Kobus Kazimierz, Wójcicki Piotr, Dydymski Tomasz, Wegrzyn Marek, Hamlawi Fahed
Klinika i Oddział Chirurgii Plastycznej SCM w Polanicy Zdroju, Akademia Medyczna, Wrocław.
Ortop Traumatol Rehabil. 2007 Mar-Apr;9(2):134-40.
Dupuytren's contracture is a common condition leading to impairment of the function of the hand which affects from 2 to 12 % of the population, mainly males, and presents as progressive contracture of fingers caused by shortening of the palmar aponeurosis. The objective of the work was to present our own approach to managing Dupuytren's disease and evaluate treatment results in patients with hypertrophy of the palmar aponeurosis. Material and method 288 patients with Dupuytren's disease were treated at the Plastic Surgery Hospital in Polanica Zdroj over a period of 25 years (1977-2002). The present paper is a retrospective analysis of treatment results in 253 patients for whom complete medical documentation was available. All patients were operated in local anaesthesia in ischemia. A Bunnell flap skin incision was followed by a fasciectomy of the hypertrophied segment of the palmar aponeurosis. The skin wound was closed using V-Y plasty. Postoperative management involved hand elevation and early rehabilitation. Results Restoration of the full range of motion and total extension in the MP joint and the interphalangeal joints were achieved in 70% and 68% of patients, respectively. Of 145 patients who were professionally active, 132 were able to return to work. Finger amputation was necessary in 2 patients, one patient suffered from arthrodesis and two other developed skin necrosis which was removed with the wound closed by skin grafts. A follow-up examination 6 months after the operation revealed a recurrence in 8 patients and deterioration of hand dexterity with finger stiffness in 4. Conclusions A low complication rate and good treatment results are arguments in favour of the approach adopted at our hospital, i.e. surgery in local anaesthesia in ischemia with compressive bandaging, using a Bunnell flap skin incision followed by radical fasciectomy and V-Y plasty.
杜普伊特伦挛缩症是一种常见病症，会导致手部功能受损，影响2%至12%的人群，主要为男性，表现为掌腱膜缩短引起的手指进行性挛缩。本研究的目的是介绍我们治疗杜普伊特伦病的方法，并评估掌腱膜肥厚患者的治疗效果。材料与方法在25年（1977 - 2002年）期间，波拉尼察兹德罗伊的整形外科医院对288例杜普伊特伦病患者进行了治疗。本文是对253例有完整医疗记录患者的治疗结果进行的回顾性分析。所有患者均在局部麻醉下于缺血状态下进行手术。采用邦内尔皮瓣皮肤切口，随后对掌腱膜肥厚段进行筋膜切除术。皮肤伤口采用V - Y成形术闭合。术后处理包括手部抬高和早期康复。结果分别有70%和68%的患者在掌指关节和指间关节实现了全范围活动和完全伸直。在145名职业活跃的患者中，132名能够重返工作岗位。2例患者需要进行手指截肢，1例患者出现关节融合，另外2例出现皮肤坏死，通过植皮闭合伤口后坏死组织被切除。术后6个月的随访检查发现8例患者复发，4例患者因手指僵硬导致手部灵活性下降。结论低并发症发生率和良好的治疗效果支持我院采用的治疗方法，即在局部麻醉下于缺血状态下进行手术，采用压迫包扎，使用邦内尔皮瓣皮肤切口，随后进行根治性筋膜切除术和V - Y成形术。
