Binter A, Neuwirth M, Rab M
Abteilung für Plastische, Ästhetische und Rekonstruktive Chirurgie, Klinikum Klagenfurt am Wörthersee, Klagenfurt, Österreich.
Handchir Mikrochir Plast Chir. 2014 Dec;46(6):355-60. doi: 10.1055/s-0034-1395604. Epub 2015 Jan 7.
The efficiency of collagenase of Clostridium histolyticum (CCH; Xiapex) in the treatment of Dupuytren's contracture has been proved in phase III studies. This retrospective study aims to evaluate our clinical results after the use of CCH.
The study included 40 Dupuytren's contractures in 37 patients. There were 32 male and 5 female patients; their average age was 66 years. The most affected finger was the ring finger (55%; 22/40), followed by the little finger (30%; 12/40) and the middle finger (15; 6/40). 14 fingers (35%) presented isolated contractures of the metacarpophalangeal joint whereas an isolated contracture of the proximal interphalangeal joint was evident in 8 (20%) fingers. 18 (45%) fingers presented combined MCP and PIP flexion contractures. None of the patients underwent any treatment prior to this study. A retrospective chart review was performed of all patients. Follow-up examinations were performed seven days, fourteen days, three months, six months and one year after the intervention. The follow-up examination included goniometry of each affected finger to assess the range of motion (ROM) before and after cord breaking. Further patient-reported outcome was accessed concerning postinterventional complaints, impairment of sensibility and satisfaction with the treatment.
The range of motion improved in all fingers. Full extension of the affected finger without any contracture could be observed in 93% of the MCP contractures, 38% of the PIP contractures and in 28% of the combined MCP and PIP contractures. Incomplete cord breaking could be observed in 9 (22.5%) fingers. In 8 fingers (20%) skin tears occurred after joint manipulation but healed up without any further surgical intervention. The recurrence rate at the latest follow-up was 2.5% (1/40). Patient satisfaction was high and none of the patients reported any complaints at the latest follow-up.
The best results could be achieved in patients with isolated contractures of the MCP joint. Regarding the good functional results, the low complication rates and the high patient satisfaction, CCH represents a simple and effective treatment for Dupuytren's contracture in selected cases.
溶组织梭菌胶原酶（CCH；商品名Xiapex）治疗掌腱膜挛缩症的疗效已在III期研究中得到证实。本回顾性研究旨在评估我们使用CCH后的临床结果。
本研究纳入了37例患者的40例掌腱膜挛缩症。男性32例，女性5例；平均年龄66岁。受累最严重的手指是环指（55%；22/40），其次是小指（30%；12/40）和中指（15%；6/40）。14根手指（35%）表现为掌指关节孤立性挛缩，而8根手指（20%）表现为近端指间关节孤立性挛缩。18根手指（45%）表现为掌指关节和近端指间关节联合屈曲挛缩。在本研究之前，所有患者均未接受过任何治疗。对所有患者进行了回顾性病历审查。在干预后7天、14天、3个月、6个月和1年进行随访检查。随访检查包括对每个受累手指进行测角，以评估腱索切断前后的活动范围（ROM）。还获取了患者关于干预后不适、感觉障碍和对治疗满意度的进一步报告结果。
所有手指的活动范围均有改善。93%的掌指关节挛缩、38%的近端指间关节挛缩以及28%的掌指关节和近端指间关节联合挛缩中，受累手指可观察到完全伸直且无任何挛缩。9根手指（22.5%）可观察到腱索切断不完全。8根手指（20%）在关节手法操作后出现皮肤撕裂，但无需进一步手术干预即可愈合。在最近一次随访时的复发率为2.5%（1/40）。患者满意度较高，在最近一次随访时，没有患者报告任何不适。
掌指关节孤立性挛缩的患者可获得最佳治疗效果。鉴于良好的功能结果、较低的并发症发生率和较高的患者满意度，CCH在特定病例中是一种简单有效的掌腱膜挛缩症治疗方法。
