Wachtel Nikolaus, Dingler Francesca Romana, Kuhlmann Constanze, Mert Sinan, Haas-Lützenberger Elisabeth Maria, Alt Verena, Moellhoff Nicholas, Giunta Riccardo, Demmer Wolfram
Department of Hand, Plastic and Aesthetic Surgery, LMU Klinikum, Ziemssenstraße 5, 80336 Munich, Germany.
Life (Basel). 2025 Jan 10;15(1):76. doi: 10.3390/life15010076.
Dupuytren's disease (DD) is a systemic connective tissue disorder of the palm, predominantly affecting men of Northern European or Caucasian origin over 55. In addition to conventional surgery, Dupuytren's contracture can be treated in a minimally invasive way by injecting bacterial collagenase into the cord. However, studies on the long-term success rate when compared to the gold standard, surgical limited fasciectomy, are limited.
This monocentric retrospective study examined 35 patients who had been treated with bacterial collagenase for Dupuytren's contracture, conducting a long-term follow-up after an average of 5.7 years. The results were compared to a control group of 40 patients treated with surgical limited fasciectomy on average 5.5 years ago. Finger extension (Tubiana stage), strength, sensitivity, the effect of possible risk factors, and patient-reported outcome measures (PROMs) were compared between the two groups.
The long-term results after therapy for DD showed a significant reduction in the Tubiana stage for both groups ( < 0.001). Additionally, we observed a longer mean preintervention Tubiana stage and a better long-term improvement in the Tubiana stage for patients with limited fasciectomy when compared to the collagenase group. (both < 0.001). Neither grip strength nor the pinch test showed significant differences when compared within each group or when comparing both groups. Both the treated and untreated fingers of patients with limited fasciectomy had a superior two-point discrimination ( < 0.001). For the URAM questionnaire, we observed a significantly better result in the control group ( < 0.01). Retrospectively, significantly more patients in the collagenase group would not choose the same therapy to treat DD (35 vs. 8%; < 0.05).
The two therapy options should be seen as complementary for the treatment of DD. Collagenase therapy seems a sensible option for DD with an earlier Tubiana stage and contractures that predominantly affect the MCP joint. Contractures with higher Tubiana stages that also affect the PIP joint should predominantly be treated with limited fasciectomy.
杜普伊特伦挛缩病（DD）是一种手掌部的系统性结缔组织疾病，主要影响55岁以上的北欧或白种男性。除了传统手术外，杜普伊特伦挛缩还可以通过向条索内注射细菌胶原酶进行微创治疗。然而，与金标准手术——有限筋膜切除术相比，关于其长期成功率的研究有限。
这项单中心回顾性研究检查了35例接受细菌胶原酶治疗杜普伊特伦挛缩的患者，平均随访5.7年后进行长期随访。将结果与平均5.5年前接受有限筋膜切除术治疗的40例患者的对照组进行比较。比较两组之间的手指伸展度（图比阿纳分期）、力量、感觉、可能的危险因素的影响以及患者报告的结局指标（PROMs）。
DD治疗后的长期结果显示两组的图比阿纳分期均显著降低（<0.001）。此外，与胶原酶组相比，我们观察到有限筋膜切除术患者干预前的图比阿纳分期平均更长，且图比阿纳分期的长期改善更好（均<0.001）。在每组内比较或两组比较时，握力和捏力测试均未显示出显著差异。有限筋膜切除术患者的治疗手指和未治疗手指的两点辨别觉均更优（<0.0）。对于URAM问卷，我们观察到对照组的结果明显更好（<0.01）。回顾性分析，胶原酶组中明显更多的患者不会选择相同的疗法来治疗DD（35%对8%；<0.05）。
这两种治疗方案应被视为治疗DD的互补方法。胶原酶治疗似乎是图比阿纳分期较早且挛缩主要影响掌指关节的DD的合理选择。图比阿纳分期较高且也影响近端指间关节的挛缩应主要采用有限筋膜切除术治疗。
