자기공명영상을 이용한 회전근 개 질환의 경과 관찰 = A Follow-Up Study of Rotator Cuff Tear Using Magnetic Resonance Imaging

다국어 초록 (Multilingual Abstract)

Purpose: Rotator cuff disease (RCD) is a common cause of shoulder pain. However little is known about the progression of RCD during conservative management. This study aimed to identify the progression of RCD using magnetic resonance imaging (MRI).
Materials and Methods: This study was conducted between 2013 and 2015; 48 patients who underwent MRI after at least one year of conservative treatment for RCD were enrolled for follow-up analysis. Rotator cuff tear (RCT) and retraction were measured using an MRI.
Tear progression was defined as an increase of 3 mm or more in tear size or retraction. Patients were divided into two groups: Small tear group and medium/large tear group. The progression of tears was analyzed.
Results: RCT occurred in 25 cases and tendinosis occurred in 23 cases. The progression was observed in 12 cases (48.0%), and new tears were observed in 2 cases (8.7%). The pre-treatment tear size and retraction were 17.8 mm and 18.9 mm, respectively; while the post treatment tear size and amount of tendon retraction were 20.2 mm and 22.3 mm, respectively. The pre-treatment anteroposterior diameter of tears showed a positive correlation with the pre-treatment tendon retraction (r=0.830, p＜0.001) but a negative correlation with the anteroposterior tear size progression (r=-0.473, p=0.017). Small size tears were found in 5 cases (20.0%) and medium/large size tears were found in 20 cases (80.0%). Among the 5 cases of small size tears, 4 cases (80.0%) showed progression, with a mean anteroposterior diameter of 7.4 mm and a mean amount of retraction of 5.9 mm. Among the 20 cases with medium/large size tears, 8 cases (40.0%) showed progression, with a mean anteroposterior diameter of 4.1 mm and a mean retraction of 6.8 mm. The frequency of tear progression was significantly different between the two groups (p＜0.001).
Conclusion: The need to use MRI monitoring during the conservative treatment of rotator cuff tears to evaluate the possibility of switching to surgical treatment. This study also suggests that an aggressive surgical treatment should be considered even for small tears, since the size of tear and retraction of tears may progress similarly regardless of the size of tear.

국문 초록 (Abstract)

목적: 회전근 개 질환은 견관절 통증의 흔한 원인이다. 그러나 보존적 치료 시 파열의 진행이나 파열의 발생에 대해서는 잘 알려져있지 않아 자기공명영상을 이용하여 회전근 개 질환의 진행 정도를 알아보고자 하였다.
대상 및 방법: 2013년부터 2015년까지 회전근 개 질환으로 최소 1년 이상 보존적 치료를 시행 후 자기공명영상을 촬영한 48예를 대상으로 하였다. 나이는 평균 64.3세(범위, 45-83세), 추시 기간은 평균 17.6개월(범위, 12-37개월)이었다. 자기공명영상에서 파열의전후 크기와 대결절부터 건의 퇴축을 측정하였다. 파열의 크기나 건의 퇴축이 3 mm 이상 증가 시 파열의 진행으로 정의하였다. 10 mm 미만의 소 파열과 10 mm의 중·대 파열 두 군으로 나누어 파열의 진행을 분석하였다.
결과: 치료 전 자기공명영상에서 회전근 개 파열은 25예였으며, 회전근 개 부분 파열은 23예였다. 파열의 진행은 12예(48.0%), 회전근 개 부분 파열에서 새로운 파열이 2예(8.7%) 관찰되었다. 파열 크기는 치료 전 전후 직경 17.8 mm, 건의 퇴축 18.9 mm였으며, 치료 후 각각 20.2 mm, 22.3 mm였다. 치료 전 파열의 전후 크기는 수술 전 퇴축과 양의 상관관계(r=0.830, p＜0.001), 전후 크기의진행과 음의 상관관계(r=-0.473,p=0.017)를 보였다. 소 파열은 5예(20.0%)였고 중·대 파열은 20예(80.0%)였다. 소 파열군 5예중 4예(80.0%)에서 진행하였고 전후 크기는 평균 7.4 mm (범위, 4.1-11.7 mm), 퇴축은 5.9 mm (범위, 4.7-7.7 mm) 진행하였다.
중·대 파열군 20예 중 8예(40.0%)에서 파열이 진행하였으며 전후 크기는 평균 4.1 mm (범위, 0.16-.3 mm), 퇴축은 6.8 mm (범위 , 3.4-14.8 mm) 진행하였다. 소 파열군과 중·대 파열군에서 파열 진행의 빈도는 통계적으로 유의한 차이를 였보다(p＜0.001).
결론: 회전근 개 파열의 보존적 치료 시 자기공명영상을 통한 추시 관찰을 통해 수술적 치료로의 전환을 고려해야 할 것으로 생각되며 소 파열군에서도 중·대 파열과 같이 파열의 크기와 퇴축이 진행하므로 소 파열의 경우에도 적극적인 수술적 치료를 고려해야 한다.

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