Journal of the Korean Orthopaedic Association (대한정형외과학회지)

Korean Orthopaedic Association (대한정형외과학회)
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Limited Wrist Fusion for Kienb$\ddot{o}$ck's Disease

제한된 수근관절 유합술로 치료한 Kienb$\ddot{o}$ck 질환

  • Lee, Sang-Myung (Department of Orthopedic Surgery, Yeouido St. Mary's Hospital, The Catholic University of Korea School of Medicine) ;
  • Song, Seok-Whan (Department of Orthopedic Surgery, Yeouido St. Mary's Hospital, The Catholic University of Korea School of Medicine) ;
  • Rhee, Seung-Koo (Department of Orthopedic Surgery, Yeouido St. Mary's Hospital, The Catholic University of Korea School of Medicine) ;
  • Park, Jae-Chul (Department of Orthopedic Surgery, Yeouido St. Mary's Hospital, The Catholic University of Korea School of Medicine) ;
  • Na, Ki-Tae (Department of Orthopedic Surgery, Yeouido St. Mary's Hospital, The Catholic University of Korea School of Medicine)
  • 이상명 (가톨릭대학교 의과대학 정형외과학교실 여의도성모병원) ;
  • 송석환 (가톨릭대학교 의과대학 정형외과학교실 여의도성모병원) ;
  • 이승구 (가톨릭대학교 의과대학 정형외과학교실 여의도성모병원) ;
  • 박재철 (가톨릭대학교 의과대학 정형외과학교실 여의도성모병원) ;
  • 나기태 (가톨릭대학교 의과대학 정형외과학교실 여의도성모병원)
  • Received : 2009.07.14
  • Accepted : 2010.06.07
  • Published : 2010.08.30
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Abstract

Purpose: To evaluate clinical outcomes of triscaphe (STT), scapho-capitate (SC) and scapho-capito-hamato-triquetral (SCHT) fusion in advanced Kienb$\ddot{o}$ck's disease. Materials and Methods: Forty patients with Lichtman stage III and IV disease were treated with limited wrist fusion. STT & SC fusion for stage IIIa and IIIb, and SCHT fusion for IIIb and IV were done according to preoperative radiologic and intraoperative articular surface findings. The mean follow-up period was 31.6 months (range 13-108) and the mean age at the time of their surgery was 44.7 years (range 22-71). There were 13 cases of STT fusion, 19 cases of SC fusion and 8 cases of SCHT fusion. For assessment of treatment results, wrist range of motion, grip strength, VAS (visual analog pain score) and any radiologic changes of the wrist were checked at last follow-up. Results: VAS score was 4.7 for STT, 3.0 for SC, 4.5 for SCHT. Grip strength, compared with the contralateral side, was 72% for STT, 78% for SC, and 54% for SCHT. Pain was more improved for the SC fusion group than for the other two groups (p=0.007). Grip strength was decreased more in the SCHT fusion group than in the other two groups (p=0.009). There were no statistically significant differences in range of motion between any of the three groups. The bone achieved union in all cases except one SC fusion. Conclusion: Limited wrist fusion in advanced Kienb$\ddot{o}$ck's disease has been regarded as a valuable method. However, SC fusion has been thought of as a more favorable technique than STT fusion with respect to pain relief. SCHT fusion is thought to be a possible salvage procedure with a limited indication for Stage IV Kienb$\ddot{o}$ck's disease.

목적: 진행된 Kienb$\ddot{o}$ck 질환의 치료 시 삼주상 유합술(STT fusion), 주상-유두골 유합술(SC fusion), 그리고 주상-유두-유구-삼각골 유합술 (SCHT fusion)의 임상적 치료 결과를 평가하고자 한다. 대상 및 방법: Lichtman 분류 제 III기 또는 IV기인 40명의 환자를 대상으로 제한적 수근관절 유합술을 실시하였다. 술 전 방사선 결과와 수술 시 관절 면에 대한 평가를 통해 삼주상 및 주상-유두골 유합술은 제 IIIa와 IIIb기에서 시행하였으며 주상-유두-유구-삼각골 유합술은 IIIb기와 IV기에서 시행하였다. 평균 추시 기간은 31.6개월(범위 13-108)이었으며 수술 시 평균 나이는 44.7세(범위 22-71)였다. 삼주상 유합술은 13예, 주상-유두골 유합술은 19예, 그리고 주상-유두-유구-삼각골 유합술은 8예에서 시행하였다. 치료 결과를 평가하기 위하여 수근 관절의 운동 범위, 파악력(grip strength), 통증(VAS, visual analog pain score)을 측정하였으며 최종 추시 방사선학적 변화도 측정하였다. 결과: VAS 점수는 삼주상 유합술에서 4.7점, 주상-유두골 유합술에서 3.0점. 주상-유두-유구-삼각골 유합술에서 4.5점이었다. 파악력은 반대편과 비교하여 삼주상 유합술에서 72%, 주상-유두골 유합술에서 78%, 주상-유두-유구-삼각골 유합술에서 54%이었다. 통증의 감소는 주상-유두골 유합술 군이 다른 두 군에 비해 우수하였으며(p=0.007), 주상-유두-유구-삼각골 유합술 군에서 파악력 감소가 관찰되었다(p= 0.009). 세 군 간에 운동 범위는 유의한 차이가 없었다. 주상-유두골 유합술을 시행한 1예를 제외하고 모든 예에서 골유합을 얻을 수 있었다. 결론: 진행된 Kienb$\ddot{o}$ck 질환의 치료로써 제한적 수근관절 유합술은 유용한 방법이며 통증의 경감에 있어서 주상-유두골 유합술이 삼주상 유합술에 비하여 우월한 결과를 보였다. 주상-유두-유구-삼각골 유합술은 제 IV기 Kienb$\ddot{o}$ck 질환에 있어서 고려해볼 만한 구제 수술이라 생각된다.

Keywords

References

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