van Rijssen Annet L, Werker Paul M N
Department for Plastic, Reconstructive, and Hand Surgery, Isala Clinics, Zwolle, The Netherlands.
J Hand Surg Am. 2012 Sep;37(9):1820-3. doi: 10.1016/j.jhsa.2012.05.022. Epub 2012 Jul 3.
Increasing options to treat Dupuytren disease include percutaneous needle fasciotomy (PNF), a minimally invasive technique that has proven to be effective for the treatment of primary disease. However, its effect on recurrent disease is not clear.
We studied 30 patients with recurrent Dupuytren disease in 40 fingers, with a mean follow-up of 4.4 years. Primary outcome measures were total passive extension deficit reduction and interval to a second recurrence, defined as an increase of more than 30° compared with the result at the end of the previous treatment. We noted complications.
Total passive extension reduction was 76%. Percutaneous needle fasciotomy was especially effective for the metacarpophalangeal joint, with an average reduction of 93%, whereas the average reduction in the proximal interphalangeal joint was 57%. A total of 50% of patients did not develop a secondary recurrence during follow-up. The other 50% did, and we treated recurrence within an average of 1.4 years after PNF. By means of PNF, we postponed tertiary treatment an average of 2.9 years starting from the initial treatment for Dupuytren disease. We successfully treated all secondary recurrences by limited fasciectomy, according to patients' wishes. We noted no major adverse effects.
Percutaneous needle fasciotomy can be applied effectively for recurrent disease; 50% of patients remain free of recurrence for a mean of 4.4 years. If a secondary recurrence occurs, it does so relatively early after treatment. Patients must therefore be willing to accept this uncertainty in the context of the advantages of PNF, such as fast recovery, low complication rate, and minimal invasiveness.
治疗掌腱膜挛缩症的方法越来越多，其中包括经皮针状筋膜切开术（PNF），这是一种微创技术，已被证明对原发性疾病的治疗有效。然而，其对复发性疾病的效果尚不清楚。
我们研究了30例患有复发性掌腱膜挛缩症的患者，共40根手指，平均随访4.4年。主要观察指标为总被动伸展缺陷的减少以及至第二次复发的间隔时间，第二次复发定义为与上一次治疗结束时的结果相比增加超过30°。我们记录了并发症情况。
总被动伸展减少率为76%。经皮针状筋膜切开术对掌指关节特别有效，平均减少率为93%，而近端指间关节的平均减少率为57%。共有50%的患者在随访期间未出现二次复发。另外50%的患者出现了二次复发，我们在PNF术后平均1.4年对复发进行了治疗。通过PNF，从掌腱膜挛缩症的初始治疗开始，我们将三次治疗平均推迟了2.9年。根据患者意愿，我们通过有限筋膜切除术成功治疗了所有二次复发。我们未发现重大不良反应。
经皮针状筋膜切开术可有效应用于复发性疾病；50%的患者平均4.4年无复发。如果出现二次复发，通常在治疗后相对较早的时间发生。因此，在PNF具有快速恢复、低并发症率和微创等优点的情况下，患者必须愿意接受这种不确定性。
