Zhou Chao, Selles Ruud W, Slijper Harm P, Feitz Reinier, van Kooij Yara, Moojen Thybout M, Hovius Steven E R
Rotterdam and Hilversum, The Netherlands.
From the Departments of Plastic, Reconstructive, and Hand Surgery and Rehabilitation Medicine, Erasmus MC University Medical Center; and Hand and Wrist Surgery, Xpert Clinic.
Plast Reconstr Surg. 2016 Oct;138(4):837-846. doi: 10.1097/PRS.0000000000002560.
Percutaneous needle aponeurotomy is a less invasive surgical alternative to limited fasciectomy for Dupuytren's contracture, but appeared less efficacious in a previous randomized clinical trial. This study compared the effectiveness of both techniques in contemporary clinical practice.
The authors evaluated prospectively gathered data from all patients who were treated with percutaneous needle aponeurotomy or limited fasciectomy between 2011 and 2014 at six hand surgery practice sites in The Netherlands. The degree of total active extension deficit, Michigan Hand Outcomes Questionnaire subscores, and complications evaluated at 6 to 12 weeks after treatment were compared after propensity score-based inverse-probability weighting to account for the differences in baseline characteristics between the treatment groups.
After inverse-probability weighting, 78 percutaneous needle aponeurotomy patients and 103 limited fasciectomy patients remained with similar characteristics (88 percent Tubiana grade I or II). The degree of total residual extension deficit at follow-up was similar between the weighted groups (percutaneous needle aponeurotomy, 21 degrees; limited fasciectomy, 18 degrees; p = 0.330). Furthermore, percutaneous needle aponeurotomy was associated with a lower mild complication rate (percutaneous needle aponeurotomy, 5.2 percent; limited fasciectomy, 24.3 percent; p < 0.001) and larger increases in the subdomain scores of satisfaction (p < 0.001), work performance (p < 0.001), activities of daily living (p = 0.009), and overall hand function (p = 0.001).
This multicenter observational study found that, among patients with mildly to moderately affected digits, percutaneous needle aponeurotomy reduced contractures as effectively as limited fasciectomy does in clinical practice. Furthermore, percutaneous needle aponeurotomy provided a more rapid functional recovery and had a lower rate of mild complications.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
经皮针状腱膜切开术是治疗掌腱膜挛缩症的一种侵入性较小的手术替代方法，可替代有限的筋膜切除术，但在之前的一项随机临床试验中疗效似乎较差。本研究比较了这两种技术在当代临床实践中的有效性。
作者前瞻性地评估了2011年至2014年期间在荷兰六个手外科实践地点接受经皮针状腱膜切开术或有限筋膜切除术治疗的所有患者的收集数据。在基于倾向评分的逆概率加权后，比较治疗后6至12周评估的总主动伸展缺损程度、密歇根手功能结果问卷子评分和并发症，以考虑治疗组之间基线特征的差异。
经过逆概率加权后，78例接受经皮针状腱膜切开术的患者和103例接受有限筋膜切除术的患者具有相似的特征（88%为图比阿纳I级或II级）。加权组之间随访时的总残余伸展缺损程度相似（经皮针状腱膜切开术，21度；有限筋膜切除术，18度；p = 0.330）。此外，经皮针状腱膜切开术的轻度并发症发生率较低（经皮针状腱膜切开术，5.2%；有限筋膜切除术，24.3%；p < 0.001），并且在满意度（p < 0.001）、工作表现（p < 0.001）、日常生活活动（p = 0.009）和整体手功能（p = 0.001）的子域评分方面有更大的提高。
这项多中心观察性研究发现，在轻度至中度受影响手指的患者中，经皮针状腱膜切开术在临床实践中减少挛缩的效果与有限筋膜切除术相同。此外，经皮针状腱膜切开术能实现更快的功能恢复，且轻度并发症发生率较低。
临床问题/证据水平：治疗性，III级。
