5요추신경

근의 탈 신경을 보인 경우에는 91.7%에서, 그리고 제 1천추신경근의 탈신경을 보인 경우

에는 83.3%에서 수술소견과 일치하였다.

5. 근전도 소견상, 세동전위 또는 양성예파 없이 다상성 전위만 나타날 때에도 요추간

판탈출증의 진단에 의의가 있다.

6. 척추기립근에서만 탈 신경의 소견이 나타날 때에도 요추간판탈출의 진단을 내릴 수

있다.

Electromyography in Diagnosis of the Herniated Lumber Dise

Min Lee

Department of Medical Science, The Graduate School, Yonsei University

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

The diagnostic accuracy of myelography, electromyography, and

clinical-neurological findings in 52 patients on whom the presence of herniated

intervertebral disc was proved surgically from March, 1974 to February, 1979 in

Severance Hospital was discussed and the results of this study was compared with

those in comparable studies in theliterature.

1) Of the cases in which operation revealed disc herniation or protrusion, the

clinical-neurological diagnosis was correct in 71.2%, the myelographic diagnosis

was coincided in 78.6%, the electromyographic diagnosis was agreed in 73.1%.

2) In the patinets which the patellar tendon reflex was weak or absent, operation

revealed a herniation between L^^3 and L^^4 in 60%. The disc herniation between

L^^4 and L^^5 was noted in 94.1% of patients with weakness of the extensors of the

great toe. Of the patients in whom the achilles tendon reflex was weak or absent,

operation revealed a lumbosacral disk herniation in 88.9%.

3) If the myelogram showed lumber disc changes, these changes were confirmed at

operation in the same levels in all patients.

4) A disc herniation between L^^3 and L^^4 was demonstrated in all cases of the

patients had L^^4 denervation of the EMG findings. The disc herniation between L^^4

and L^^5 was seen in 91.7% of them had L^^5 denervation.

A lumbosacral disc herniation was noted in 83.3% of them had S^^1 denervation.

5) Polyphasic motor units were significant in the absence of fibrillation or

positive sharp wave potentials in the diagnosis of the herniated lumbar disc.

6) Signs of denervation in the spinal musculature but not in the leg muscles were

considered significant in patients with diagnostic problems of the lumbar

radiculopathy.

In sumary, it is suggested that electromyography is not superior to the

myelography or the clinical-neurological examination.

But the electromyography aids the surgeon in the diagnosis of a compression

lesion of a specific nerve root.