Werker Paul M N, Pess Gary M, van Rijssen Annet L, Denkler Keith
University of Groningen, University Medical Centre Groningen, The Netherlands.
J Hand Surg Am. 2012 Oct;37(10):2095-2105.e7. doi: 10.1016/j.jhsa.2012.06.032. Epub 2012 Aug 30.
To call attention to the wide variety of definitions for recurrence that have been employed in studies of different invasive procedures for the treatment of Dupuytren contracture and how this important limitation has contributed to the wide range of reported results.
This study reviewed definitions and rates of contracture correction and recurrence in patients undergoing invasive treatment of Dupuytren contracture. A literature search was carried out in January 2011 using the terms "Dupuytren" AND ("fasciectomy" OR "fasciotomy" OR "dermofasciectomy" OR "aponeurotomy" OR "aponeurectomy") and limited to studies in English.
The search returned 218 studies, of which 21 had definitions, quantitative results for contracture correction and recurrence, and a sample size of at least 20 patients. Definitions for correction of contracture and recurrence varied greatly among articles and were almost always qualitative. Percentages of patients who achieved correction of contracture (ie, responder rate) when evaluated at various times after completion of surgery ranged from 15% to 96% for fasciectomy/aponeurectomy. Responder rates were not reported for fasciotomy/aponeurotomy. Recurrence rates ranged from 12% to 73% for patients treated with fasciectomy/aponeurectomy and from 33% to 100% for fasciotomy/aponeurotomy. Review of these reports underscored the difficulty involved in comparing correction of contracture and recurrence rates for different surgical interventions because of differences in definition and duration of follow-up.
Clearly defined objective definitions for correction of contracture and for recurrence are needed for more meaningful comparisons of results achieved with different surgical interventions.
Recurrence after surgical intervention for Dupuytren contracture is common. This study, which evaluated reported rates of recurrence following surgical treatment of Dupuytren contracture, provides clinicians with practical information regarding expected long-term outcomes of surgical treatment choices.
TYPE OF STUDY/LEVEL OF EVIDENCE: Economic and decision analysis III.
提醒人们注意在不同侵入性手术治疗掌腱膜挛缩症的研究中所采用的各种复发定义，以及这一重要局限性是如何导致所报道结果的广泛差异的。
本研究回顾了接受掌腱膜挛缩症侵入性治疗患者的挛缩矫正和复发的定义及发生率。2011年1月进行文献检索，检索词为“掌腱膜”与（“筋膜切除术”或“筋膜切开术”或“真皮筋膜切除术”或“腱膜切开术”或“腱膜切除术”），且仅限于英文研究。
检索返回218项研究，其中21项有挛缩矫正和复发的定义、定量结果以及至少20例患者的样本量。各文章中挛缩矫正和复发的定义差异很大，且几乎都是定性的。筋膜切除术/腱膜切除术患者在手术后不同时间点评估时达到挛缩矫正的患者百分比（即反应率）为15%至96%。筋膜切开术/腱膜切开术未报告反应率。筋膜切除术/腱膜切除术治疗的患者复发率为12%至73%，筋膜切开术/腱膜切开术治疗的患者复发率为33%至100%。对这些报告的回顾强调了由于定义和随访时间的差异，比较不同手术干预的挛缩矫正和复发率存在困难。
需要明确界定挛缩矫正和复发的客观定义，以便更有意义地比较不同手术干预所取得的结果。
掌腱膜挛缩症手术干预后的复发很常见。本研究评估了掌腱膜挛缩症手术治疗后报道的复发率，为临床医生提供了有关手术治疗选择预期长期结果的实用信息。
研究类型/证据水平：经济与决策分析III。
