Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA and Department of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway.
Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA.
Bone Joint J. 2018 Sep;100-B(9):1138-1145. doi: 10.1302/0301-620X.100B9.BJJ-2017-1194.R2.
Dupuytren's contracture is a benign, myoproliferative condition affecting the palmar fascia that results in progressive contractures of the fingers. Despite increased knowledge of the cellular and connective tissue changes involved, neither a cure nor an optimum form of treatment exists. The aim of this systematic review was to summarize the best available evidence on the management of this condition.
A comprehensive database search for randomized controlled trials (RCTs) was performed until August 2017. We studied RCTs comparing open fasciectomy with percutaneous needle aponeurotomy (PNA), collagenase clostridium histolyticum (CCH) with placebo, and CCH with PNA, in addition to adjuvant treatments aiming to improve the outcome of open fasciectomy. A total of 20 studies, involving 1584 patients, were included.
PNA tended to provide higher patient satisfaction with fewer adverse events, but had a higher rate of recurrence compared with limited fasciectomy. Although efficacious, treatment with CCH had notable recurrence rates and a high rate of transient adverse events. Recent comparative studies have shown no difference in clinical outcome between patients treated with PNA and those treated with CCH.
Currently there remains limited evidence to guide the management of patients with Dupuytren's contracture. Cite this article: Bone Joint J 2018;100-B:1138-45.
掌腱膜挛缩症是一种良性、肌纤维增生性疾病，影响掌筋膜，导致手指进行性挛缩。尽管对涉及的细胞和结缔组织变化有了更多的了解，但既没有治愈方法，也没有最佳的治疗方法。本系统评价的目的是总结该疾病治疗的最佳现有证据。
对随机对照试验（RCT）进行了全面的数据库检索，检索时间截至 2017 年 8 月。我们研究了 RCT，比较了开放性筋膜切开术与经皮针刀切开术（PNA）、胶原酶组织溶纤维蛋白（CCH）与安慰剂以及 CCH 与 PNA，此外还研究了旨在改善开放性筋膜切开术效果的辅助治疗。共纳入 20 项研究，涉及 1584 例患者。
PNA 倾向于提供更高的患者满意度，不良事件更少，但与局限性筋膜切开术相比，复发率更高。虽然有效，但 CCH 治疗的复发率很高，且有一过性不良事件发生率也很高。最近的比较研究表明，接受 PNA 治疗和接受 CCH 治疗的患者在临床结果方面没有差异。
目前，关于掌腱膜挛缩症患者的治疗管理仍然缺乏足够的证据。
