Atroshi Isam, Strandberg Emelie, Lauritzson Anna, Ahlgren Eva, Waldén Markus
Department of Orthopedics Hässleholm-Kristianstad-Ystad, Hässleholm Hospital, Hässleholm, Sweden.
BMJ Open. 2014 Jan 15;4(1):e004166. doi: 10.1136/bmjopen-2013-004166.
To compare collagenase injections and surgery (fasciectomy) for Dupuytren's contracture (DC) regarding actual total direct treatment costs and short-term outcomes.
Retrospective cohort study.
Orthopaedic department of a regional hospital in Sweden.
Patients aged 65 years or older with previously untreated DC of 30° or greater in the metacarpophalangeal (MCP) and/or proximal interphalangeal (PIP) joints of the small, ring or middle finger. The collagenase group comprised 16 consecutive patients treated during the first 6 months following the introduction of collagenase as treatment for DC at the study centre. The controls were 16 patients randomly selected among those operated on with fasciectomy at the same centre during the preceding 3 years.
Treatment with collagenase was given during two standard outpatient clinic visits (injection of 0.9 mg, distributed at multiple sites in a palpable cord, and next-day finger extension under local anaesthesia) followed by night-time splinting. Fasciectomy was carried out in the operating room (day surgery) under general or regional anaesthesia using standard technique, followed by therapy and splinting.
Actual total direct costs (salaries of all medical personnel involved in care, medications, materials and other relevant costs), and total MCP and PIP extension deficit (degrees) measured by hand therapists at 6-12 weeks after the treatment.
Collagenase injection required fewer hospital outpatient visits to a therapist and nurse than fasciectomy. Total treatment cost for collagenase injection was US$1418.04 and for fasciectomy US$2102.56. The post-treatment median (IQR) total extension deficit was 10 (0-30) for the collagenase group and 10 (0-34) for the fasciectomy group.
Treatment of DC with one collagenase injection costs 33% less than fasciectomy with equivalent efficacy at 6 weeks regarding reduction in contracture.
比较胶原酶注射和手术（筋膜切除术）治疗掌腱膜挛缩症（DC）的实际总直接治疗成本和短期疗效。
回顾性队列研究。
瑞典一家地区医院的骨科。
年龄在65岁及以上，小指、环指或中指掌指关节（MCP）和/或近端指间关节（PIP）存在30°或更大角度的未经治疗的DC患者。胶原酶组包括在研究中心将胶原酶作为DC治疗方法引入后的前6个月内连续治疗的16例患者。对照组是在之前3年内在同一中心接受筋膜切除术的16例随机选择的患者。
在两次标准门诊就诊期间进行胶原酶治疗（注射0.9毫克，分布于可触及的条索多个部位，并在局部麻醉下于次日进行手指伸展），随后进行夜间夹板固定。筋膜切除术在手术室（日间手术）采用标准技术在全身或区域麻醉下进行，随后进行治疗和夹板固定。
实际总直接成本（参与护理的所有医务人员的工资、药物、材料及其他相关成本），以及在治疗后6至12周由手部治疗师测量的MCP和PIP总伸展缺损（度数）。
与筋膜切除术相比，胶原酶注射所需的医院门诊就诊治疗师和护士的次数更少。胶原酶注射的总治疗成本为1418.04美元，筋膜切除术为2102.56美元。胶原酶组治疗后的总伸展缺损中位数（IQR）为10（0-30），筋膜切除术组为10（0-34）。
在治疗DC方面，单次胶原酶注射的成本比筋膜切除术低33%，且在6周时减少挛缩方面疗效相当。
