흉곽출구증후군에서 사각근 주사요법의 임상적 효용성 = Clinical Efficacy of Scalene Injection for Thoracic Outlet Syndrome

다국어 초록 (Multilingual Abstract)

Purpose: We introduce the novel treatment technique, scalene injection, and study its clinical efficacy for diagnosis, treatment, and pain control for patients with thoracic outlet syndrome.
Methods: Between November 2001 and October 2018, 266 patients were studied retrospectively. To evaluate the efficacy and sustainability, we checked the numerical rating scale (NRS) for pain relief and neck disability index (NDI) for functional improvements, prior to and 1, 12 weeks after the injection. The safety was evaluated by examining side effects for at least 24 hours from the point of injection.
Results: NRS was improved from 7.12 to 3.11 at 1 week, and to 3.05 at 12 weeks (p<0.05). NDI was improved from 15.87 to 6.15 at 1 week, and to 6.19 at 12 weeks (p<0.05). There were two cases of convulsion immediately after the injection and were treated with prompt oxygen supply and sedatives. Transient side effects included two cases of dyspnea and one case of nausea and were resolved within 1 hour after. All five cases showed symptoms of side effects on the day of injection and were resolved within a day. A total of 242 patients (91.0%) experienced immediate declines in NRS and 161 patients experienced persistent declines for more than 12 weeks. However, 24 patients (9.0%) showed no improvement and 20 patients (7.5%) experienced increases in NRS.
Conclusion: Scalene injection is also effective as a therapeutic method. However, this study suggests that it must be done with monitoring of vital signs in an operating room for any possible complications and side effects.

국문 초록 (Abstract)

목적: 흉곽출구증후군 환자의 진단과 치료, 통증 관리에 사각근 주사요법의 임상적 효용성에 대해 알아본다.
방법: 시술 전후 및 3개월째의 효과 판정을 위하여 통증은 숫자평가척도(numerical rating scale, NRS)로, 기능적 불편 정도는 경부장애척도(neck disability index, NDI)로 평가하였다. 추가로 시술 중과 직후, 다음날까지 발생한 부작용을 조사하여 안전성을 평가하였다.
결과: NRS는 시술 전 평균 7.12에서 시술 1주에 3.11, 12주에 3.05로 호전되었고 NDI는 시술 전 평균 15.87에서 시술 1주에 6.15, 12주에 6.19로 향상되었다(p<0.05). 시술 후 2예에서 발작을 보였으나 즉각적인 산소 공급 및 진정제 투여 후 안정되었으며, 2예에서 호흡곤란, 1예에서 오심을 보였으나 1시간 내로 호전되었다. 5예 모두 시술 당일에만 증상을 보이고 시술 다음날까지 지속되는 부작용은 없었다. 242명(91.0%)에서 시술 후 즉각적인 NRS의 감소가 있었는데 161명은 감소가 12주 이상 지속되었다. 24명(9.0%)은 시술 후 NRS의 호전이 없었고 20명(7.5%)은 1개월 내에 NRS가 상승하였다.
결론: 흉곽출구증후군에서 사각근 주사요법은 진단 목적뿐 아니라 효과적인 치료법이 될 수 있으나, 부작용을 고려하면 수술실에서 활력징후 관찰 하에 시행해야 할 것으로 생각된다.

참고문헌 (Reference)

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