From the Department of Orthopaedic Surgery, Brigham and Women's Hospital; and Harvard Medical School.
Plast Reconstr Surg. 2020 Nov;146(5):1071-1079. doi: 10.1097/PRS.0000000000007243.
The objective of this study was to determine the rates of patient satisfaction, perceived recurrence of flexion deformity, and additional treatment after collagenase clostridium histolyticum treatment for Dupuytren's contracture at a minimum of 5-year follow-up.
A retrospective study was performed of 199 digits in 142 patients who underwent collagenase clostridium histolyticum treatments from April of 2010 to December of 2013 with a minimum of 5-year follow-up. Patients were contacted by telephone regarding perceived recurrence, additional treatment, satisfaction, and willingness to undergo this treatment again.
At an average 7.2-year follow-up, 160 of 199 digits (80 percent) had perceived recurrence, and 105 of 199 digits (53 percent) underwent additional treatment. Average satisfaction was 6.5 on a Likert scale ranging from 1 to 10, and 67 percent would undergo collagenase clostridium histolyticum treatment again. Multivariable logistic regression analysis showed that higher Charlson Comorbidity Index (OR, 0.77; 95 percent CI, 0.63 to 0.93) and isolated metacarpophalangeal joint involvement (OR, 0.53; 95 percent CI, 0.29 to 0.97) were associated with decreased odds of additional treatment, and higher American Society of Anesthesiologists physical status classification (OR, 2.49; 95 percent CI, 1.35 to 4.48) and nonsmoker status (OR, 0.23; 95 percent CI, 0.09 to 0.59) were associated with willingness to undergo the treatment again.
Patients may be counseled that the long-term perceived recurrence rate of Dupuytren's contractures after collagenase clostridium histolyticum treatment is high, and more than half of patients seek additional treatment. Satisfaction and willingness to undergo collagenase clostridium histolyticum treatment decrease with perceived recurrence.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
本研究旨在确定在至少 5 年的随访中，接受胶原酶梭菌组织溶菌素治疗的 199 个指节中，患者满意度、感知复发的屈曲畸形率和额外治疗的情况。
对 2010 年 4 月至 2013 年 12 月接受胶原酶梭菌组织溶菌素治疗的 142 例患者的 199 个指节进行回顾性研究，随访时间至少为 5 年。通过电话联系患者，了解他们对复发、额外治疗、满意度以及再次接受这种治疗的意愿。
在平均 7.2 年的随访中，199 个指节中有 160 个（80%）感知复发，199 个指节中有 105 个（53%）接受了额外治疗。平均满意度为 1 到 10 分制的 6.5 分，67%的患者愿意再次接受胶原酶梭菌组织溶菌素治疗。多变量逻辑回归分析显示，Charlson 合并症指数较高（OR，0.77；95%CI，0.63 至 0.93）和孤立的掌指关节受累（OR，0.53；95%CI，0.29 至 0.97）与接受额外治疗的可能性降低相关，而美国麻醉医师协会身体状况分类较高（OR，2.49；95%CI，1.35 至 4.48）和非吸烟者状态（OR，0.23；95%CI，0.09 至 0.59）与再次接受治疗的意愿相关。
患者可能需要接受长期的咨询，即接受胶原酶梭菌组织溶菌素治疗后的 5 年随访中，Dupuytren 挛缩的长期感知复发率较高，超过一半的患者寻求额外治疗。满意度和再次接受胶原酶梭菌组织溶菌素治疗的意愿随着感知复发而降低。
临床问题/证据水平：治疗，III 级。
