Journal of the Korean Orthopaedic Association (대한정형외과학회지)

Korean Orthopaedic Association (대한정형외과학회)
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Surgical Treatment for Hand and Wrist Problems in Rheumatoid Arthritis

류마티스 관절염에서 손과 손목에 대한 수술적 치료

  • Lee, Chang-Hun (Department of Orthopaedic Surgery, Hanyang University College of Medicine) ;
  • Lee, Kwang-Hyun (Department of Orthopaedic Surgery, Hanyang University College of Medicine)
  • 이창훈 (한양대학교 의과대학 정형외과학교실) ;
  • 이광현 (한양대학교 의과대학 정형외과학교실)
  • Received : 2020.06.01
  • Accepted : 2020.07.22
  • Published : 2020.12.30
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Abstract

Rheumatoid arthritis is a systemic disease with chronic progress, but the recent rapid developments of drug treatments have led many patients to gain control of their disease activity. As a result, surgery has been performed less commonly on the wrist or hand than in the past. On the other hand, surgical treatment is still essential to patients who do not respond to those medications. For the successful treatment of symptomatic deformed joints or functional disability, surgeons should understand that the pathology of rheumatoid arthritis proceeds differently in every patient. Furthermore, because rheumatoid arthritis often invades multiple joints in the hand and wrist, the patients often require multiple operations simultaneously. This paper summarizes the current concepts of surgical treatment of rheumatoid arthritis in the hand and wrist based on more than 30 years' experience of our senior surgeon and a literature review.

류마티스 관절염은 만성 경과를 보이는 전신 질환이지만 최근 약물 치료의 비약적 발전으로 인해 많은 환자들이 질병 활성 조절을 얻고 있다. 이에 따라 손과 손목에 시행하던 수술이 예전에 비해 줄어드는 추세를 보이고 있지만 안타깝게도 약물 치료에 반응하지 않는 환자는 여전히 존재하고 있고, 그들에게 수술은 약물과 함께 필요한 필수적 치료 방법이다. 관절이 파괴 및 변형되고, 근력 저하가 발생한 환자의 손과 손목을 수술하기 위해서 집도의는 환자마다 각기 다른 양상으로 진행되는 류마티스 관절염의 병리를 이해해야 한다. 특히 류마티스 관절염은 동시에 여러 관절을 침범하여 문제가 발생하는 경우가 빈번하여 한 가지의 수술만 하기 보다는 여러 가지의 수술을 함께 시행하는 경우가 많으므로 류마티스 관절염 환자의 손과 손목에서 발생하는 문제들에 대해 종합적인 이해가 필요하겠다. 이번 종설에서 저자는 30여 년간 류마티스 관절염에 대한 수술을 하면서 중요하게 생각하였던 개념을 정리하였고, 각 수술의 임상 결과를 문헌 고찰과 함께 기술하였다.

Keywords

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