Malafa Menyoli M, Lehrman Craig, Criley Jerry W, Amirlak Bardia
Department of Plastic and Reconstructive Surgery, University of Texas Southwestern Medical Center, Dallas, Tex.; and Physical Medicine and Rehab, VA North Texas Healthcare System, Physical Medicine and Rehab Service, Dallas, Tex.
Plast Reconstr Surg Glob Open. 2016 Feb 26;4(2):e629. doi: 10.1097/GOX.0000000000000565. eCollection 2016 Feb.
Surgery remains the gold standard in the treatment of Dupuytren contracture but is technically demanding, carries significant risk of complications, and requires prolonged recovery time. Collagenase injection is an efficacious alternative to surgery; however, contracture release often requires multiple treatments spaced a month apart. We report our experience with a new collagenase treatment protocol aimed to minimize the total treatment time per joint contracture.
We performed a single institution retrospective review of patients with Dupuytren contracture treated with collagenase using our protocol from 2011 to 2013. Patients returned 24 hours after collagenase injection for cord manipulation by a certified hand therapist while under digital block. Treatment success was defined as reduction in contracture to 5 degrees or less. Successfully treated joints were evaluated for recurrence (>10 degrees contracture) at 30-day and 6-month follow-up appointments. Serious adverse events, including skin tears, were recorded.
Success was achieved in 36 of 47 treated joints (76.6%) after a single injection. There were 2 recurrences in 32 joints at 30-day follow-up (6.2%) and no recurrences in 17 joints available at 6-month follow-up. Skin tears were the only serious adverse event occurring in 18 of 47 cord ruptures (38.3%). All healed secondarily without complication.
Our protocol preserves treatment efficacy while maximizing efficiency. Achieving successful cord rupture with a single injection allows earlier return of function, reduced cost of treatment, and increased convenience for the patient. Patients, particularly those with greater contractures, should be counseled regarding the risk of skin tear during cord manipulation.
手术仍是治疗杜普伊特伦挛缩症的金标准，但技术要求高，并发症风险大，且恢复时间长。胶原酶注射是一种有效的手术替代方法；然而，挛缩松解通常需要每月间隔进行多次治疗。我们报告了我们使用一种新的胶原酶治疗方案的经验，该方案旨在将每个关节挛缩的总治疗时间降至最低。
我们对2011年至2013年使用我们的方案接受胶原酶治疗的杜普伊特伦挛缩症患者进行了单机构回顾性研究。胶原酶注射24小时后，患者在指神经阻滞下由认证的手部治疗师进行条索处理。治疗成功定义为挛缩减少至5度或更小。在30天和6个月的随访预约中，对成功治疗的关节进行复发评估（挛缩>10度）。记录包括皮肤撕裂在内的严重不良事件。
47个治疗关节中有36个（76.6%）单次注射后成功。30天随访时，32个关节中有2个复发（6.2%），6个月随访时17个可用关节中无复发。皮肤撕裂是47例条索破裂中18例（38.3%）发生的唯一严重不良事件。所有均二期愈合，无并发症。
我们的方案在保持治疗效果的同时最大限度地提高了效率。单次注射实现成功的条索破裂可使功能更早恢复，降低治疗成本，并增加患者的便利性。应向患者，特别是挛缩程度较大的患者，告知条索处理过程中皮肤撕裂的风险。
