혈액투석 환자에서 수근관증후군: 임상적 특징과 수술적 치료의 결과 = Carpal Tunnel Syndrome in Patients Undergoing Long-Term Hemodialysis Therapy: Clinical Characteristics and Results of Surgical Treatment

다국어 초록 (Multilingual Abstract)

Purpose: Carpal tunnel syndrome (CTS) has become increasingly recognized as a complication of long-term hemodialysis. This study evaluated the clinical characteristics and compared the results of carpal tunnel release for CTS patients with or without hemodialysis.
Methods: We retrospectively reviewed the clinical characteristics and surgical outcomes of 49 chronic hemodialysis patients with 83 CTS hands. Also, 100 patients were selected for the control group. Patient characteristics, accompanying systemic conditions, operative outcomes were compared.
Results: In hemodialysis group, the mean age and hemodialysis duration were 59.5±10.5 years and 4.1±2.5 years, respectively. Of the 83 hands with CTS, 45 (54.2%) had arteriovenous fistulas, while 38 (45.7%) did not (p=0.02). Most (81.6%) of the patients reported symptom improvement after surgical treatment, and the remaining patients (18.4%) reported persistent and recurrent symptoms. Rates of remaining symptoms and reoperations were significantly higher in the CTS patients with hemodialysis group.
Conclusion: Majority of CTS patients with hemodialysis have much improved after transverse carpal ligament release. However, they showed higher recurrence than idiopathic CTS patients. In recurrent patients, use of the extended carpal tunnel release is effective in symptom relief.

국문 초록 (Abstract)

목적: 수근관증후군은 장기간 혈액투석을 받는 환자에서 발생하는 신경학적 합병증으로 이 연구에서는 혈액투석을 받는환자의 수근관증후군의 임상적 특성을 분석하였고 투석을 받지 않는 군과 비교하였다.
방법: 혈액투석을 받는 수근관증후군 환자 49명, 83개 손을 연구에 포함하였고 후향적 분석을 하였다. 또한 같은 기간내 수근관증후군으로 수술 받은 100명의 환자를 대조군으로 잡았으며 환자의 특성 동반된 전신질환, 수술 결과를 조사하였다.
결과: 혈액투석 그룹에서 평균 연령과 혈액투석기간은 각각 59.5±10.5년, 4.1±2.5년이었다. 83개 손 중 45개(54.2%) 의 손은 동정맥루가 있는 쪽에서 38개(45.7%)는 없는 쪽에서 수근관증후군이 발생하였다. 대부분의 환자(81.6%)는 수술 후 증상이 완화되었고 나머지 18.4% 환자에서는 증상이 지속되거나 재발하였다. 증상의 재발이나 지속으로 재수술을 하는 비율은 혈액투석 그룹에서 더 높았다.
결론: 혈액투석 환자에서 최소 개방 횡수근 유리술을 통해 대부분의 환자에서 증상의 호전을 기대할 수 있고 수술 후 재발률이 높은 특징을 갖고 있다. 재발하거나 증상이 지속되는 경우는 확장 횡수근 절제술을 통해 섬유화와 부종, 불완전한 절제 등을 확인하여 증상완화를 기대해 볼 수 있다.

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