Plastic & Reconstructive Surgery Research, School of Translational Medicine, Manchester Academic Health Science Centre, Manchester Interdisciplinary Biocentre, University of Manchester, 131 Princess Street, Manchester M1 7ND, UK.
Nat Rev Rheumatol. 2010 Dec;6(12):715-26. doi: 10.1038/nrrheum.2010.180. Epub 2010 Nov 9.
Dupuytren disease (DD) is a fibroproliferative disorder of unknown etiology that often results in shortening and thickening of the palmar fascia, leading to permanent and irreversible flexion contracture of the digits. This Review provides a detailed update of the scientific understanding of DD and its clinical management, with perspectives on emerging research and therapy. Established risk factors include genetic predisposition and ethnicity, as well as sex and age. Several environmental risk factors (some considered controversial) include smoking, alcohol intake, trauma, diabetes, epilepsy and use of anticonvulsant drugs, and exposure to vibration. DD has been variously attributed to the presence of oxygen free radicals, trauma to the palmar fascia, or aberrant immune responses with altered antigen presentation, or to interactions between these proposed mechanisms. The presence of immune cells and related phenomena in DD-affected tissue suggests that DD is possibly immune-related. Mechanically, digital contracture is caused by myofibroblasts in the DD palmar fascia; however, the exact origin of this cell type remains unknown. The mainstay of treatment is surgical release or excision of the affected palmodigital tissue, but symptoms often recur. Nonsurgical correction of DD contractures can be achieved by Clostridium histolyticum collagenase injection, although the long-term safety and recurrence rate of this procedure requires further assessment.
掌腱膜挛缩症（Dupuytren 病，DD）是一种病因不明的纤维增生性疾病，常导致掌筋膜缩短和增厚，导致手指永久性和不可逆的弯曲挛缩。本综述详细介绍了对 DD 的科学认识及其临床管理的最新进展，包括对新兴研究和治疗方法的展望。已确定的风险因素包括遗传易感性和种族，以及性别和年龄。一些环境风险因素（有些被认为有争议）包括吸烟、饮酒、创伤、糖尿病、癫痫和使用抗癫痫药物，以及接触振动。DD 归因于氧自由基的存在、掌筋膜的创伤，或异常的免疫反应导致抗原呈递改变，或这些拟议机制之间的相互作用。DD 受累组织中免疫细胞和相关现象的存在表明 DD 可能与免疫有关。在机械方面，手指挛缩是由 DD 掌筋膜中的肌成纤维细胞引起的；然而，这种细胞类型的确切来源仍不清楚。该病的主要治疗方法是手术松解或切除受累的掌指组织，但症状常复发。通过注射胶原酶（如注射型 A 型肉毒毒素）可以非手术矫正 DD 挛缩，但该方法的长期安全性和复发率仍需进一步评估。
