Zwolle and Groningen, The Netherlands From the Department of Plastic, Reconstructive and Hand Surgery, Isala Clinics, and the Department of Plastic Surgery, University Medical Centre Groningen, and the University of Groningen.
Plast Reconstr Surg. 2012 Feb;129(2):469-477. doi: 10.1097/PRS.0b013e31823aea95.
The increasing number of methods for treating Dupuytren's disease indicates a need for comparative studies. In this article, the 5-year follow-up results of a randomized controlled study that compared percutaneous needle fasciotomy and limited fasciectomy are presented.
One hundred eleven patients with 115 affected hands with a minimal passive extension deficit of 30 degrees were assigned randomly to the two groups. Follow-up examinations were performed at 1 and 6 weeks; 6 months; and 1, 2, 3, 4, and 5 years. Outcome parameters were total passive extension deficit, patient satisfaction, flexion, and sensibility. Furthermore, disease extension was recorded. The primary endpoint was recurrence, defined as an increase of total passive extension deficit of greater than 30 degrees. Ninety-three patients reached this endpoint.
The recurrence rate after 5 years in the needle fasciotomy group (84.9 percent) was significantly higher than in the limited fasciectomy group (20.9 percent) (p < 0.001), and occurred significantly sooner in the needle fasciotomy group (p = 0.001). Older age at the time of treatment decreased the recurrence rate (p = 0.005). No other diathesis characteristics influenced recurrence. Patient satisfaction was high in both groups but was significantly higher in the limited fasciectomy group. Nevertheless, many patients (53 percent) preferred percutaneous needle fasciotomy in case of recurrence.
Percutaneous needle fasciotomy is the preferred treatment for elderly patients with Dupuytren's disease and for those willing to accept a possible early recurrence in the context of the advantages, such as fast recovery, a low complication rate, and minimal invasiveness.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.
治疗杜普伊特伦挛缩症的方法越来越多，这表明需要进行比较研究。本文报告了一项经皮针刀松解术与局限性筋膜切除术随机对照研究的 5 年随访结果。
将 115 例 115 只患手（最小被动伸展度丧失 30 度）的患者随机分为两组。在 1 周和 6 周；6 个月；1 年、2 年、3 年、4 年和 5 年进行随访检查。主要的结局参数是总被动伸展缺失、患者满意度、弯曲和感觉。此外，还记录了疾病的扩展情况。主要终点是复发，定义为总被动伸展缺失增加大于 30 度。93 例患者达到了这一终点。
经皮针刀松解组 5 年后的复发率（84.9%）明显高于局限性筋膜切除术组（20.9%）（p<0.001），且经皮针刀松解组的复发时间更早（p=0.001）。治疗时年龄较大的患者复发率较低（p=0.005）。其他体质特征不影响复发。两组患者的满意度均较高，但局限性筋膜切除术组的满意度明显更高。然而，许多患者（53%）在复发的情况下更喜欢经皮针刀松解术。
对于老年杜普伊特伦挛缩症患者和愿意接受早期复发的患者（考虑到快速恢复、低并发症率和微创的优势），经皮针刀松解术是首选治疗方法。
临床问题/证据水平：治疗，II 级。
