Eckerdal David, Nivestam Axel, Dahlin Lars B
Department of Clinical Sciences Malmö - Hand Surgery, Lund University and Skåne University Hospital, Malmö, Sweden.
BMC Musculoskelet Disord. 2014 Apr 2;15:117. doi: 10.1186/1471-2474-15-117.
The conventional treatment for Dupuytren's disease is surgery. The introduction of alternative treatment strategies creates a need to track outcomes and costs relating to surgical treatment and risk factors, such as smoking and diabetes. This was the aim of the present study.
In a prospective study, the outcome of open surgical treatment for finger flexion contracture in Dupuytren's disease (175 patients; 182 surgical procedures) was studied by evaluating valid QuickDASH forms answered by subjects before surgery and one year postoperatively. Data were also obtained from medical records, and preoperative declarations concerning health.
In all subjects (median [25% - 75% percentiles] age 68 [62-73]), the QuickDASH score improved from 22 [9-36] to 5 [0-18]. Smokers (27/179 procedures) were younger and had a more severe degree of disease and dysfunction preoperatively than non-smokers, but the outcome of surgery did not differ between the groups. Subjects with diabetes (20/181 procedures) were younger than those without diabetes, but their disease severity or outcome did not differ. Hand specialists operated faster than residents, but the surgical outcome did not differ. Healthcare costs for surgery for Dupuytren's contracture were $ 2392 (€ 1859), which were not higher among smokers or subjects with diabetes. Only 22 patients remained in hospital (2 [1-2.3] days) and 28 patients needed sick leave (28 [21-31] days). The occurrence of necrosis of skin flaps (12%) or infections (6%) was no more frequent among smokers or those with diabetes.
There is no difference in surgical outcome for finger flexion contracture in Dupuytren's disease between smokers and non-smokers or between subjects with or without diabetes, although smokers had more severe preoperative contracture. The costs for surgical treatment for finger flexion contracture in Dupuytren's disease should be viewed in relation to that for other treatment strategies.
Dupuytren挛缩症的传统治疗方法是手术。替代治疗策略的引入使得有必要追踪与手术治疗相关的结果和成本以及诸如吸烟和糖尿病等风险因素。这是本研究的目的。
在一项前瞻性研究中，通过评估受试者术前和术后一年填写的有效QuickDASH表格，研究了Dupuytren挛缩症手指屈曲挛缩的开放手术治疗结果（175例患者；182例手术）。数据还来自病历以及术前健康声明。
在所有受试者中（年龄中位数[25%-75%百分位数]为68岁[62-73岁]），QuickDASH评分从22分[9-36分]提高到5分[0-18分]。吸烟者（27/179例手术）比不吸烟者更年轻，术前疾病和功能障碍程度更严重，但两组手术结果无差异。糖尿病患者（20/181例手术）比非糖尿病患者更年轻，但他们的疾病严重程度或结果无差异。手部专科医生手术速度比住院医生快，但手术结果无差异。Dupuytren挛缩症手术的医疗费用为2392美元（1859欧元），吸烟者或糖尿病患者的费用并不更高。仅22例患者住院（2[1-2.3]天），28例患者需要病假（28[21-31]天）。吸烟者或糖尿病患者中皮瓣坏死（12%）或感染（6%）的发生率并不更高。
尽管吸烟者术前挛缩更严重，但Dupuytren挛缩症手指屈曲挛缩的手术结果在吸烟者和不吸烟者之间或糖尿病患者和非糖尿病患者之间并无差异。Dupuytren挛缩症手指屈曲挛缩的手术治疗成本应与其他治疗策略的成本相关联来看待。
