From the Department of Plastic and Reconstructive Surgery and Hand Surgery and the Department of Rehabilitation Medicine and Physical Therapy, Erasmus Medical Center; the Xpert Clinic, Hand and Wrist Center; and Handtherapie Nederland.
Plast Reconstr Surg. 2018 Dec;142(6):1523-1531. doi: 10.1097/PRS.0000000000004982.
In the Dupuytren Rotterdam randomized controlled trial, percutaneous aponeurotomy with lipofilling (PALF) was as effective as limited fasciectomy in correcting primary Dupuytren's contracture after 1 year. The authors report the 5-year results of this trial, with a special focus on recurrence of contractures.
The authors invited all patients who had undergone PALF or limited fasciectomy to participate in a posttrial follow-up assessment. Thirty-one PALF patients and 21 limited fasciectomy patients were assessed by an independent examiner for the degree of contracture and whether patients had undergone a secondary procedure. The primary composite endpoint was recurrence rate, defined as either 20 degrees or greater worsening in contracture (relative to week 3) or as having undergone a secondary procedure for a new or worsening contracture.
At 5 years, more joints in the PALF group than in the limited fasciectomy group had a recurrence (74 percent versus 39 percent; p = 0.002). When redefining recurrence as a worsening in total extension deficit of at least 30 degrees for treated digits as often reported, this was 77 percent versus 32 percent (p = 0.001). Total extension deficit was also worse for PALF-reated digits (53 degrees versus 31 degrees; p < 0.010).
Although the authors previously reported that PALF offers a shorter convalescence and fewer long-term complications but a similar degree of contracture correction at 1-year follow-up, at 5 years, the corrections were less durable than those for limited fasciectomy. This again highlights that limited fasciectomy and different types of needle aponeurotomy have specific advantages and disadvantages to weigh by patients and clinicians.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.
在 Dupuytren Rotterdam 随机对照试验中，经皮腱膜切开术联合脂肪填充（PALF）与局限性筋膜切开术在治疗原发性 Dupuytren 挛缩方面在 1 年后同样有效。作者报告了该试验的 5 年结果，特别关注挛缩的复发情况。
作者邀请所有接受过 PALF 或局限性筋膜切开术的患者参加一项试验后随访评估。31 名 PALF 患者和 21 名局限性筋膜切开术患者由独立检查者评估挛缩程度以及患者是否接受了二次手术。主要复合终点为复发率，定义为挛缩程度较第 3 周恶化 20 度或以上（与基线相比）或因新的或恶化的挛缩而接受二次手术。
在 5 年时，PALF 组比局限性筋膜切开术组有更多的关节出现复发（74%比 39%；p = 0.002）。当将复发重新定义为治疗手指的总伸直缺损至少恶化 30 度（如既往报道）时，这一比例为 77%比 32%（p = 0.001）。PALF 治疗手指的总伸直缺损也更差（53 度比 31 度；p < 0.010）。
尽管作者先前报告 PALF 在 1 年随访时提供了更短的恢复期和更少的长期并发症，但挛缩矫正程度相似，但在 5 年时，矫正效果不如局限性筋膜切开术持久。这再次强调，局限性筋膜切开术和不同类型的针刀腱膜切开术有其特定的优缺点，需要患者和临床医生权衡。
临床问题/证据水平：治疗性，II 级。
