Engstrand Christina, Krevers Barbro, Nylander Göran, Kvist Joanna
Department of Hand Surgery, Plastic Surgery and Burns, County Council of Östergötland; Division of Physiotherapy, and Division of Health Care Analysis, Department of Medical and Health Sciences, Linköping University; Linköping, Sweden.
Department of Hand Surgery, Plastic Surgery and Burns, County Council of Östergötland; Division of Physiotherapy, and Division of Health Care Analysis, Department of Medical and Health Sciences, Linköping University; Linköping, Sweden.
J Hand Surg Am. 2014 Jul;39(7):1333-1343.e2. doi: 10.1016/j.jhsa.2014.04.029.
To describe changes in joint motion, sensibility, and scar pliability and to investigate the patients' expectations, self-reported recovery, and satisfaction with hand function, disability, and quality of life after surgery and hand therapy for Dupuytren disease.
This prospective cohort study collected measurements before surgery and 3, 6, and 12 months after surgery and hand therapy. Ninety patients with total active extension deficits of 60° or more from Dupuytren contracture were included. Outcomes measures were range of motion; sensibility; scar pliability; self-reported outcomes on expectations, recovery, and satisfaction with hand function; Disabilities of the Arm, Shoulder, and Hand scores; safety and social issues of hand function; physical activity habits; and quality of life with the Euroqol.
The extension deficit decreased, and there was a transient decrease in active finger flexion during the first year after surgery. Sensibility remained unaffected. Generally, patients with surgery on multiple fingers had worse scar pliability. The majority of the patients had their expectations met, and at 6 months, 32% considered hand function as fully recovered, and 73% were satisfied with their hand function. Fear of hurting the hand and worry about not trusting the hand function were of greatest concern among safety and social issues. The Disability of the Arm, Shoulder, and Hand score and the Euroqol improved over time.
After surgery and hand therapy, disability decreased independent of single or multiple operated fingers. The total active finger extension improved enough for the patients to reach a functional range of motion despite an impairment of active finger flexion still present 12 months after treatment.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
描述关节活动度、感觉及瘢痕柔韧性的变化，并调查Dupuytren病患者术后及手部治疗后对手部功能、残疾情况及生活质量的期望、自我报告的恢复情况及满意度。
这项前瞻性队列研究在手术前以及手术后和手部治疗后的3、6和12个月收集测量数据。纳入90例因Dupuytren挛缩导致总主动伸展缺损60°或以上的患者。结果指标包括活动范围；感觉；瘢痕柔韧性；关于期望、恢复及对手部功能满意度的自我报告结果；手臂、肩部和手部残疾评分；手部功能的安全性和社会问题；身体活动习惯；以及使用欧洲五维度健康量表评估的生活质量。
伸展缺损减少，术后第一年主动手指屈曲有短暂下降。感觉未受影响。一般来说，多手指手术的患者瘢痕柔韧性较差。大多数患者的期望得到满足，6个月时，32%的患者认为手部功能已完全恢复，73%的患者对其手部功能感到满意。在安全性和社会问题中，对手部受伤的恐惧和对手部功能不信任的担忧最为突出。手臂、肩部和手部残疾评分及欧洲五维度健康量表随时间改善。
术后及手部治疗后，残疾情况有所减轻，与单指或多指手术无关。尽管治疗12个月后仍存在主动手指屈曲障碍，但总主动手指伸展改善到足以使患者达到功能活动范围。
研究类型/证据水平：治疗性IV级。
