대한영상의학회지 (Journal of the Korean Society of Radiology)

  • 제82권3호
  • /
  • Pages.613-623
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  • 2021
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  • 1738-2637(pISSN)
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  • 2288-2928(eISSN)
대한영상의학회 (The Korean Society of Radiology)
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내측상과염 환자의 임상항목과 자기공명영상 항목 중 조기 수술적 치료가 필요한 환자군이 갖는 인자에 관한 분석

Clinical Assessments and MRI Findings Suggesting Early Surgical Treatment for Patients with Medial Epicondylitis

  • 박형인 (인제대학교 의과대학 해운대백병원 영상의학과) ;
  • 한석 (인제대학교 의과대학 해운대백병원 영상의학과) ;
  • 이지숙 (인제대학교 의과대학 해운대백병원 영상의학과) ;
  • 방진영 (인제대학교 의과대학 해운대백병원 정형외과) ;
  • 김영복 (인제대학교 의과대학 해운대백병원 정형외과) ;
  • 정현경 (인제대학교 의과대학 해운대백병원 영상의학과) ;
  • 백지연 (인제대학교 의과대학 해운대백병원 영상의학과)
  • Hyungin Park (Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital) ;
  • Seok Hahn (Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital) ;
  • Jisook Yi (Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital) ;
  • Jin-Young Bang (Department of Orthopaedic Surgery, Inje University College of Medicine, Haeundae Paik Hospital) ;
  • Youngbok Kim (Department of Orthopaedic Surgery, Inje University College of Medicine, Haeundae Paik Hospital) ;
  • Hyung Kyung Jung (Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital) ;
  • Jiyeon Baik (Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital)
  • 투고 : 2020.05.18
  • 심사 : 2020.07.04
  • 발행 : 2021.05.01
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초록

목적 내측 상과염 환자들 중 최종적으로 수술적 치료를 받게 된 환자들의 임상 및 자기공명영상 인자들의 특징을 알아보고자 한다. 대상과 방법 2010년 3월부터 2018년 12월까지 내측 상과염으로 진단받은 환자들 중에서 주관절 자기공명영상을 촬영한 52명의 환자들을 역행적으로 조사하였다. 환자들의 인구통계학적 및 임상적 정보, 자기공명영상 소견들이 평가되었다. 모든 변수들은 보존적인 치료를 받은 환자군과 수술적 치료를 받은 환자군 사이에서 비교되었고, 로지스틱 회귀분석을 통해 어떤 인자가 수술적 치료를 받은 환자군과 연관 있는지 분석하였다. 결과 횡단면 및 관상면 공통 굴곡근 건의 파열 크기(p < 0.001, p = 0.013), 횡단면 및 관상면 공통 굴곡근 건의 이상 정도(p = 0.022, p = 0.003)가 유의미한 차이를 보였다. 또한 내측 측부 인대의 이상 정도(p = 0.025) 또한 유의미한 차이를 보였다. 로지스틱 회귀분석에서는 오직 공통 굴곡근 건의 횡단면 파열 크기(오즈비: 1.864; 95% 신뢰구간: 1.264~2.750)가 수술적 치료와 관련이 있었다. 결론 내측 상과염으로 진단받은 환자들 중, 더 큰 횡단면 공통 굴곡근 건 파열을 동반한 환자들이 결과적으로 수술을 받게 되는 경향성이 보였다.

Purpose To evaluate the MRI findings and clinical factors that are characteristic of patients who ultimately undergo surgery for medial epicondylitis. Materials and Methods Fifty-two consecutive patients who were diagnosed with medial epicondylitis and underwent an elbow MRI between March 2010 and December 2018 were included in this retrospective study. The patients' demographic information, clinical data, and MRI findings were evaluated. All variables were compared between the conservative treatment and surgical treatment groups. Logistic regression analyses were conducted to identify which factors were associated with surgical treatment. Results Common flexor tear (CFT) tear size showed a statistically significant difference in both the transverse and longitudinal planes (p < 0.001, p = 0.013). The CFT abnormality grade significantly differed in both the transverse and longitudinal planes (p = 0.022, p = 0.003). A significant difference was also found in the medial collateral ligament abnormality (p = 0.025). Logistic regression analyses showed that only the transverse diameter of the CFT tear size (odds ratio: 1.864; 95% confidence interval: 1.264-2.750) was correlated with surgical treatment. Conclusion Of patients diagnosed with medial epicondylitis, patients with a larger transverse CFT tear size tend to undergo surgical treatment ultimately.

키워드

참고문헌

  1. Tarpada SP, Morris MT, Lian J, Rashidi S. Current advances in the treatment of medial and lateral epicondylitis. J Orthop 2018;15:107-110 
  2. Walker-Bone K, Palmer KT, Reading I, Coggon D, Cooper C. Occupation and epicondylitis: a population-based study. Rheumatology (Oxford) 2012;51:305-310 
  3. Vinod AV, Ross G. An effective approach to diagnosis and surgical repair of refractory medial epicondylitis. J Shoulder Elbow Surg 2015;24:1172-1177 
  4. Ellenbecker TS, Nirschl R, Renstrom P. Current concepts in examination and treatment of elbow tendon injury. Sports Health 2013;5:186-194 
  5. McMurtrie A, Watts AC. (vi) Tennis elbow and Golfer's elbow. Orthop Trauma 2012;26:337-344 
  6. Walz DM, Newman JS, Konin GP, Ross G. Epicondylitis: pathogenesis, imaging, and treatment. Radiographics 2010;30:167-184 
  7. Jeon JY, Lee MH, Jeon IH, Chung HW, Lee SH, Shin MJ. Lateral epicondylitis: associations of MR imaging and clinical assessments with treatment options in patients receiving conservative and arthroscopic managements. Eur Radiol 2018;28:972-981 
  8. Shiri R, Viikari-Juntura E, Varonen H, Heliovaara M. Prevalence and determinants of lateral and medial epicondylitis: a population study. Am J Epidemiol 2006;164:1065-1074 
  9. O'Dell MC, Urena J, Fursevich D, Sanchez E, LiMarzi G, Bancroft L. Imaging sports-related elbow injuries. Appl Radiol 2015;44:7-15 
  10. Konin GP, Nazarian LN, Walz DM. US of the elbow: indications, technique, normal anatomy, and pathologic conditions. Radiographics 2013;33:E125-E147 
  11. Han SH, Lee JK, Kim HJ, Lee SH, Kim JW, Kim TS. The result of surgical treatment of medial epicondylitis: analysis with more than a 5-year follow-up. J Shoulder Elbow Surg 2016;25:1704-1709 
  12. Do Nascimento AT, Claudio GK. Arthroscopic surgical treatment of medial epicondylitis. J Shoulder Elbow Surg 2017;26:2232-2235 
  13. Cho BK, Kim YM, Kim DS, Choi ES, Shon HC, Park KJ, et al. Mini-open muscle resection procedure under local anesthesia for lateral and medial epicondylitis. Clin Orthop Surg 2009;1:123-127 
  14. Donaldson O, Vannet N, Gosens T, Kulkarni R. Tendinopathies around the elbow part 2: medial elbow, distal biceps and triceps tendinopathies. Shoulder Elbow 2014;6:47-56 
  15. Bauer S, Wang A, Butler R, Fallon M, Nairn R, Budgeon C, et al. Reliability of a 3 T MRI protocol for objective grading of supraspinatus tendonosis and partial thickness tears. J Orthop Surg Res 2014;9:128 
  16. Schertz M, Mutschler C, Masmejean E, Silvera J. High-resolution ultrasound in etiological evaluation of ulnar neuropathy at the elbow. Eur J Radiol 2017;95:111-117 
  17. Baumer P, Dombert T, Staub F, Kaestel T, Bartsch AJ, Heiland S, et al. Ulnar neuropathy at the elbow: MR neurography--nerve T2 signal increase and caliber. Radiology 2011;260:199-206 
  18. Hayashi D, Roemer FW, Katur A, Felson DT, Yang SO, Alomran F, et al. Imaging of synovitis in osteoarthritis: current status and outlook. Semin Arthritis Rheum 2011;41:116-130 
  19. Roemer FW, Kassim Javaid M, Guermazi A, Thomas M, Kiran A, Keen R, et al. Anatomical distribution of synovitis in knee osteoarthritis and its association with joint effusion assessed on non-enhanced and contrast-enhanced MRI. Osteoarthritis Cartilage 2010;18:1269-1274 
  20. Bucknor MD, Stevens KJ, Steinbach LS. Elbow imaging in sport: sports imaging series. Radiology 2016;279:12-28 
  21. Patten RM. Overuse syndromes and injuries involving the elbow: MR imaging findings. AJR Am J Roentgenol 1995;164:1205-1211 
  22. Dlabach JA, Baker Jr CL. Lateral and medial epicondylitis in the overhead athlete. Oper Tech Orthop 2001;11:46-54 
  23. Nirschl RP, Ashman ES. Elbow tendinopathy: tennis elbow. Clin Sports Med 2003;22:813-836 
  24. Martinoli C, Bianchi S, Giovagnorio F, Pugliese F. Ultrasound of the elbow. Skeletal Radiol 2001;30:605-614 
  25. Finlay K, Ferri M, Friedman L. Ultrasound of the elbow. Skeletal Radiol 2004;33:63-79 
  26. Morrey BF, An KN. Functional anatomy of the ligaments of the elbow. Clin Orthop Relat Res 1985;201:84-90 
  27. Otoshi K, Kikuchi S, Shishido H, Konno S. The proximal origins of the flexor-pronator muscles and their role in the dynamic stabilization of the elbow joint: an anatomical study. Surg Radiol Anat 2014;36:289-294 
  28. Kurvers H, Verhaar J. The results of operative treatment of medial epicondylitis. J Bone Joint Surg Am 1995;77:1374-1379 
  29. Gabel GT, Morrey BF. Operative treatment of medical epicondylitis. Influence of concomitant ulnar neuropathy at the elbow. J Bone Joint Surg Am 1995;77:1065-1069