Notarnicola A, Maccagnano G, Rifino F, Pesce V, Gallone M F, Covelli I, Moretti B
Course of Motor and Sports Sciences, Department of Basic Medical Science, Neuroscience and Sensory Organs, Faculty of Medicine and Surgery, University of Bari, Bari, Italy
Orthopedics Section, Department of Basic Medical Science, Neuroscience and Sensory Organs, Faculty of Medicine and Surgery, University of Bari, General Hospital, Bari, Italy
J Biol Regul Homeost Agents. 2017 Jul-Sep;31(3):775-784.
Dupuytren’s disease is a debilitating disease of the hand characterized by nodules on the surface of the palm with progressive loss of finger extension. The chosen forms of treatment are infiltrative and surgical. Conservative treatment could be useful but few studies have been carried out and these regarded mainly stretching exercises and thermo-therapy. To date, no study has analyzed the effects of biostimulation with shock-waves (SW) and high energy laser therapy [Temperature controlled High Energy Adjustable multi-mode emission Laser (THEAL)]. We recruited 45 patients, 32 males and 13 females (average age 63.4 years) affected by early or late stage Dupuytren’s disease [33 metacarpophalangeal (MCP) joints, 12 proximal interphalangeal (PIP) joints]. We randomized the patients into three treatment groups: extracorporeal shockwave therapy (ESWT), THEAL and stretching exercises. Follow-ups were at the end of treatment (T1), after 1 month (T2), and after 3 months (T3). The three forms of treatment determined a progressive clinical-functional improvement. The pain relief was statistically significant for SW and THEAL at all follow-ups (FUs) (p</=0.01). The functional recovery was statistically significant in the SW group at all FUs and in the THEAL and Stretching groups at T1 and T2 (p<0.01). Patient satisfaction level was higher for SW at T2 and T3 and for THEAL at T2 (p</=0.01). The extension deficit recovery as regards the MCP and PIP joints was statistically significant in the SW group at T1 and T2 (p</= 0.01) and in the stretching group at T1 (p<0.01). The SW and THEAL treatments appear safe, have good efficacy and are associated with good patient satisfaction in the short and medium terms. Further studies may verify the possibility of repeated cycles and/or combined therapies to improve results.
杜普伊特伦挛缩病是一种手部致残性疾病，其特征为手掌表面出现结节，并伴有手指伸展功能的逐渐丧失。治疗方法包括浸润治疗和手术治疗。保守治疗可能有用，但相关研究较少，且主要涉及伸展运动和热疗。迄今为止，尚无研究分析冲击波（SW）生物刺激和高能激光治疗[温控高能可调多模式发射激光（THEAL）]的效果。我们招募了45例患者，其中男性32例，女性13例（平均年龄63.4岁），患有早期或晚期杜普伊特伦挛缩病[33个掌指（MCP）关节，12个近端指间（PIP）关节]。我们将患者随机分为三个治疗组：体外冲击波治疗（ESWT）、THEAL治疗和伸展运动组。随访时间为治疗结束时（T1）、1个月后（T2）和3个月后（T3）。这三种治疗方式均带来了临床功能的逐步改善。在所有随访中，SW和THEAL治疗的疼痛缓解具有统计学意义（p≤0.01）。在所有随访中，SW组的功能恢复具有统计学意义，THEAL组和伸展运动组在T1和T2时功能恢复具有统计学意义（p<0.01）。在T2和T3时，SW治疗组的患者满意度较高，在T2时THEAL治疗组的患者满意度较高（p≤0.01）。在T1和T2时，SW组MCP和PIP关节的伸展功能缺损恢复具有统计学意义（p≤0.01），在T1时伸展运动组具有统计学意义（p<0.01）。SW和THEAL治疗似乎是安全的，疗效良好，且在短期和中期内患者满意度较高。进一步的研究可能会验证重复治疗周期和/或联合治疗以改善治疗效果的可能性。
