Department of Orthopedics, Hässleholm-Kristianstad Hospitals, Hässleholm, Sweden; Department of Clinical Sciences-Orthopedics, Lund University, Lund, Sweden.
Department of Rehabilitation, Hässleholm-Kristianstad Hospitals, Hässleholm, Sweden.
J Hand Surg Am. 2022 Sep;47(9):834-842. doi: 10.1016/j.jhsa.2022.04.019. Epub 2022 Jul 20.
To compare collagenase injection with surgical fasciectomy in Dupuytren disease (DD) for the prevalence of contracture in treated fingers 5 years after treatment.
This was a single-center, comparative cohort study comprising 2 cohorts of patients treated for DD in 1 or more of 3 ulnar fingers with collagenase injection (159 patients) or surgical fasciectomy (59 patients). At 5 years after treatment, 13 collagenase-treated and 8 fasciectomy-treated patients had undergone subsequent treatment on the treated fingers and were considered to have current contracture. Of the remaining patients, 112 collagenase-treated patients (128 hands, 180 fingers) and 46 fasciectomy-treated patients (49 hands, 63 fingers) attended follow-up evaluation performed by 2 independent examiners (participation rate 84% and 93%, respectively). We defined current contracture in a treated finger as an active extension deficit of ≥20° in the metacarpophalangeal (MCP) or proximal interphalangeal (PIP) joint or a total (MCP + PIP) active extension deficit (TAED) of ≥30°. We used linear mixed models to analyze differences between the cohorts over time.
In the collagenase cohort, current contracture was present in 45 (25%) MCP and 60 (33%) PIP joints, and in the fasciectomy cohort, current contracture was present in 12 MCP (19%) and 30 PIP (48%) joints; a TAED of ≥30° was present in 79 (44%) of the collagenase-treated and 30 (48%) of the fasciectomy-treated fingers. In MCP and PIP joints with ≥20° pretreatment contracture, complete correction was observed in 82 (56%) MCP and 30 (30%) PIP joints in the collagenase cohort and 23 (70%) MCP and 5 (16%) PIP joints in the fasciectomy cohort. There was no statistically significant difference between the 2 cohorts in the TAED change over time.
In patients with DD, collagenase injection and surgical fasciectomy improved finger joint contracture over the pretreatment status but had a high prevalence of joint contracture in the treated fingers 5 years after treatment.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
比较胶原酶注射与手术筋膜切开术治疗掌腱膜挛缩症（DD）患者，治疗后 5 年时治疗手指挛缩的发生率。
这是一项单中心、对比队列研究，纳入在 1 个或多个无名指接受胶原酶注射（159 例患者）或手术筋膜切开术（59 例患者）治疗的 2 个队列的患者。治疗后 5 年，13 例胶原酶治疗患者和 8 例筋膜切开术治疗患者在治疗手指上接受了后续治疗，被认为存在当前挛缩。在其余患者中，112 例胶原酶治疗患者（128 只手，180 个手指）和 46 例筋膜切开术治疗患者（49 只手，63 个手指）接受了 2 名独立检查者进行的随访评估（参与率分别为 84%和 93%）。我们将治疗手指的当前挛缩定义为掌指关节（MCP）或近指间关节（PIP）的主动伸展度丧失≥20°，或总（MCP+PIP）主动伸展度丧失≥30°。我们使用线性混合模型来分析不同时间点两组之间的差异。
在胶原酶组中，45 个（25%）MCP 和 60 个（33%）PIP 关节存在当前挛缩，在筋膜切开术组中，12 个 MCP（19%）和 30 个 PIP（48%）关节存在当前挛缩；79 个（44%）胶原酶治疗手指和 30 个（48%）筋膜切开术治疗手指的 TAED≥30°。在 MCP 和 PIP 关节存在≥20°的术前挛缩的情况下，胶原酶组中 82 个（56%）MCP 和 30 个（30%）PIP 关节和筋膜切开术组中 23 个（70%）MCP 和 5 个（16%）PIP 关节完全矫正。两组之间 TAED 的变化随时间没有统计学上的显著差异。
在 DD 患者中，胶原酶注射和手术筋膜切开术改善了手指关节挛缩，但治疗后 5 年时治疗手指的关节挛缩仍然很高。
研究类型/证据水平：治疗性 IV 级。
