Legato Joseph M, Gill Meera K, Coutelle Nino A, Nydick Jason A
Florida Orthopaedic Institute, Temple Terrace, FL.
Foundation for Orthopaedic Research and Education, Tampa, FL.
J Hand Surg Am. 2024 Dec;49(12):1271.e1-1271.e4. doi: 10.1016/j.jhsa.2023.03.026. Epub 2023 May 29.
Injectable collagenase Clostridium histolyticum has been an effective and well-tolerated nonsurgical treatment option for the management of Dupuytren contracture of the hand. The purpose of this study was to determine the efficacy of collagenase injection and adverse event rate in patients who had undergone previous collagenase treatment.
A retrospective chart review was performed on 332 patients treated with collagenase injection for Dupuytren contracture by three fellowship-trained hand surgeons at a single institution from 2009 to 2019. Fifty-nine joints in 45 patients underwent repeat collagenase therapy for recurrent contracture in the same digit. Pretreatment and posttreatment total metacarpophalangeal and proximal interphalangeal joint flexion contractures were recorded, with complete correction defined as <5° residual digital flexion contracture. Postmanipulation skin tears and adverse events were recorded. A comparison was made between average contracture improvement after initial collagenase injection and that after repeat injection.
Forty-five patients with an average duration of 30 months (range, 6-73 months) between initial and repeat collagenase therapies were identified. The mean improvement after first collagenase injection was 45° ± 24° (39° for metacarpophalangeal joint and 50° for proximal interphalangeal joint) compared with a mean improvement of 43° ± 23° (41° for metacarpophalangeal joint and 44° for proximal interphalangeal joint) after second injection. Although similar complete correction rates and skin tear rates (32.2 % for initial and 30.5% for repeat) were observed between initial (80%) and repeat injections (73%), the occurrence of adverse events was 3 times higher (3.4% for initial and 10.2% for repeat) in the latter group.
Collagenase treatment of Dupuytren contracture yields effective total flexion contracture correction. Repeat collagenase treatment of previously treated digits yields similar deformity correction and complete correction rates but a higher incidence of adverse events.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
注射用溶组织梭状芽孢杆菌胶原酶一直是治疗手部掌腱膜挛缩症的一种有效且耐受性良好的非手术治疗选择。本研究的目的是确定在先前接受过胶原酶治疗的患者中胶原酶注射的疗效和不良事件发生率。
对2009年至2019年期间在单一机构由三名接受过专科培训的手外科医生用胶原酶注射治疗掌腱膜挛缩症的332例患者进行回顾性病历审查。45例患者的59个关节因同一手指复发性挛缩接受了重复胶原酶治疗。记录治疗前和治疗后掌指关节和近端指间关节的总屈曲挛缩情况，完全矫正定义为残留手指屈曲挛缩<5°。记录手法操作后皮肤撕裂和不良事件。比较初次胶原酶注射后和重复注射后的平均挛缩改善情况。
确定了45例患者，初次和重复胶原酶治疗之间的平均间隔时间为30个月（范围6 - 73个月）。初次胶原酶注射后的平均改善为45°±24°（掌指关节为39°，近端指间关节为50°），而第二次注射后的平均改善为43°±23°（掌指关节为41°，近端指间关节为44°）。虽然初次注射（80%）和重复注射（73%）之间观察到相似的完全矫正率和皮肤撕裂率（初次为32.2%，重复为30.5%），但后一组不良事件的发生率高出3倍（初次为3.4%，重复为10.2%）。
胶原酶治疗掌腱膜挛缩症可有效矫正总屈曲挛缩。对先前治疗过的手指重复进行胶原酶治疗可产生相似的畸形矫正和完全矫正率，但不良事件发生率更高。
研究类型/证据水平：治疗性IV级。
