Sakai Akinori, Zenke Yukichi, Menuki Kunitaka, Yamanaka Yoshiaki, Tajima Takafumi, Uchida Soshi
* Department of Orthopaedic Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan.
† Department of Orthopaedic Surgery, Wakamatsu Hospital, University of Occupational and Environmental Health, Kitakyushu, Japan.
J Hand Surg Asian Pac Vol. 2019 Mar;24(1):65-71. doi: 10.1142/S2424835519500127.
Some cases treated with open palm technique need relatively long wound healing time. This study aims to clarify whether the preoperative lifestyle-related diseases or factors are associated with surgical results after the open palm technique for Dupuytren's contracture.
The study included 122 fingers of 84 hands of 84 consecutive male patients with Dupuytren's contracture who were treated with McCash's open palm technique at our hospital from 1980 to 2016. The average age of the patients was 68.0 years (range, 39-86). The follow-up period was at least 6 months (average, 36.3 months). Using multiple regression analysis, we investigated preoperative factors associated with surgical results. The factors examined were age, affected side, contracture of the little finger, number of contracted fingers, contracture of the proximal interphalangeal (PIP) joint, Meyerding classification, diabetes mellitus, hypertension, alcohol intake, and smoking. Surgical results were judged at 6 months after surgery and wound healing time was evaluated.
According to Tubiana's criteria, there were 59 excellent hands (70.2%), 18 good hands (21.4%), 5 fair hands (6.0%), and 2 poor hands (2.4%) at the final physical examination after surgery. The average of the percentage of improvement in contracture was 86.1%. The average number of days needed until complete open wound closure was 22.9 days. Multiple regression analysis revealed that the significant preoperative factors associated with the percentage of improvement in contracture were multiple contracted fingers and involvement of PIP joint contracture, and that the factor associated with delayed wound healing was current smoking.
Multiple contracted fingers and involvement of PIP joint contracture are associated with insufficient improvement of joint contracture. Current smoking is associated with delayed wound healing, but not with improvement of joint contracture, after the open palm technique for Dupuytren's disease in men.
一些采用开放手掌技术治疗的病例伤口愈合时间相对较长。本研究旨在阐明术前与生活方式相关的疾病或因素是否与掌腱膜挛缩症开放手掌技术术后的手术效果相关。
本研究纳入了1980年至2016年在我院接受麦卡什开放手掌技术治疗的84例连续性男性掌腱膜挛缩症患者的84只手的122根手指。患者的平均年龄为68.0岁（范围39 - 86岁）。随访期至少6个月（平均36.3个月）。我们采用多元回归分析来研究与手术效果相关的术前因素。所检查的因素包括年龄、患侧、小指挛缩、挛缩手指数量、近端指间（PIP）关节挛缩、迈耶丁分级、糖尿病、高血压、酒精摄入和吸烟。在术后6个月判断手术效果并评估伤口愈合时间。
根据图比亚纳标准，术后最终体格检查时，有59只手为优（70.2%），18只手为良（21.4%），5只手为中（6.0%），2只手为差（2.4%）。挛缩改善百分比的平均值为86.1%。直至伤口完全愈合所需的平均天数为22.9天。多元回归分析显示，与挛缩改善百分比显著相关的术前因素是多个挛缩手指和PIP关节挛缩的累及，与伤口愈合延迟相关的因素是当前吸烟。
多个挛缩手指和PIP关节挛缩的累及与关节挛缩改善不足相关。在男性掌腱膜挛缩症开放手掌技术术后，当前吸烟与伤口愈合延迟相关，但与关节挛缩改善无关。
Zotero 插件