Dias Joseph J, Singh Harvinder Pal, Ullah Aamer, Bhowal Bhaskar, Thompson John R
University Hospitals of Leicester NHS Trust and the Department of Epidemiology, University of Leicester, Leicester, UK.
J Hand Surg Am. 2013 Oct;38(10):1987-93. doi: 10.1016/j.jhsa.2013.05.038. Epub 2013 Jul 30.
To study the evolution of deformity of the proximal interphalangeal joint over 5 years after good surgical correction of Dupuytren-induced contracture.
We assessed 63 patients (72 fingers; 69 hands) with Dupuytren disease for the degree of contracture, its correction after surgery, and the range of movement at the proximal interphalangeal joints at 3 and 6 months, and 1, 3, and 5 years after fasciectomy with or without the use of a firebreak graft. We investigated associations between the recurrence of contracture and preoperative patient and surgical factors.
There were 4 patterns of evolution of contracture after surgical correction. A total of 31 patients (33 hands) showed good improvement that was maintained for 5 years (minimal recontracture group). Twenty patients (23 hands) showed good initial improvement, which mildly worsened (< 20°) but was then maintained over 5 years (mild early recontracture group). Four patients (5 hands) worsened in first 3 months after surgery (> 20°) but there was no further worsening (severe early recontracture group). Eight patients (8 hands) worsened progressively over 5 years (progressive recontracture group). Worsening of contracture more than 6° between 3 and 6 months after surgery predicted progressive recontracture at 5 years.
Recurrence of contracture (not disease recurrence) could be predicted as early as 6 months after surgery for Dupuytren disease.
研究Dupuytren挛缩症经良好手术矫正后5年间近端指间关节畸形的演变情况。
我们评估了63例患有Dupuytren病的患者（72根手指；69只手），观察其挛缩程度、手术后的矫正情况以及在筋膜切除术（使用或不使用阻断移植）后3个月、6个月、1年、3年和5年时近端指间关节的活动范围。我们调查了挛缩复发与术前患者及手术因素之间的关联。
手术矫正后挛缩有4种演变模式。共有31例患者（33只手）显示出良好的改善，并维持了5年（最小再挛缩组）。20例患者（23只手）最初改善良好，但随后轻度恶化（<20°），但在5年期间保持稳定（轻度早期再挛缩组）。4例患者（5只手）在术后前3个月恶化（>20°），但之后未进一步恶化（严重早期再挛缩组）。8例患者（8只手）在5年期间逐渐恶化（进行性再挛缩组）。术后3至6个月挛缩恶化超过6°预示着5年后会出现进行性再挛缩。
Dupuytren病手术后早在6个月就可以预测挛缩的复发（而非疾病复发）。
