드꿰르벵 병 환자에서 초음파를 이용한 수근부 제 1 신전 구획 평가

Abstract

Purpose :Only one previous study about retinacular thickening or stenosis in the first extensor compartment was published.The purpose of this study was to measure the thickness of retinaculum and the stenosis of fibro-osseous canal in de Quervain disease and to figure out another landmark for intracompartment septum. Materials and Methods :This study was prospective and carried with the case group of 60 de Quervain diseases and the 60 healthy control groups.Subjects were placed in a sitted position and the arms were in neutral position with the radial styloid facing upward. After applying ultrasonic gel on the radial styloid area, transverse scanning of the first extensor compartment was made.The thickness of the extensor retinaculum , the cross-section areas of the tendons and the compartment were measured. The ultrasonographic findings of bony crest in the first extensor compartment were also recorded. Results : The mean thickness of the extensor retinaculum were 0.9mm (SD 0.38) in the case group and 0.35 (SD 0.06) in the control group. The difference was significant (p=0.0001).In the receiver operation characteristic (ROC) curve, the ideal reference of thickness of the extensor retinaculum was 0.45mm with area under curve (AUC) of 0.99. 96.3% of sensitivity and 93.3% of specificity were expected to diagnosis de Quervain disease with the reference in ultrasonographic examination. The stenosis ratio was calculated with 0.86 (SD 0.09) in disease group.The rational number was 0.78 (SD 0.15) in control group. And the stenosis ratio was different with that of the control group (p=0.04).The intracompartmental septum was presented in 48 cases (80%) during the operation.The sensitivity of the ultrasonographic examination was 98% and the specificity was 92%.The bony crest in the first extensor compartment could be classified 3 categories by the shape of the groove which was comprised with the crest as medial wall and the radial styloid process as bottom in the ultrasonographic examination. Conclusion :The extensor retinaculum was thicker and the first extensor compartment was stenotic in de Quervain disease. The cut off value of the extensor retinaculum was 0.45mm (sensitivity 96%, specificity 93%). And we believe the bony crest might be provided as another landmark to double-check the presence of the intracompartmental septum.