Annals of Occupational and Environmental Medicine

The Korean Society of Occupational & Environmental Medicine (대한직업환경의학회)
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A Case of Kienbo¨ck's Disease from Repetitive Contact Stress

반복적인 접촉 스트레스에 의해 발생한 키엔벡병 사례

  • Kim, Chul-Ju (Department of Occupational and Environmental Medicine, Hallym University Scared Heart Hospital) ;
  • Ju, Young-Su (Department of Occupational and Environmental Medicine, Hallym University Scared Heart Hospital) ;
  • Im, Hyoung-June (Department of Occupational and Environmental Medicine, Hallym University Scared Heart Hospital) ;
  • Bang, Yae-Won (Department of Occupational and Environmental Medicine, Hallym University Scared Heart Hospital) ;
  • Kwon, Young-Jun (Department of Occupational and Environmental Medicine, Hangang Scared Heart Hospital)
  • 김철주 (한림대학교 성심병원 산업의학과) ;
  • 주영수 (한림대학교 성심병원 산업의학과) ;
  • 임형준 (한림대학교 성심병원 산업의학과) ;
  • 방예원 (한림대학교 성심병원 산업의학과) ;
  • 권영준 (한강성심병원 산업의학과)
  • Published : 2011.09.30
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Abstract

Objectives: Kienbock's disease, which is characterized by osteonecrosis of the lunate bone, causes progressive chronic pain and dysfunction of the hand and wrist. Even though occurrence of the disease was reported approximately 100 years ago and it is suspected to be work-related to some degree, the etiology has not been clearly discribed and the disease has rarely been considered as an occupation-related disease. As such, we submit this case as the first report of Kienbo¨ck's disease in Korea, with clinical findings, x-ray, MRI (magnetic resonance imaging) and strain index results along with a literature review. Methods: The patient was carefully interviewed and her medical records were properly reviewed by the authors with her consent. The authors also visited her factory work site to inspect and videotape the working environment and to conduct an ergonomic evaluation with a strain index. Results: Excessively repeated contact stress was found to be concentrated on her right hand and the environment was discovered to be hazardous from an ergonomic standpoint. The literature review revealed that heavy loads on the hand might be related to the cause or deterioration associated with Kienbo¨ck's disease. ; therefore, it is very likely that her disease is related to her work. Conclusions: There is much evidence to suggest that heavy workloads involving hand and wrist intensive tasks may cause and worsen Kienbo¨ck's disease. However, to date epidemiologic studies clarifying the etiology of the disease have not been sufficiently reported. Therefore, further research focusing on the etiology and prevention of the disease are required. In addition, practical guidelines for hand and wrist intensive tasks are needed to prevent disease development and worsening.

목적: 월상골(lunate)의 골괴사를 특징으로 하는 키엔벡병은 점진적인 손과 손목의 만성통증과 기능장애를 일 으킨다. 보고 된지 100년이 지났고 병의 발생이 직업력과 일정정도 관계있음이 알려졌으나, 발생이 드물어 연구를 찾기 힘들고 아직까지 명확한 발병 원인이 알려져 있지 않아 직업병으로 승인된 사례는 거의 없다. 이에 종이박스 완성 작업에서 반복동작에 의해 발생한 키엔벡병 1례를 임상소견, 방사선 검사, 자기공명영상 검사 등의 검사소견과 이와 관련된 직업력 및 SI(strain index)를 통한 동작분석, 문헌고찰과 더불어 보고하고자 한다. 방법: 환자를 면담하였고 병원의 의무기록을 확인하였으며 키엔벡병과 관련된 문헌을 고찰하였다. 또한 사업장을 방문하여 작업환경을 조사하고 작업과정을 비디오 촬영하여 SI를 사용한 인간공학적 평가를 실시하였다. 결과: 본 사례의 환자는 과도한 반복 작업을 한 것으로 나타났고 인간공학적 평가에서 매우 위험한 작업으로 평가되었으며, 기존 문헌고찰 결과 이러한 손의 부담 작업들이 키엔벡병의 발생 또는 악화와 연관성이 있다는 많은 보고들이 있었다. 그러므로 이 환자의 질병은 작업과 관련되어 발생 또는 악화되었을 가능성이 상당히 높다고 할 수 있다. 결론: 손과 손목을 반복적으로 사용하는 작업이 키엔벡병을 일으키고 악화시킨다는 근거는 많지만 이를 명확히 할 수 있는 역학적 연구는 아직 부족한 현실이며, 이는 키엔벡병의 발생이 드물고 병을 주로 다루는 의사가 주로 치료에 관심이 있는 정형외과나 성형외과 의사이기 때문으로 보인다. 따라서 병의 발생과 예방에 중점을 둔 추가 연구가 필요하며, 나아가 손과 손목의 작업성 질환에 대한 관리지침을 개발하여 이 환자처럼 1년이 넘게 손목 통증이 있으나 일을 계속하여 병을 악화시키는 사례에 대한 예방이 필요하다.

Keywords

References

  1. Irisarri C. Aetiology of Kienbock's disease. J hand Surg Br 2004;29(3):281-7. https://doi.org/10.1016/j.jhsb.2004.01.006
  2. Beredjiklian PK. Kienbock's disease. J hand Surg Am 2009;34(1):167-75. https://doi.org/10.1016/j.jhsa.2008.10.012
  3. The Korean Orthopedic Association. Orthopedics, 6th edition, volume 1 (translated by Kim CJ). Newest Medicine Company. Seoul. 2006. pp 576-7. (Korean)
  4. Moore JS, Garq A. The Strain Index: a proposed method to analyze jobs for risk of distal upper extremity disorders. Am Ind Hyq Assoc J 1995;56(5):443-58. https://doi.org/10.1080/15428119591016863
  5. Schuind F, Eslami S, Ledoux P. Kienbock's disease. J Bone Joint Surg Br 2008;90(2):133-9.
  6. Schuind F, Cooney WP, Linscheid RL, An KN, Chao EY. Force and pressure transmission through the normal wrist. A theoretical two-dimensional study in the posteroanterior plane. J Biomech 1995;28(5):587-601. https://doi.org/10.1016/0021-9290(94)00093-J
  7. Watson HK, Guidera PM. Aetiology of Kienbock's disease. J hand Surg Br 1997;22(1):5-7. https://doi.org/10.1016/S0266-7681(97)80004-6
  8. Iwasaki N, Minami A, Miyazawa T, Kaneda K. Force distribution through the wrist joint in patients with different stages of Kienbock's disease: using computed tomography osteoabsorptiometry. J Hand Surg Am 2000;25(5):870-6. https://doi.org/10.1053/jhsu.2000.16353
  9. Panagis JS, Gelberman RH, Taleisnik J, Baumgaertner M. The arterial anatomy of the human carpus. Part II: the intraosseous vascularity. J Hand Surg Am 1983;8(4):375-82.
  10. Lee ML. The intraosseus arterial pattern of the carpal lunate bone and its relation to avascular necrosis. Acta Ortho Scand 1963;33:43-55. https://doi.org/10.3109/17453676308999833
  11. Gelberman RH, Bauman TD, Menon J, Akeson WH. The vascularity of the lunate bone and Kienbock's disease. J Hand Surg Am 1980;5(3):272-8.
  12. Pichler M, Putz R. The venous drainage of the lunate bone. Surg Radiol Anat 2003;24(6):372-6.
  13. Allan CH, Joshi A, Lichtman DM. Kienbock's disease: diagnosis and treatment. J Am Acad Orthop Surg 2001;9(2):128-36.
  14. Waqner JP, Chung KC. A historical report on Robert Kienbock(1871-1953) and Kienbock's Disease. J hand Surg Am 2005;30(6):1117-21. https://doi.org/10.1016/j.jhsa.2005.08.002
  15. Therkelsen F, Andersen K. Lunatomalacia. Acta Chir Scand 1949;97(6):503-26.
  16. Gemne G, Saraste H. Bone and joint pathology in workers using hand-held vibrating tools. An overview. Scand J Work Environ Health 1987;13(4):290-300. https://doi.org/10.5271/sjweh.2048
  17. Nakamura R, Imaeda T, Suzuki K, Miura T. Sportsrelated Kienbo¨ck's disease. Am J Sports Med 1991;19(1):88-91. https://doi.org/10.1177/036354659101900115
  18. Joji S, Mizuseki T, Katayama S, Tsuge K, Ikuta Y. Aetiology of Kienbock's disease based on a study of the condition among patients with cerebral palsy. J Hand Surg Br 1993;18(3):294-8. https://doi.org/10.1016/0266-7681(93)90044-G
  19. Schiltenwolf M, Martini AK, Mau HC, Eversheim S, Brocai DR, Jensen CH. Further investigations of the intraosseous pressure characteristics in necrotic lunates (Kienbock's disease). J Hand Surg Am 1996;21(5):754-8. https://doi.org/10.1016/S0363-5023(96)80187-0
  20. Jurado R, Ribeiro M. Possible role of systemic inflammatory reaction in vascular access thrombosis. South Med J 1999;92(9):877-81. https://doi.org/10.1097/00007611-199909000-00005
  21. Esmon CT. New mechanisms for vascular control of inflammation mediated by natural anticoagulant proteins. J Exp Med 2002;196(5):565-77. https://doi.org/10.1084/jem.20020077
  22. Culp RW, Schaffer JL, Osterman AL, Bora FW Jr. Kienbo¨ck's disease in a patient with Crohn's enteritis treated with corticosteroids. J hand Surg Am 1989;14(2 Pt 1):294-6. https://doi.org/10.1016/0363-5023(89)90024-5
  23. Lanzer W, Szabo R, Gelberman R. A vascular necrosis of the lunate and sickle cell anemia. A case report. Clin Orthop Relat Res 1984;187:168-71.
  24. Lee JH, Yoo HJ, You MK, Kang JD. Treatment of Kienbock's disease using fascia late-two cases report-. J korean Orthop Assoc 1985;20(5):981-5. (Korean)
  25. Chung MS, Won CH, Yoon BH. Distraction-motion arthroplasty for the management of Kienbock's Disease. J korean Orthop Assoc 1987;22(1):92-6. (Korean)
  26. Kim ID, Ihn JC, Kim PT, Kyung HS, Shin SH. Radial shortening or radial wedge osteotomy for Kienbock's disease. J korean Orthop Assoc 1997;32(1):133-40. (Korean)
  27. Shin HD, Kim KC, Woo SE, Li X, Kang TH. Limited intercarpal arthrodesis in Kienbock's disease. J korean Orthop Assoc 2006;41(6):947-52. (Korean)
  28. Ha KI, Hahn SH, Chung MY, Kim HJ, An TW. Ulnar lengthening in the treatment of Kienbock's disease. J korean Orthop Assoc 1989;24(3):872-8. (Korean)
  29. Cheon SJ, Son KM, Kim HT, Suh JT, Yoo CI. Pathologic rupture of flexor pollicis longus tendon secondary to Kienbock's disease-a case report-. J korean Orthop Assoc 2006;41(3):578-81.
  30. Park BJ, Chung DW, Han CS, Jeon IH, Kwon HG. The long term follow-up result of revascularization in treatment for Kienbck`s disease. J Korean Soc Surg Hand 1998;3(1):33-41. (Korean)
  31. Chung DW, Han JS, Lee CW, Ok JC, Baek CH. Pronator quadratus pedicled one graft for the Kienbock's disease-Three cases report-. J korean Orthop Assoc 1995;30(5):1458-62. (Korean)
  32. Moon ES, Rhym IS, Park JH. The triscaphe fusion in Kienbocks disease. J Korean Soc Surg Hand 1996;1(1):74-82. (Korean)
  33. Lee SK, Huh DY. Long-term follow-up after the treatment of Kienbock's disease by packing of fascia lata flap. J korean Orthop Assoc 1988;23(2):515-22. (Korean)
  34. Shin SJ, Kim DW, Kang HJ, Hahn SB, Kang ES. Surgical treatment of the Kienbck's disease. J Korean Soc Surg Hand 1999;4(2):186-92. (Korean)
  35. Lee SK, Kim TH. Clinical study of Kienbock's disease. J korean Orthop Assoc 1990;25(5):1453-61. (Korean)
  36. Lee SU, Yoo MC, Lee S. Microvascular loop graft in the treatment of the Kienbock's disease. J korean Orthop Assoc 1985;20(2):319-23. (Korean)
  37. Chung DW, Han CS, Nam GU, Park BY, Han HS. Original report : Kienbock's disease treated with vascular loop graft. J Korean Microsurg Soc 1993;2(1): 13-9.(Korean)