Dent Craig, Coutelle Nino, Moore Andrew, Nester Matthew, Simon Peter, Nydick Jason A
Foundation for Orthopaedic Research and Education, Temple Terrace, FL.
Department of Orthopaedics and Sports Medicine, University of South Florida, Tampa, FL.
J Hand Surg Glob Online. 2024 Jul 9;6(5):627-630. doi: 10.1016/j.jhsg.2024.05.009. eCollection 2024 Sep.
Dupuytren contracture is characterized by the formation of cords and nodules in the palm. Surgical release has historically been the definitive treatment. Collagenase clostridium histolyticum (CCH) has been used successfully as an alternative to surgery. The treatment of proximal interphalangeal (PIP) contractures is the most challenging. The purpose of this study was to evaluate CCH treatment for Dupuytren contracture of the PIP joint.
A retrospective chart review was performed for CCH treatment of Dupuytren contracture at a single institution from January 2010 to April 2023. Data collected included pretreatment/posttreatment total flexion contracture and adverse events. Contractures were analyzed both by severity (high >40° and low <40°) and type (isolated PIP; combined metacarpophalangeal and PIP).
A total of 304 patients with 470 PIP joints treated were included. Digits with isolated and combined contractures each had an average pre-CCH treatment contracture of 51 (±23) degrees. Postmanipulations the contractures were 6 (±13) and 7 (±16) degrees, respectively. Clinical success (<5° residual contracture) and improvement (>50% correction of contracture) were associated with low severity contractures at postmanipulation. There were 256 adverse events recorded (54.5%), including 187 skin tears (39.8%), 68 cases of lymphadenopathy (14.5%), and one injection site infection (0.2%). High severity and combined contractures were independently associated with an increased incidence of skin tears upon manipulation.
Collagenase clostridium histolyticum treatment is effective for isolated or combined PIP joint contractures. Adverse events were associated with more severe contractures. Given the degree of improvement based on contracture severity, earlier intervention may provide better correction of contracture.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic III.
掌腱膜挛缩症的特征是手掌中形成条索和结节。从历史上看，手术松解一直是确定性治疗方法。溶组织梭状芽孢杆菌胶原酶（CCH）已成功用作手术的替代方法。近端指间关节（PIP）挛缩的治疗最具挑战性。本研究的目的是评估CCH治疗PIP关节掌腱膜挛缩症的效果。
对2010年1月至2023年4月在单一机构接受CCH治疗掌腱膜挛缩症的患者进行回顾性病历审查。收集的数据包括治疗前/治疗后总的屈曲挛缩和不良事件。挛缩按严重程度（高>40°和低<40°）和类型（孤立的PIP；掌指关节和PIP联合）进行分析。
共纳入304例患者的470个PIP关节。孤立性挛缩和联合性挛缩的手指在CCH治疗前的平均挛缩角度分别为51（±23）度。手法治疗后，挛缩角度分别为6（±13）度和7（±16）度。临床成功（残留挛缩<5°）和改善（挛缩矫正>50%）与手法治疗后低严重程度的挛缩相关。记录到256例不良事件（54.5%），包括187例皮肤撕裂（39.8%）、68例淋巴结病（14.5%）和1例注射部位感染（0.2%）。高严重程度和联合性挛缩与手法治疗后皮肤撕裂的发生率增加独立相关。
溶组织梭状芽孢杆菌胶原酶治疗孤立性或联合性PIP关节挛缩有效。不良事件与更严重的挛缩相关。鉴于基于挛缩严重程度的改善程度，早期干预可能提供更好的挛缩矫正。
研究类型/证据水平：治疗性III级。
