초기 키엔벡 병에서 보존적 치료의 결과 (The Results of Conservative Management for Early Stage Kienbock’s Disease)

서지정보

· 발행기관 : 대한수부외과학회
· 수록지 정보 : Archives of Hand and Microsurgery / 19권 / 4호 / 180 ~ 188페이지
· 저자명 : 제갈믿음, 박민종

초록

목적: 초기 키엔벡 병은 진행을 막기 위해 수술적 치료를 시행하는 것이 일반적이다. 저자들은 통증이 없거나 경미한키엔벡 병 초기 병기 환자들은 월상골이 유지될 수 있다는 가정 하에 보존적 치료를 시행한 후 그 임상적, 방사선학적결과를 보고하고자 한다.
방법: 키엔벡 병으로 진단받은 환자들 중 Lichtman 분류 I, II, IIIA 이면서 통증이 없거나 경미한 23명의 환자들을 대상으로 보존적 치료를 시행하면서 전향적으로 연구하였다. 남자 10명, 여자 13명이었으며 진단 당시의 평균 나이는53.9세(범위, 19-81세), 추시 기간은 평균 51.3개월(범위, 12-174개월)이었다. 임상적 평가로 수근 관절 관절 운동 범위의 변화와 최종 추시에서의 환자 만족도를 Dornan’s Criteria를 이용해서 측정하였고 방사선적 평가로 Lichtman 병기를 최종 추시에서 비교하였다. 초기 내원 시 환자들의 Lichtman 병기는 I기 3명, II기 11명, IIIA 9명이었다.
결과: 수근 관절 운동 범위는 전 예에서 호전되었고 환자의 만족도는 excellent 11예, good이 11예, fair 1예, poor 0예다. 초기 내원 시의 Lichtman 병기가 최종 추시까지 변화가 없이 유지되는 경우가 16예(69.6%)였고 월상골의 붕괴가더 진행되어 Lichtman 병기가 악화된 경우가 7예(30.4%)였다. 특히 월상골이 최종 추시에서 내원 초기보다 뚜렷한 방사선학적인 호전을 보인 경우가 3예 관찰되었다.
결론: 키엔벡 병의 초기 병기에서 환자의 통증이 없거나 경미하다면 임상 증상의 변화와 월상골의 방사선학적 변화를면밀히 관찰하면서 보존적 치료를 시도하는 것도 좋은 임상적 결과를 얻을 수 있는 방법이라고 생각된다.

영어초록

Purpose: Early stage Kienböck’s disease is commonly treated with a surgical intervention to avoid progression to degenerative change. The purpose of this study was to evaluate the clinical and radiographic outcomes of conservative management in patients with an early stage Kienböck’s disease with a hypothe- sis that the lunate can be maintained in patients with no pain or tolerable pain.
Methods: Twenty-three patients with a Lichtman stage I, II or IIIA Kienböck’s disease were managed conservatively and investigated prospectively. There were ten men and thirteen women. Mean age at first visit was 53.9 years old and mean follow-up period was 51.3 months. The clinical outcomes were evaluated by range of motion, subjective satisfaction of patients at final follow-up.
Radiographic measurements of the Lichtman stage were assessed at first visit and at the final follow-up. Three patients were Lichtman stage I, eleven patients were II and nine patients were IIIA.
Results: Range of motion improved in all cases. According to Dornan’s criteria, eleven patients were excellent, another eleven patients were good and one patient was fair. Based on Lichtman stage, no change was seen in sixteen patients, while seven showed progression. Three patients revealed improved radiographic findings of the lunate at final follow-up.
Conclusion: We found that conservative management including close observa- tion of clinical and radiographic changes can provide satisfactory clinical improvement in patients with no pain or tolerable pain in early stage Kienböck’s disease.
Results: Range of motion improved in all cases. According to Dornan’s criteria,eleven patients were excellent, another eleven patients were good and onepatient was fair. Based on Lichtman stage, no change was seen in sixteenpatients, while seven showed progression. Three patients revealed improvedradiographic findings of the lunate at final follow-up.
Conclusion: We found that conservative management including close observationof clinical and radiographic changes can provide satisfactory clinicalimprovement in patients with no pain or tolerable pain in early stage Kienböck’sdisease.

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