Brauns Annelien, Van Nuffel Maarten, De Smet Luc, Degreef Ilse
Orthopaedic Department, Hand Unit, University Hospitals Leuven, Pellenberg Campus, Pellenberg, Belgium.
Orthopaedic Department, Hand Unit, University Hospitals Leuven, Pellenberg Campus, Pellenberg, Belgium.
J Hand Ther. 2017 Jul-Sep;30(3):253-261. doi: 10.1016/j.jht.2016.11.011. Epub 2017 Feb 21.
Randomized clinical trial on 2 patient groups with Dupuytren's disease.
Despite an unpredictable outcome, surgery remains an important treatment for Dupuytren's disease. Orthotic devices are a controversial noninvasive treatment method to influence the myofibroblasts in the nodules.
To detect how much improvement 2 types of orthotic device (tension and compression) as only treatment intervention can provide on a Dupuytren's contracture. Is a compression orthosis better than a tension orthosis?
Thirty patients with measurable flexion contractures of the fingers were identified. Both primary and recurrence cases were included. Patients were randomized in 2 groups of 15 patients. One group had a standard tension orthosis (Levame), the other group a newly designed silicon compression orthotic device. Patients were instructed to wear the orthotic devices 20 hours a day during 3 months. Data were collected at first visit and after 3 months of orthotic treatment. Primary outcomes were active extension deficit of each joint and total active extension (TAE) of the digit. Secondary outcome was patient satisfaction. Visual Analog Scale (VAS) score of function and esthetics (0-10 points) were recorded at the start and after 3 months.
Flexion contracture was reduced at least 5 degrees in all patients. After 3 months, TAE was significantly reduced in both groups (both P < .001).The mean change in TAE was 32.36° in the tension group and 46.47° in the compression group. Although reduction of TAE deficit was bigger in the compression group, this difference was not statistically significant (P = .39). VAS scale of esthetics and functionality was significantly increased in both treatment groups. The functional VAS scale after 3 months was 11% higher in the compression group than in the tension group (P = .03). A major complication of a tension orthotic is skin ulcers.
Too much tension may cause myofibroblast stimulation and disease progression, whereas continuous limited tension can improve flexion contractures. The idea of a compression device is based on the treatment concept of hypertrophic burn scars.
Tension and compression orthotic devices can be used as a nonoperative treatment of Dupuytren's disease in both early proliferative untreated hands and aggressive postsurgery recurrence. Although there is no statistically significant difference, compression orthoses appear to be more effective and are better tolerated. Nevertheless, adjustment of orthotic design and research on long-term results are needed.
I (Randomized controlled trial, Therapeutic study).
针对两组患有杜普伊特伦挛缩症的患者进行的随机临床试验。
尽管手术结果不可预测，但手术仍是治疗杜普伊特伦挛缩症的重要方法。矫形器是一种有争议的非侵入性治疗方法，用于影响结节中的肌成纤维细胞。
检测仅作为治疗干预措施的两种矫形器（张力型和压迫型）能在多大程度上改善杜普伊特伦挛缩症。压迫型矫形器是否比张力型矫形器更好？
确定30例手指有可测量的屈曲挛缩的患者。纳入原发性和复发性病例。患者被随机分为两组，每组15例。一组佩戴标准张力型矫形器（Levame），另一组佩戴新设计的硅胶压迫型矫形器。患者被指示每天佩戴矫形器20小时，持续3个月。在首次就诊时和矫形治疗3个月后收集数据。主要结局指标是每个关节的主动伸展不足和手指的总主动伸展（TAE）。次要结局指标是患者满意度。在开始时和3个月后记录功能和美观的视觉模拟量表（VAS）评分（0-10分）。
所有患者的屈曲挛缩至少减少了5度。3个月后，两组的TAE均显著降低（均P <.001）。张力组TAE的平均变化为32.36°，压迫组为46.47°。尽管压迫组TAE不足的减少幅度更大，但差异无统计学意义（P =.39）。两个治疗组的美观和功能VAS评分均显著提高。3个月后压迫组的功能VAS评分比张力组高11%（P =.03）。张力型矫形器的一个主要并发症是皮肤溃疡。
过度的张力可能会刺激肌成纤维细胞并导致疾病进展，而持续的有限张力可以改善屈曲挛缩。压迫装置的理念基于肥厚性烧伤瘢痕的治疗概念。
张力型和压迫型矫形器可用于早期未治疗的增殖性手部和术后侵袭性复发的杜普伊特伦挛缩症的非手术治疗。尽管没有统计学上的显著差异，但压迫型矫形器似乎更有效且耐受性更好。然而，需要调整矫形器设计并研究长期结果。
I（随机对照试验，治疗性研究）。
