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掌腱膜挛缩症治疗后的并发症。一项系统的文献综述。

Complications after treating Dupuytren's disease. A systematic literature review.

作者信息

Krefter C, Marks M, Hensler S, Herren D B, Calcagni M

机构信息

Department of Hand Surgery, Schulthess Klinik, Lengghalde 2, 8008 Zurich, Switzerland.

Department of Teaching, Research and Development, Schulthess Klinik, Lengghalde 2, 8008 Zurich, Switzerland.

出版信息

Hand Surg Rehabil. 2017 Oct;36(5):322-329. doi: 10.1016/j.hansur.2017.07.002. Epub 2017 Sep 14.

Abstract

The objective of this study was to review the incidence of complications associated with different treatment options for patients with Dupuytren's disease. In a systematic literature review, the PubMed, EMBASE, Cochrane and Scopus databases were searched for clinical studies reporting complications after collagenase treatment, percutaneous needle fasciotomy (PNF), fasciectomy and dermofasciectomy. The incidence of complications was extracted from each study and stratified by procedure. From a total of 2251 references, 113 studies were analyzed and included with complication incidences varying from 0% to 100%. The highest number of nerve and vessel lesions were reported after fasciectomy, whereas the highest rate of edema was after collagenase injection. Accidental skin tears were mostly associated with collagenase and PNF treatment. Pooled complication incidences were 17.4% (95% CI: 11.7-23.1) for fasciectomy, 78.0% (95% CI: 59.6-96.4) for collagenase treatment, 18.9% (95% CI: -5.5-43.3) for PNF and 11.6% (95% CI: 0.0-23.2) for dermofasciectomy. Due to inconsistencies in reporting complications as well as the lack of a standardized definition, the literature does not provide evidence in favor of a specific procedure for Dupuytren's disease. A standardized definition of complications is required to improve the comparability of published results.

摘要

本研究的目的是回顾与杜普伊特伦挛缩症患者不同治疗方案相关的并发症发生率。在一项系统的文献综述中,检索了PubMed、EMBASE、Cochrane和Scopus数据库,以查找报告胶原酶治疗、经皮针状筋膜切开术(PNF)、筋膜切除术和皮肤筋膜切除术术后并发症的临床研究。从每项研究中提取并发症发生率,并按手术方式进行分层。在总共2251篇参考文献中,分析并纳入了113项研究,并发症发生率从0%到100%不等。筋膜切除术后报告的神经和血管损伤数量最多,而胶原酶注射后水肿发生率最高。意外皮肤撕裂大多与胶原酶和PNF治疗有关。筋膜切除术的合并并发症发生率为17.4%(95%CI:11.7-23.1),胶原酶治疗为78.0%(95%CI:59.6-96.4),PNF为18.9%(95%CI:-5.5-43.3),皮肤筋膜切除术为11.6%(95%CI:0.0-23.2)。由于并发症报告存在不一致性以及缺乏标准化定义,文献中没有提供支持杜普伊特伦挛缩症特定手术方式的证据。需要对并发症进行标准化定义,以提高已发表结果的可比性。

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