Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA.
Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA.
J Hand Surg Am. 2023 Dec;48(12):1200-1209. doi: 10.1016/j.jhsa.2023.08.008. Epub 2023 Sep 16.
The objective of this systematic review and meta-analysis was to synthesize the available randomized controlled trial data comparing needle fasciotomy and collagenase treatment for single-digit Dupuytren contractures with a minimum of 3-year follow-up and determine whether one treatment is superior regarding contracture correction and functional outcomes.
A systematic review and meta-analysis was conducted by searching four databases for randomized controlled trials investigating the single-digit treatment outcomes for Dupuytren contracture comparing collagenase treatment and needle fasciotomy with a minimum of 3-year follow-up. The risk of bias of included studies was assessed using the Cochrane risk-of-bias tool. A meta-analysis was performed using a random effects model in anticipation of unobserved heterogeneity. The primary outcome measure was contracture recurrence. Secondary outcome measures included final fixed flexion contracture (FFC), Quick Disabilities of Arm, Shoulder and Hand (QuickDASH) scores, and Unité Rhumatologique des Affections de la Main (URAM) scores.
After screening 264 articles, 4 randomized clinical trials were eligible for final inclusion. One trial had a high risk of bias, and two trials had some concern for bias. The final meta-analysis included 347 patients, 169 who underwent collagenase treatment and 178 who underwent needle fasciotomy. No significant differences were noted between the groups in contracture recurrence, FFC, and URAM scores. The pooled data showed a higher QuickDASH score in the collagenase treatment group compared with the needle fasciotomy group, but the observed difference was less than what would be expected to be clinically relevant.
Needle fasciotomy and collagenase treatment have similar outcomes with regards to contracture recurrence, final FFC, QuickDASH scores, and URAM scores for the single-digit treatment for Dupuytren contracture at a minimum of 3-year follow-up. Relevant factors that may be considered during the shared decision-making process for treatment selection include surgeon and patient preferences, costs of treatment, and the disparate complication profiles of these two treatments.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic II.
本系统评价和荟萃分析的目的是综合现有随机对照试验数据，比较最小随访时间为 3 年的单指节挛缩的硬结切开术和胶原酶治疗，并确定这两种治疗方法在挛缩矫正和功能结果方面是否存在优劣。
通过检索四个数据库，查找比较胶原酶治疗和硬结切开术治疗单指节挛缩的最小随访时间为 3 年的随机对照试验，对其进行系统评价和荟萃分析。使用 Cochrane 偏倚风险工具评估纳入研究的偏倚风险。由于预计存在未观察到的异质性，因此采用随机效应模型进行荟萃分析。主要结局测量指标为挛缩复发。次要结局测量指标包括最终固定屈曲挛缩（FFC）、快速上肢和手部功能障碍（QuickDASH）评分和手部关节炎影响评估（URAM）评分。
在筛选了 264 篇文章后，有 4 项随机临床试验符合最终纳入标准。其中 1 项试验存在高偏倚风险，2 项试验存在一定的偏倚顾虑。最终的荟萃分析纳入了 347 名患者，其中 169 名接受了胶原酶治疗，178 名接受了硬结切开术治疗。在挛缩复发、FFC 和 URAM 评分方面，两组间无显著差异。汇总数据显示，胶原酶治疗组的 QuickDASH 评分高于硬结切开术组，但观察到的差异小于预期的临床相关差异。
在最小随访时间为 3 年的单指节挛缩治疗中，硬结切开术和胶原酶治疗在挛缩复发、最终 FFC、QuickDASH 评分和 URAM 评分方面的结果相似。在治疗选择的共同决策过程中，可能需要考虑到相关因素，包括外科医生和患者的偏好、治疗费用以及这两种治疗方法的不同并发症特征。
研究类型/证据水平：治疗性 II 级。
