The George Washington University, Washington, DC, USA.
William Beaumont Army Medical Center, El Paso, TX, USA.
Hand (N Y). 2022 Sep;17(5):815-824. doi: 10.1177/1558944720974119. Epub 2021 Jan 21.
This systematic review investigates complications and recurrence of Dupuytren's contracture in metacarpophalangeal joints (MCPJs) and/or proximal interphalangeal joints (PIPJs) of fingers treated with collagenase clostridium histolyticum (CCH). A review of the literature on Dupuytren's disease was performed using PRISMA guidelines. Included publications described complications and/or recurrences for contractures ≥20° in MCPJs and/or PIPJs treated with CCH. Successful treatments reduced contractures to ≤5° immediately. Treatment-related adverse events (AEs) were classified as minor, major surgical, and major nonsurgical. Contracture recurrence involved return of fixed-flexion contracture ≥20° in a successfully treated finger in patients with ≥12 months of follow-up. Of 2675 patients (3753 joints), 94% experienced ≥1 treatment-related AE, most commonly peripheral edema (64%), pain in extremity (53%), and contusion (51%). Major surgical complications occurred in 9 patients (1.0%). Major nonsurgical complications occurred in 2 patients, specifically nonrupture tendon injury and anaphylaxis. Of 1488 patients (2069 joints), recurrences were reported in 23% of successfully treated joints (n = 466; 20% MCPJs, 28% PIPJs), on average 12 to 24 months after treatment. MCPJs achieved greater success than PIPJs in initial contracture reduction (77% versus 36%). CCH is a safe, effective treatment to improve hand function in Dupuytren's contracture. Most AEs are minor and self-resolving, although the risk of major AEs still exists. Following treatment, 23% of successfully treated joints experience recurrence, typically within 12 to 24 months but sometimes as early as 6 months. Surgeons are encouraged to discuss these risks with patients for shared decision-making regarding optimal treatment modalities.
本系统评价调查了用胶原酶组织溶菌素（CCH）治疗的掌指关节（MCPJ）和/或近侧指间关节（PIPJ）的手指的Dupuytren 挛缩的并发症和复发情况。使用 PRISMA 指南对 Dupuytren 病的文献进行了综述。纳入的出版物描述了用 CCH 治疗的 MCPJ 和/或 PIPJ 挛缩≥20°的并发症和/或复发情况。成功的治疗可使挛缩立即减少至≤5°。将与治疗相关的不良事件（AE）分为轻微、重大手术和重大非手术。挛缩复发是指在≥12 个月随访的患者中，成功治疗的手指中固定屈曲挛缩≥20°的复发。在 2675 名患者（3753 个关节）中，94%的患者发生了≥1 次与治疗相关的 AE，最常见的是周围水肿（64%）、肢体疼痛（53%）和瘀伤（51%）。9 例患者（1.0%）发生了重大手术并发症。2 例患者发生了重大非手术并发症，分别为非破裂肌腱损伤和过敏反应。在 1488 名患者（2069 个关节）中，成功治疗的关节中有 23%（n=466；20% MCPJ，28% PIPJ）报告了复发，平均在治疗后 12 至 24 个月。MCPJ 在初始挛缩减少方面比 PIPJ 更成功（77%对 36%）。CCH 是一种安全有效的治疗方法，可改善 Dupuytren 挛缩患者的手部功能。大多数 AE 是轻微的，可自行缓解，但仍存在发生重大 AE 的风险。治疗后，23%的成功治疗关节会出现复发，通常在 12 至 24 个月内，但有时也会在 6 个月内。鼓励外科医生与患者讨论这些风险，以便就最佳治疗方式做出共同决策。
