경도의 무지 수근 중수 관절염에 시행한 중수골 신전 절골술: 후향적 장기 추시 결과 (Metacarpal Extension Osteotomy for Mild Thumb Carpometacarpal Arthritis: Retrospective Long-Term Outcomes)

서지정보

· 발행기관 : 대한정형외과학회
· 수록지 정보 : 대한정형외과학회지 / 50권 / 6호 / 520 ~ 526페이지
· 저자명 : 김동규, 신현대, 전제형, 차수민

초록

목적: 경도의 무지 수근 중수 관절염에서 중수골 신전 절골술을 시행 후 임상적, 방사선적 결과를 보고하고자 한다.
대상 및 방법: 1999년부터 2008년까지 신전 절골술을 시행한 11예 중, 최소 6년의 추시가 가능했던 7예를 후향적으로 분석하였다. 남녀 비는 2:5, 평균 연령은 38.9세, 증상 발현 기간은 평균 11.2개월, Eaton 병기는 2예에서 I, 5예에서 II였다. 수술 전 visual analogue scale (VAS) 점수는 3.7점(3-4점), disabilities of the arm, shoulder and hand scale (DASH) 점수는 40.1점(32-51점), 관절 가동 범위는 외측 외전 38.5o (30o-45o), 수장측 외전 42.1o (40o-45o)였다. 악력은 건측에 비해 82% (64%-90%), 집기력은 72% (40%-100%) 수준이었다.
결과: 평균 추시 기간은 8.5년이었으며 1예를 제외하고는 당시의 직업을 유지하였다. 최종 VAS는 0.7 (0-2), DASH 점수는 11.7 (8-16), 수장측 외전은 45o (40o-45o), 악력은 92.3% (73%-117%), 집기력은 94.4% (75%-117%)로 호전되었다. 최종 Eaton 병기는 5예에서 병기가 유지되었으며 2예에서 1병기씩 진행되었다.
결론: 무지 중수골의 신전 절골술은 경도의 무지 수근 중수 관절염의 치료에 효과적일 것으로 판단된다.

영어초록

Purpose: We report clinical and radiologic outcomes after metacarpal extension osteotomy for mild osteoarthritis of the thumb carpometacarpal joint.
Materials and Methods: From 1999 to 2008, 11 patients were diagnosed with mild thumb carpometacarpal arthritis (Eaton stage I, II), and extension osteotomies were performed. Of these, seven patients with at least 6 years follow-up were analyzed retrospectively. Male to female ratio was 2:5, and mean age at time of surgery was 38.9 years old. Symptom onset period was a mean of 11.2 months. Two patients were I, and five patients were II in Eaton stage. Preoperative visual analogue scale (VAS) and disabilities of the arm, shoulder and hand scale (DASH) scores were 3.7 points (3-4 points), and 40.1 points (32-51 points). Radial abduction was 38.5o (30o-45o), and volar abduction was 42.1o (40o-45o). Grip strengths and pinch powers, compared with the normal contralateral side were 82% (64%-90%) and 72% (40%-100%), respectively.
Results: The mean follow-up period was 8.5 years, and all patients except one maintained their occupational activity during the follow-up period. Final VAS and DASH scores were 0.7 points (0-2 points) and 11.7 points (8-16 points), respectively, and were statistically significant. Volar abduction, grip strengths, and pinch power were improved to 45o (40o-50o), 92.3% (73%-117%), and 94.4% (75%-117%) with statistical significances. In five patients, Eaton stages did not change, and two patients advanced to the next stage (stage I to II in one patient, stage II to III in one patient).
Conclusion: Among the various treatment options for mild thumb carpometacarpal arthritis, metacarpal extension osteotomy may be considered as an effective treatment.

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