• Journal of Korean Neurosurgical Society
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• 제56권1호
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• pp.21-27
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• 2014

Objective : Infectious spinal disease is regarded as an infection by a specific organism that affects the vertebral body, intervertebral disc and adjacent perivertebral soft tissue. Its incidence seems to be increasing as a result of larger proportion of the older patients with chronic debilitating disease, the rise of intravenous drug abuser, and the increase in spinal procedure and surgery. In Korea, studies assessing infectious spinal disease are rare and have not been addressed in recent times. The objectives of this study are to describe the epidemiology of all kind of spinal infectious disease and their clinical and microbiological characteristics as well as to assess the diagnostic methodology and the parameters related to the outcomes. Methods : A retrospective study was performed in all infectious spinal disease cases presenting from January 2005 to April 2010 to three tertiary teaching hospitals within a city of 1.5 million in Korea. Patient demographics, risk factors, clinical features, and outcomes were assessed. Risk factors entailed the presence of diabetes, chronic renal failure, liver cirrhosis, immunosuppressants, remote infection, underlying malignancy and previous spinal surgery or procedure. We comparatively analyzed the results between the groups of pyogenic and tuberculous spinal infection. SPSS version 14 statistical software was used to perform the analyses of the data. The threshold for statistical significance was established at p<0.05. Results : Ninety-two cases fulfilled the inclusion criteria and were reviewed. Overall, patients of tuberculous spinal infection (TSI) and pyogenic spinal infection (PSI) entailed 20 (21.7%) and 72 (78.3%) cases, respectively. A previous spinal surgery or procedure was the most commonly noted risk factor (39.1%), followed by diabetes (15.2%). The occurrence of both pyogenic and tuberculous spondylitis was predominant in the lumbar spine. Discs are more easily invaded in PSI. At initial presentation, white cell blood count and C-reactive protein levels were higher in PSI compared to TSI (p<0.05). Etiological agents were identified in 53.3%, and the most effective method for identification of etiological agents was tissue culture (50.0%). Staphyococcus aureus was the most commonly isolated infective agent associated with pyogenic spondylitis, followed by E. coli. Surgical treatment was performed in 31.5% of pyogenic spondylitis and in 35.0% of tuberculous spondylitis cases. Conclusion : Many previous studies in Korea usually reported that tuberculous spondylitis is the predominant infection. However, in our study, the number of pyogenic infection was 3 times greater than that of tuberculous spinal disease. Etiological agents were identified in a half of all infectious spinal disease. For better outcomes, we should try to identify the causative microorganism before antibiotic therapy and make every effort to improve the result of culture and biopsy.

• 대한예방한의학회지
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• 제21권3호
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• pp.1-10
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• 2017

Objectives : The purpose of this study is to investigate the practice patterns of traditional Korean medicine (TKM) doctors and the acceptance of payment model in order to develop a new TKM health insurance payment model linked with TKM clinical practice guidelines (CPGs). Methods : Lumbar herniated intervertebral disc (HIVD) and idiopathic facial palsy (IFP) were selected as a test diseases to develop a new TKM payment model. The level of benefit coverage in the National Health Insurance (NHI) was designed. The survey asked 228 TKM doctors about their practice patterns in HIVD and IFP patients and acceptance of new payment model. Results : Mean of medical cost for treatment of HIVD was 441,000 KW, mean of treatment period ranged from 4.9 to 17.5 weeks, and mean of number of treatment ranged from 14.6 to 50.4 HIVD patients. In the case of IFP, mean of medical cost for treatment of IFP was 468,000 KW, mean of treatment period was at least 4.2 and up to 15.9 weeks and mean of number of treatment ranged from 14.2 to 52 IFP patients. Conclusions : Current study suggests that mixed payment model of per-visit and episode-based model seem to be proper. The model 1 bundles both items which were covered and not covered by NHI in a rational way. The model 2 is based on the development and application of critical pathway. Lastly, model 3 suggests bundling of items covered by current NHI. Acceptance of TKM doctors is expected to be highest in the model 3.

• Journal of Acupuncture Research
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• 제18권6호
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• pp.59-69
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• 2001

Objective : The aim of this study is to assess the ability of the CPT test to dignosis radiculopathy in Korean with NeuvalTM CPT database. Method : Electrical stimulation(at 2000, 250, and 5Hz) using Neurometer was applied to the 19 patients who felt back and sciatic pain with herniated intervertevral disc(HIVD) of L-spine, dignosisd by lumbar CT or MRI, and the 33 patients who felt only back or hip or leg pain without HIVD, stenosis, spondylolisthesis which causing radiculopathy. The test sites were toe1, toe3 and toe5 related to L4, L5 and S1 nerve roots. Results : The mean values of the CPT of HIVD group was stiatically lower than LBP group at toe1-250Hz, toe3-2000Hz, 250Hz and toe5-250Hz, 5Hz. The grading CPT score of HIVD group was stastically higher than LBP group at the toe3(L5). The VAS of HIVD group was stastically higher than LBP group. Conclusion : These results suggest that the CPT test can be a valuable testing for diagnosing radiculopathy in Korean. In using CPT test further study is needed for the diagnosis and evaluation of sensory nerve dysfunction in the musculoskeletal disease.

• 대한예방한의학회지
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• 제14권3호
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• pp.117-127
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• 2010

Objectives : The purpose of this study was to find out the characteristics of patients who admitted due to industrial accident and to promote the superiority of oriental medical treatment on the sequelae of industrial accident. Methods : We analyzed the medical charts of 51 inpatients in a local oriental medicine hospital. The patients had been hospitalized from May 1, 2003 to October 31, 2010. Results : 1. By gender, males accounted for 78.4%, while females 21.6%. By age, most incidences occurred in the forties(29.4%), fifties(23.5%) and thirties(19.6%) in order. 2. Most causes of accident was carelessness(27.5%) and fall down(21.6%) was the next. 3. With regard to the interval from occurrence of accidents to hospitalization, 20 cases(39.2%) were found to be hospitalized 31～90 days after the accidents, followed by 11 cases(21.6%) in 91～180 days and 7 cases(13.7%) in 181～360 days. 4. Most cases turned out to be injuries with 40 patients from Sequelae of intracerebral hemorrhage (23.5%) and Lumbar and other intervertebral disc disorders with radiculopathy(13.7%). The mean duration of hospitalization was $209.03{\pm}346.04$ days. Inpatients of Organic brain syndrome NOS numbered the longest stay($676{\pm}86.26$days), Sequelae of intracerebral hemorrhage recorded $541.91{\pm}541.83$ days hospitalized. 5. Most of inpatients were treated with acupuncture(100%), herbal medication(98.0%), oriental physiological therapy(82.3%), and moxibustion(76.4%). Conclusions : This article will help the researchers related to Oriental medicine establish basic source of Oriental medicine approach for inpatients due to industrial accident.

• Journal of Chest Surgery
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• 제40권6호
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• pp.455-458
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• 2007

4개월 전 요추 4, 5번 추궁절제술을 시행받은 40세 남자환자가 호흡곤란과 하지부종을 주소로 내원하였다. 우측하복부에서 박동성 종괴가 촉진되었고 기계잡음이 청진되었다. 흉부단순촬영에서 심비대소견이 관찰되었고, 복부 전산화 단층촬영에서 제5요추 위치의 총장골동맥과 정맥간에 가성동맥류를 동반한 동정맥루가 존재하였다. 복부정중절개를 하여 동맥류를 통한 동정맥 누공의 일차봉합을 시도하여 상,하부 대동맥과 대정맥 감자결찰 후 동맥류를 절개하였으나 대량출혈이 발생하여 누공봉합에 실패한 후 동맥류를 봉합하였다. 동맥치환술로 수술계획을 변경한 후 동맥류에 연해있는 대동맥과 양측 총장골동맥을 절단봉합한 후, 인공도관을 이용하여 동맥을 재건하였고, 동맥류는 총장골정맥에 붙어있는 상태에서 축소성형술을 시행하였다. 환자는 수술 후 별다른 합병증 없이 8일째 퇴원하였고, 이후 별다른 문제없이 24개월간 추적관찰 중이다. 일반적으로 요추궁절제술 후 발생한 동정맥루에서는 누공봉합술을 시행하나 본 증례에서는 동맥치환술과 동맥류 축소성형술을 시행하였기에 문헌고찰과 함께 보고하는 바이다.

• 한방재활의학과학회지
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• 제23권4호
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• pp.213-223
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• 2013

Objectives Low back pain (LBP) is one of the most common reason for people in Korea to visit Korean medical institutions. To assess actual amounts of use in the treatment of LBP in Korean medicine and to provide objective base line data for policy decision making, research regarding the current state of LBP patients' treatment in Korean medical institutions are in need. Methods The current study was designed as a retrospective chart review to investigate descriptive characteristics of LBP patients. The clinical records of 304 patients who were hospitalized for the treatment of LBP in Korean rehabilitation medicine inpatient clinics of five different Korean medicine hospitals were analyzed. The percentage of patient characteristics such as sex, age, average duration of admission, insurance type, diagnosed LBP related disease code, and rates of interventions applied were assessed. Results 1. The female sex was significantly predominant among patients with LBP : 105 patients (34.5%) were male and 199 patients (65.5%) were female. Percentage of the patients' age appeared as followed : 76 people (25.0%) were in their 50s, 64 people (21.1%) were in their 40s, 51 people (16.8%) were in their 30s, 37 people (12.2%) were in their 60s, and 33 people (10.9%) were in their 70s. Approximately half of the total LBP patients investigated were older than 50. 2. The average duration of admission was 16.2 days. Approximately one third (30.3%) of the patients were hospitalized for 8 to 14 days. 3. Female patients tended to stay admitted in hospitals slightly longer than male patients. Elderly (age 60~79) patients stayed in hospitals longer (17.8 days) compared to younger (age 20~39) patients (13.5 days). 4. More than half of the patients (171 cases, 56.3%) had their hospital bills covered with automobile insurance. 40.1% (122 cases) of the patients had medical insurance to cover their hospital bills. The average duration of admission of patients who had automobile insurance was 14.2 days, while that of the patients who had medical insurance was 18.4 days. 5. "Sprain and strain of the lumbar spine and pelvis" was the most commonly used (195 cases, 64.1%) disease code in patients with LBP. Patients diagnosed as "lumbar and other intervertebral disc disorders with radiculopathy" required the longest admission duration (22.1 days). 6. Herbal medication was applied to all of the patients during admission. Acupuncture was applied to all of the patients except one case diagnosed as spinal stenosis. Physical therapy, cupping therapy, moxibustion therapy, chuna therapy, and pharmacopuncture therapy were applied to 94.7, 92.8, 85.2, 83.9, and 49.7% of the patients, respectively. 7. There were certain differences among Korean medicine hospitals in terms of the LBP patients' duration of admission, type of insurance, frequency of the disease code use, type of intervention applied. Conclusions It is thought that the current study can be used as reference data in assessing the current state of LBP treatment in Korean rehabilitation medicine and a basis for future research. Provided improvements of certain limitations of the current study in future researches, such data would act as better base line data in policy decision making.

• 한방재활의학과학회지
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• 제19권1호
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• pp.135-143
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• 2009

목적 : 요통은 임상에서 가장 흔하게 접할 수 있는 질환이며, 동시에 통증으로 인한 근무 결손도나 생활 불편감이 높은 질병이다. 그래서, 많은 연구들이 요통을 일으키는 원인 혹은 악화시키는 유발 인자를 밝혀내려는데 초점이 맞추어져 있다. 이번 연구의 목적은 편측 요통을 호소하는 환자에 있어서 MRI에서 조사된 척추 주위 근육의 지방량과 통증과의 관계에 대해서 알아보는데 있다. 방법 : 2007년 11월부터 2008년 4월까지 본원에 요통으로 내원한 환자를 대상으로, 편측 요통을 호소하며, 체질량 지수가 $25kg/m^2$ 이하이며, 만 20세이상 40세미만인 환자 24명을 대상으로 연구를 진행하였다. MRI에서 조사되어진 L4-5 디스크 레벨의 척추 주위 근육의 지방량을 객관적인 pseudocoloring technique을 이용해 측정하고, paired t-test로 결과를 분석하여 요통이 유발된 측과 지방량의 관계에 대해서 연구하였다. 결과 : 요통이 있는 측의 지방량과 요통이 없는 측의 지방량을 측정하여 데이터를 분석하였다. 양측의 지방량과 통증의 유무에 대한 관계는 통계적으로 유의한 수치를 나타냈다(P <0.05). 요통이 있는 측과 없는 측과의 성별, 나이, BMI의 통계적인 차이는 없었으며, 지방량 측정시 남자들이 여자들에 비해 지방량이 더 높게 측정되었다(남자 $8.5{\pm}5.1%$, 여자 $6.5{\pm}3.6%$). 결론 : 이 연구를 통해 척추 주위 근육의 지방량과 요통에 대한 상관성의 증거를 제시하였다. 잘 선별되어진 환자의 MRI를 통해 객관적인 방법으로 지방량을 체크를 하였으며, 추후 더 많은 개체수를 이용해 보다 더 정확한 관련성을 파악하고, 나아가 지방량에 따른 통증 강도의 상관성에 대해서 연구가 필요하리라 생각된다.

• 한국임상수의학회지
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• 제24권2호
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• pp.225-228
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• 2007

개 추간판 디스크 2 증례(症例)를 대상으로 봉독약침 및 봉독약침과 한약제로 각각 치료하였다. 증례(症例) 1은 흉-요추부 추간판탈출증(T11-T12, T12-T13, L3-L4 및 L4-L5)으로 진단(診斷)된 증례이었으며. 증례 2는 흉추부 추간판탈출증(T10-T11 및 T12-T13)으로 진단(診斷)된 증례이었다. 이들 증례에 대하여 봉독약침(0.1 ml/혈위, 총$200{\mu}g$)을 실시(實施)하였으며, 운동요법과 수영요법도 병용하였다. 봉독약침에 사용한 혈위는 GV20-Bai Hui, GB30-Huan Tiao, ST36-Zu San Li, GB34-Yang Ling Quan, ST40-Feng Long, ST41-Jie Xi 및 BL40-Wei Zhong, 병변부 및 압통점이었다. 또한 증례 2에 대하여는 봉독약침과 더불어 Zheng Gu Zi Jin Dan(정골자금단(正骨紫金丹) : 1 g), Shiuh Duann(속단(續斷) .0.2 g), Du Zhong(두중(杜仲) : 0.2 g), Mo Yao(몰약(沒藥 : 0.2 g), Ru Xiang(유향(乳香) : 0.2 g) 및 Pyrite(자연동(自然銅) : 0.2 g)를 각각 총 9일간 경구투여(2회/1일)하였다. 증례 1은 총 4주간 11회 치료, 증례(症例) 2는 총 2주간 6회 치료 후 각각 보행이 가능하였다.