溶组织梭状芽孢杆菌胶原酶治疗掌腱膜挛缩症时的皮肤撕裂伤

Skin Laceration in Collagenase Clostridium histolyticum Treatment for Dupuytren's Contracture.

作者信息

Sanjuan-Cervero Rafael, Carrera-Hueso Francisco J, Oliver-Mengual Salvador, Ramon-Barrios Maria A, Peimer Clayton A, Fikri-Benbrahim Narjis

机构信息

Rafael Sanjuan-Cervero, MS, Orthopaedic Surgeon, Orthopedics and Traumatology Surgery, Hospital de Denia, Partida Beniadlà, Alicante, Spain; and Doctoral Program in Pharmacy, University of Granada, Granada, Spain. Francisco J. Carrera-Hueso, PhD, PharmD, Pharmacy Service, Hospital Dr Moliner, Valencia, Spain. Salvador Oliver-Mengual, BSN, Nursery, Grade of Nurse, Orthopedics and Traumatology Surgery, Hospital de Denia, Alicante, Spain. Maria A. Ramon-Barrios, BSN, Nursery, Grade of Nurse, Pharmacy Service, Hospital Dr Moliner, Valencia, Spain. Clayton A. Peimer, MD, Orthopaedic Surgeon, UP Health System Marquette/Duke Life Point, Marquette, MI. Narjis Fikri-Benbrahim, PhD, PharmD, Researcher, Academic Center in Pharmaceutical Care, University of Granada, Granada, Spain.

出版信息

Orthop Nurs. 2018 Mar/Apr;37(2):144-153. doi: 10.1097/NOR.0000000000000435.

DOI:10.1097/NOR.0000000000000435

PMID:29570549

Abstract

BACKGROUND

Dupuytren's contracture produces a progressive flexion contracture of the affected fingers. Collagenase Clostridium histolyticum produces breakdown of the cord in the hand and/or finger(s) that tightens as a result of the disease creating a contracture, allowing manual traction and cord rupture. One of the side effects is spontaneous skin laceration when the finger is extended.

OBJECTIVES

To evaluate the development of skin lacerations in Dupuytren's contracture treated with collagenase Clostridium histolyticum, to determine predisposing factors, and evaluate the effectiveness of 2 different treatments (antiseptic and non-antiseptic dressings).

PARTICIPANTS

Included 157 patients diagnosed with Dupuytren's contracture and treated with collagenase Clostridium histolyticum.

METHODS

Analysis of variables and logistic regression model were applied to determine their possible relationship with skin lacerations. The effectiveness of the type of treatment used was evaluated by comparing the amount of time required for healing.

RESULTS

Skin lacerations were present in 33.1% (n = 52) of patients, with an average laceration length of 1.12 (SD: 0.70) cm. Characteristics that were significant predisposing factors for lacerations were disease bilateralism (p = .002), previous surgical intervention (p = .003), and initial matacarpophalangeal joint contracture (p < .001). Worse initial contracture (Z = 5.94; p < .001) had a greater risk of laceration as did those who had prior hand surgery, or whose little finger was affected. Average treatment length of healing was 11.24 days (SD: 8.13). All wounds healed successfully. There were no significant differences (p = .511) in healing between different dressings evaluated.

CONCLUSIONS

Skin lacerations as a consequence of treating Dupuytren's contracture with collagenase Clostridium histolyticum occur often and are moderately serious. For all cases, evolution is satisfactory in less than 2 weeks, and the type of treatment does not appear to make any difference in healing time.

摘要

背景

杜普伊特伦挛缩症会导致患指出现进行性屈曲挛缩。溶组织梭状芽孢杆菌胶原酶可分解因该病导致手部和/或手指挛缩而紧绷的条索，从而便于手法牵引和条索断裂。其中一个副作用是手指伸直时出现自发性皮肤裂伤。

目的

评估使用溶组织梭状芽孢杆菌胶原酶治疗杜普伊特伦挛缩症时皮肤裂伤的发生情况，确定诱发因素，并评估两种不同治疗方法（抗菌敷料和非抗菌敷料）的有效性。

参与者

纳入157例诊断为杜普伊特伦挛缩症并接受溶组织梭状芽孢杆菌胶原酶治疗的患者。

方法

应用变量分析和逻辑回归模型来确定它们与皮肤裂伤的可能关系。通过比较愈合所需时间来评估所用治疗方法的有效性。

结果

33.1%（n = 52）的患者出现皮肤裂伤，平均裂伤长度为1.12（标准差：0.70）厘米。显著增加裂伤风险的因素包括疾病双侧性（p = 0.002）、既往手术干预（p = 0.003）和初始掌指关节挛缩（p < 0.001）。初始挛缩越严重（Z = 5.94；p < 0.001），裂伤风险越高，既往有手部手术史或小指受累的患者也是如此。平均治疗愈合时间为11.24天（标准差：8.13）。所有伤口均成功愈合。评估的不同敷料之间在愈合方面无显著差异（p = 0.511）。