Lipman Marc D, Carstensen Samuel Evan, Deal Dylan Nicole
University of Virginia Health System, Charlottesville, VA, USA.
Hand (N Y). 2017 Jan;12(1):13-20. doi: 10.1177/1558944716647101. Epub 2016 May 3.
Dupuytren disease is a common fibroproliferative disorder. Multiple procedural treatment options are available, with Collagenase Clostridium Histolyticum (CCH) injection being introduced in 2010. The purpose of this study was to investigate trends in the treatment of Dupuytren disease in the United States between 2007 and 2014. The PearlDiver Humana database was queried using International Classification of Diseases, Ninth Revision (ICD-9) and Current Procedural Terminology (CPT) codes for patients with Dupuytren disease that received percutaneous needle aponeurotomy (PNA), fasciotomy, fasciectomy, and CCH injection. Patients were filtered by age, number of comorbidities, and gender. Change in composition of treatments over time was analyzed for each demographic group between 2007 and 2014. Patients presenting to clinic for Dupuytren disease increased from 1118 to 3280, with unchanging treatment percentage of 41. Percent fasciotomies and fasciectomies decreased from 5% to 3% and 33% to 21%, while CCH injection increased to 11% by 2012 to 2014. Percent fasciotomies decreased ( < .05) in younger healthier (age <65, 0-1 comorbidities) and older less healthy (age 65-74, 4+ comorbidities) populations. Percent fasciectomies decreased significantly in nearly all age and comorbidity groups, but by greater amounts in patients with 2+ comorbidities with increasing age. Percent CCH injections increased in all groups, at rates similar to the losses seen in open procedures. CCH injections have risen to substantial levels, with corresponding decreases in the percentage of patients receiving fasciotomies and fasciectomies. Patient age, comorbidities, and gender appear to have influence on the treatment chosen, likely due to their effects on surgical risk and the importance of timely return to activity.
掌腱膜挛缩症是一种常见的纤维增生性疾病。有多种手术治疗方案可供选择，溶组织梭状芽孢杆菌胶原酶（CCH）注射于2010年被引入。本研究的目的是调查2007年至2014年美国掌腱膜挛缩症的治疗趋势。使用国际疾病分类第九版（ICD - 9）和当前手术操作术语（CPT）编码查询PearlDiver Humana数据库，以获取接受经皮针状腱膜切开术（PNA）、筋膜切开术、筋膜切除术和CCH注射的掌腱膜挛缩症患者信息。患者按年龄、合并症数量和性别进行筛选。分析了2007年至2014年各人口统计学组治疗构成随时间的变化。因掌腱膜挛缩症到诊所就诊的患者从1118例增加到3280例，治疗比例保持在41%不变。筋膜切开术和筋膜切除术的比例分别从5%降至3%以及从33%降至21%，而到2012年至2014年CCH注射增加到11%。在较年轻健康（年龄<65岁，0 - 1种合并症）和较年长不太健康（年龄65 - 74岁，4种及以上合并症）人群中，筋膜切开术的比例下降（<0.05）。几乎在所有年龄和合并症组中，筋膜切除术的比例均显著下降，但在合并症2种及以上且年龄增加的患者中下降幅度更大。所有组中CCH注射的比例均增加，其增加速率与开放性手术比例的下降速率相似。CCH注射已上升到相当高的水平，同时接受筋膜切开术和筋膜切除术的患者比例相应下降。患者的年龄、合并症和性别似乎对所选治疗方法有影响，这可能是由于它们对手术风险的影响以及及时恢复活动的重要性。
