Molenkamp Sanne, Schouten Tanneke A M, Broekstra Dieuwke C, Werker Paul M N, Moolenburgh J Daniel
Groningen, The Netherlands.
From the Department of Plastic Surgery, University of Groningen and University Medical Center Groningen; and the Department of Rheumatology, Medical Center Alkmaar.
Plast Reconstr Surg. 2017 Jun;139(6):1415-1421. doi: 10.1097/PRS.0000000000003357.
Percutaneous needle fasciotomy is a minimally invasive treatment modality for Dupuytren disease. In this study, the authors analyzed the efficacy and complication rate of percutaneous needle fasciotomy using a statistical method that takes the multilevel structure of data, regarding multiple measurements from the same patient, into account.
The data of 470 treated rays from 451 patients with Dupuytren disease that underwent percutaneous needle fasciotomy were analyzed retrospectively. The authors described the early postoperative results of percutaneous needle fasciotomy and applied linear mixed models to compare mean correction of passive extension deficit between joints and efficacy of primary versus secondary percutaneous needle fasciotomy.
Mean preoperative passive extension deficits at the metacarpophalangeal, proximal interphalangeal, and distal interphalangeal joints were 37, 40, and 31 degrees, respectively. Mean preoperative total passive extension deficit was 54 degrees. Results were excellent, with a mean total passive extension deficit correction of 85 percent. Percutaneous needle fasciotomy was most effective for metacarpophalangeal joints and less effective for proximal interphalangeal and distal interphalangeal joints. Secondary percutaneous needle fasciotomy was as effective as primary percutaneous needle fasciotomy. Complications were rare and mostly minor.
The results of this study confirm that percutaneous needle fasciotomy is an effective and safe treatment modality for patients with mild to moderate disease who prefer a minimally invasive procedure.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
经皮针状筋膜切开术是治疗掌腱膜挛缩症的一种微创治疗方式。在本研究中，作者采用一种考虑到同一患者多次测量数据的多层次结构的统计方法，分析了经皮针状筋膜切开术的疗效和并发症发生率。
回顾性分析了451例接受经皮针状筋膜切开术的掌腱膜挛缩症患者的470条治疗射线的数据。作者描述了经皮针状筋膜切开术的早期术后结果，并应用线性混合模型比较关节间被动伸展缺陷的平均矫正情况以及初次与二次经皮针状筋膜切开术的疗效。
掌指关节、近端指间关节和远端指间关节术前被动伸展缺陷的平均度数分别为37度、40度和31度。术前被动伸展总缺陷的平均度数为54度。结果良好，被动伸展总缺陷平均矫正率为85%。经皮针状筋膜切开术对掌指关节最有效，对近端指间关节和远端指间关节效果较差。二次经皮针状筋膜切开术与初次经皮针状筋膜切开术效果相同。并发症罕见，且大多较轻微。
本研究结果证实，经皮针状筋膜切开术对于倾向于微创治疗的轻至中度疾病患者是一种有效且安全的治疗方式。
临床问题/证据水平：治疗性，IV级。
