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韓國人 腰椎間核脫出症에 關한 硏究 Posterior Herniation of the Lumbar Nucleus Pulposus

최신의학 1967년 10권 5호 p.45 ~ 56
송두호,
소속 상세정보
송두호 (  ) 
서울대학교 의과대학 신경외과학교실

Abstract


Though low back pain and radiating leg pain carry little threat to life, they may interfere greatly with living. Their frequency and their causes of suffering, and disability have been a constant stimulus to- investigation.
. Rupture of the annulus fibrosus of the lumbar intervertebral disc with herniation of the nucleus pulposus is a common cause of low back pain with or without radiating leg pain which was not well recognized until the contribution of Mixter and Barr in 1934. Now after approximately 30 years of investigation, there is still great diversity of opinion concerning diagnostic criteria, methods of treatment and results obtained by various methods of treatment.
The purpose of this investigation is to analyze the clinical findings based on 651 Korean patients treated by excision of the herniated nucleus pulposus at the Seoul National University Hospital between September 1, 1957 and August 31, 1966.
In this series the criteria for operative intervention were: (1) the only absolute indication for immediate surgery was the sudden appearance of severe neurologic disturbance such as sphincter disturbance as well as weakness and severe pain in one or both legs; (2) the bedridden patients who was completely disabled by low back pain and whose leg pain recurres with every attempt at ambulation (3) failure of the pain to improve, in spite of adequate conservative treatment, and the clinical history and neurologic findings were clear cut; (4) if Peyton´s sign (contralateral pain) was positive in addition to other neurologic findings; and (5) the presence of muscle atrophy involving leg or gluteal muscles with other neurologic signs.
The surgical technique was standard. Under general anesthesia, if the patient was apprehensive or restless, or spinal anesthesia, the patient was placed in the prone position with the table flexed in order to open the interlaminal space. Removal of ligamentum flavum and minimal removal of bone from the
y i .
laminae was usual method to expose the herniated nucleus pulposus. After decompression of the root by removal of the herniated portion of the disc, remaining nucleus pulposus was also completely removed as possible as, and closed the wound.
There were 428 males (65.7 per cent.) and 223 females (34.3 per cent.). The males were affected about twice as often as females. The youngest patient was aged seventeen years and the oldest seventy years. The majority of cases were between the ages of 21 and 40 years (62.7 per cent.). In male the highest

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