척수손상의 연구

Abstract

[영문]

Since Aug. 1953, 117 traumatic paraplegia of spinal cord injuries by battle wounds and accident during the Korean conflict have been thoroughly observed at the 3rd R. 0. K. Army Hospital, a paraplegia center. From these cases conclusions were drawn, and these are summarized below :

(1) The age of these cases ranges from 13 to 54, and the classifications of them shows 115 males and 2 females by sex : and 109 soldiers, 2 farmers, 2 laborers, 2 businessmen, and 3 students by occupation.

(2) The most common accidents which led to the injuries in these cases were automobile accidents of which rate occupies 34.2% (40 cases) the total number, the other causes of injureies were wounds by shell fragments, and gun shot in the sequence of larger-number.

(3) Among the 87 pathologically verified patients the compression of spinal cord

or cauda equina was observed in 41 cases occupying the highest percentage of 47, the contusion and transection of cord were found in the rest of the patients.

(4) As for the level of injuries, the injury below the 6th thoracic vertebra was the commonest in the cases of gunshot and shell fragment; and the injury at the cervical vertebra 4 and 5, and between 7th thoracic and 4th lumbar vertebra was most common in the trauma cases the level of spinal segment injuries was about the same as that of vertebral injuries, but was higher than the corresponding segment to the vertebral injuries by 2.7 to 3.5 segments.

(5) The complet paralysis was exceedingly more common in the injuries of cervicothoracic vertebral columns than in the lumber vertebral traumas, according to the observation by pathological classification, there were more complete paralysis cases among the cases of transection and contusion than among any other kinds of cord injury cases.

(6) The high rate of rehabilitation was observed in the cases of cord injury below T10 and cord compression as well as in the cases who received proper treatment within 3 days after cord injury.

(7) Spinal shock in these lasts about 1-17 week period, serum protein begins to be reduced sharply in the stage of spinal shock, especially from the 3rd day after the injury. In a certain case serum protein reduced to the minimum degree of 3.2 gm % at the end of shock and had a tendency to increase gradually from the time the spinal shock does not occur.

(8) Out of 117 cases of spinal cord injury 59 (51%) were complete paralysis and the rest of 58 were incomplete paralysis.

(9) Out of 117 patients 22 (18.7%) manifested with incomplete lesion of Brownsequard type, 18 revealed Reithosen anest hesia, and 63 complained of pains of which cause was unknown.

(10) After examination of these series following their shock stages, 43 cases revealed patholocical signs such as Babinski and increasing D.T.R. Those who had anal reflex had bulbocavernous reflex. Anal reflex was found much more among those who had injuries at the segments in high level than those with inluries at the segments in low level.

The reflexing bladder was easily developed in the cases with anal reflex, and such patient seemed also to have good bowel movement, many flacid paralysis were seen among these having no anal reflex.

(11) When the patient has partial transection in cord, urinary retention may occur temporarily. Even in the case of complete transection in cord, when the sacral bladder control center was intact usually reflexing bladder was developed easily. The average period of urinary retention in these series was 3 months to 6 months, and the formation period of reflex bladder was about 6 weeks in the case of carvial cord injury and 20 weeks inthoracic cord injury.

(12) The loss of reflex function of bowel was severe only in the series of complete cord transection at the high level segment but on the other hand, it was not so severe in the case of injury below lumbar segment level or partial transection of the spinal cord.

(13) Priapism was seen in most cases with complete transection of cord at the high segmental level, but this was rarely seen in the cases with partial transection of cord and canda equinal injury. Voluntary erection of penis was observed in some of the latter cases, and 4 such patients had given birth to babies.

(14) Severe symphathetic blockade syndrome was revealed in tih cases of complete

cervical cord transection but not in the cases of incomplete transection.

(15) The location of primary cord injury was about two Segment below the Dermatome in the series of cervical cord injury, and 4 or 5 Segment below the Dermatome in the series of lumbo Sacral cord injury.

(16) In determining diagaosis of spinal cord injury cases it is important to note their various reflexes, such as the reflex during the spinal shock stage, mass refles, and brisk and pathological reflex in late stage.

(17) L.P, and Queckenstedt's test disclosed only hemorrhage and the degree of blockade in the spine canal, but did not neveal any degree of cord injury

(18) It is considered that Myelography is not worth whil and sometimes rather harmful for diagnosis of spinal cord injuries particulary in the first stage of onset.

(19) In the 104(89%) out of the total cases decubitus ulcer was found.

(20) Violent massage induced the myositis osficance.

(21) In many cases, ankylosis appeared in the digital joints where patients hands does not reach.

(22) The occureance of the myositis osficance in the spinal cord injury case does not relate with the level of injury and his disease is occurred even in the case of the cauda equina injury.

(23) Any open spinal cord injury should be indicated for the laminectomy with debridement.

(24) Severe associated injury other than the cord injury should he treated first and then when its Vital Sign becomes stable, laminectomy must be performed. It is risky to perform laminectomy when the patient has a Symphathetic blockade Syndrome.

(25) The following condition should be indicated for the laminectomy in the closed spinal cord injury cases:

a) The complete block of subarachoid space.

b) When, the X-Ray of spine reveals impinging of bone fragment into the spinal canal.

c) When the patient has the continuous ascending of dermatome.

d) When the patient has root pain.

(26) The heavy medication of albumin and correction of A.G.Ratio may be effective for prevention and treatment of decubitus ulcer.

(27) Late laminectomy and foraminatomy were very benerecial for the patients with injury below the lumbar segment and cauda equina.

(28) When the revision and laminectomy of compound lamina fracture were required the operation should be started form the intact lamina to keep away from redamage of cord.

(29) To form a reflexing bladder, the application of clip open method using an urinary drainag tube of Foley catheter in 6 or 8 hours interval was more successful than applying the Tidal drainage method in these cases of Korean condition.

(30) In most cases of cervical cord injuries, the ascites was developed and this ascites was eliminated by passive movement of diaphlagma or by the ambulation of the patient with wheelchair.

(31) In few instances among the reflexing bladder, the re-retention of urine in the bladder occured dus to inhibitory impulse from the Sacral Segment.

(32) The ultimate purpose of treatment for spinal cord injuries was the rehabilitation. For rehabilitation of the patients, it was unnecessary waiting for the functional recovery of cord. For the early rehabilitation in these series, it was important to provide physical therapy and both active and passive exercises immediately following the treatment of bone fracture thus the 54 (47%) cases out of 117 were rehabilitated.

(33) On Examination of Cc**2 content in the Venous Blood drawn from the Medial Marginal Vein of the Lower extremity of the Paraplegia and the Basilic Vein or the Medial Cubiti Vein of his upper extremity, the content of Cc**2 in Serum of the upper extremity is higher than that of the lower extremity.