수부 및 수근부의 비결핵 항산균 심부 감염의 진단 및 치료 = Diagnosis and Treatment for Deep Nontuberculous Mycobacteria Infection of the Hand and Wrist

다국어 초록 (Multilingual Abstract)

Purpose: The purpose of this study was to present a systematic treatment method for nontuberculous mycobacteria (NTM) infection of the hand and wrist to gain better clinical outcomes.
Methods: 10 patients of deep NTM infection of the hand and wrist were reviewed. Extensive debridement was performed in all cases. When biopsy result suggested mycobacterial infection such as granulomatous inflammation, empirical tuberculosis medication was started. After culture confirmed NTM growth, the species was identified and in vitro sensitivity test was performed. Then medication was switched according to the results. Functional outcomes of the hand and wrist were measured by total active motion of the fingers and by range of motion of the wrist respectively.
Results: Diagnosis was tenosynovitis in seven patients, infective arthritis and osteomyelitis combined with tenosynovitis of the wrist in three patients. Two patients had recurred skin ulcer during follow-up period and undergone second debridement. After second operation, no patient had a persistent discharging sinus and all patient were completely healed during follow-up period. Functional outcome of the eight patients who had NTM infection of their hand was excellent in two, good in four, fair in one, poor in one. Mean range of motion of the two patients who had osteomyelitis of their wrist was dorsiflexion 20°, volar flexion 15°, radial deviation 0°, ulnar deviation 15°.
Conclusion: Our standardized treatment protocol can be helpful for treatment of deep NTM infection of the hand and wrist.

국문 초록 (Abstract)

목적: 더 나은 임상 결과를 위한 수부 및 수근부의 비결핵 항산균 심부 감염의 진단과 치료 방법을 정리하여 그 지침을 제시하고자 하였다.
방법: 수부 및 수근부의 비결핵 항산균 심부 감염 환자 10명을 대상으로 광범위 변연절제술을 시행하였고 조직 검사가 항산균을 인한 감염을 시사하면 경험적으로 항결핵제를 투여하였다. 이후 균배양이 확인되면 신속 균동정 및 약물 감수성 검사를 시행하고 그에 맞는 약물 치료를 시행하였다. 수지의 기능적 결과는 total active motion으로 평가하였고 수근 관절은 관절 운동 각도로 평가하였다.
결과: 7명이 수부 및 수근부의 건초염 3명이 감염성 관절염 및 골수염으로 진단되었다. 추적 관찰 기간 중 2명의 환자에서 피부 궤양이 재발하여 2차 수술을 시행하였고 이후 재발 소견 보이지 않아 모두 임상적으로 치유된 소견을 보였다. 수지의 기능적 결과는 2예에서 excellent, 4예에서 good, 1예에서 fair, 1예에서 poor, 평균 수근 관절 운동은 2명에서 배측 굴곡 20°, 수장측 굴곡 15°, 요측 변위 0°, 척측 변위 15°였다.
결론: 이 연구에서 제시한 진단 및 치료 지침이 수부 및 수근부의 비결핵 항상균 심부 감염 치료에 도움이 될 것으로 생각된다.

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