Melamed Eitan, Beutel Bryan G, Goldstein Shaul, Angel David
* Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY, USA.
† Department of Orthopaedic Surgery, Bnai Zion Medical Center and the Rappaport Faculty of Medicine, Haifa, Israel.
J Hand Surg Asian Pac Vol. 2017 Sep;22(3):309-314. doi: 10.1142/S0218810417500356.
The aim of this study was to compare clinical outcomes, and identify predictors thereof, after fasciectomy for Dupuytren's disease in a series of diabetic patients compared with non-diabetic patients.
Thirty-eight patients were examined following partial palmar and/or digital fasciectomy for Dupuytren's disease (11 diabetics, 27 non-diabetics). Each patient was assessed for degree of pre- and post-operative flexion contractures at the MCP and PIP joints, post-operative Patient Evaluation Measure (PEM) total score, post-operative grip strength, limited joint mobility (LJM), recurrence, extension, and a composite outcomes score based upon grip strength and the degree of joint contractures. All measurements in the diabetic cohort were compared to those in the non-diabetic group, and a logistic regression analysis was performed to identify the predictive value of several variables on outcomes.
Complication rates between the two groups were statistically similar (p = 0.67). There were no significant differences in pre-operative MCP (p = 0.69), post-operative MCP (p = 0.39), pre-operative PIP (p = 0.40), or post-operative PIP (p = 0.13) joint flexion contractures between the two groups. Additionally, there was no significant difference in extension (p = 0.35) or recurrence (p~1) rates, post-operative grip strengths (p = 0.64), or PEM total scores (p = 0.32). However, the rate of LJM was significantly higher in the diabetic population (p = 0.02). Both female gender (p = 0.01) and a non-smoking status (p = 0.04) were found to be predictive of better outcomes following fasciectomy. Diabetes was not found to be an independent predictor of outcome (p = 0.73).
Clinical results after fasciectomy for Dupuytren's disease in diabetic patients are not different from results obtained in non-diabetic patients. Diabetes is not independently predictive of surgical outcomes. Female gender and non-smoking status are independent predictors of a better outcome following fasciectomy.
本研究旨在比较一系列糖尿病患者与非糖尿病患者在接受Dupuytren挛缩病筋膜切除术后的临床结局，并确定其预测因素。
对38例接受部分手掌和/或手指筋膜切除术治疗Dupuytren挛缩病的患者进行检查（11例糖尿病患者，27例非糖尿病患者）。评估每位患者术前和术后掌指关节（MCP）和近端指间关节（PIP）的屈曲挛缩程度、术后患者评估量表（PEM）总分、术后握力、关节活动受限（LJM）、复发、伸展情况，以及基于握力和关节挛缩程度的综合结局评分。将糖尿病队列中的所有测量结果与非糖尿病组进行比较，并进行逻辑回归分析以确定几个变量对结局的预测价值。
两组之间的并发症发生率在统计学上相似（p = 0.67）。两组术前MCP关节（p = 0.69）、术后MCP关节（p = 0.39）、术前PIP关节（p = 0.40）或术后PIP关节（p = 0.13）的屈曲挛缩程度无显著差异。此外，伸展率（p = 0.35）或复发率（p~1）、术后握力（p = 0.64）或PEM总分（p = 0.32）也无显著差异。然而，糖尿病患者的LJM发生率显著更高（p = 0.02）。发现女性（p = 0.01）和非吸烟状态（p = 0.04）是筋膜切除术后结局较好的预测因素。未发现糖尿病是结局的独立预测因素（p = 0.73）。
糖尿病患者接受Dupuytren挛缩病筋膜切除术后的临床结果与非糖尿病患者的结果无差异。糖尿病并非手术结局的独立预测因素。女性和非吸烟状态是筋膜切除术后结局较好的独立预测因素。
