Seth Ishith, McClure Vicki, Lim Bryan, Cuomo Roberto, Ross Richard J, Rozen Warren M
Faculty of Science, Medicine, and Health, Monash University, Melbourne, VIC 3004, Australia.
Department of Plastic and Reconstructive Surgery, Peninsula Health, Melbourne, VIC 3199, Australia.
Life (Basel). 2025 Feb 8;15(2):259. doi: 10.3390/life15020259.
Minimally invasive treatments for Dupuytren's disease (DD), such as percutaneous needle fasciotomy (PNF) and collagenase clostridium histolyticum (CCH), have become alternatives to open surgeries. This meta-analysis compared these treatments in terms of complications, patient satisfaction, clinical outcomes, and recurrence. Relevant studies up to June 2024 were identified through major databases, following PRISMA guidelines, and the study was registered on PROSPERO. Statistical analysis using Review Manager 5.4 found PNF had lower post-operative rates of oedema (RR = 0.15, 95% CI [0.09, 0.27], < 0.00001), lymphadenopathy (RR = 0.09, 95% CI [0.02, 0.38], = 0.0010), and pruritus (RR = 0.1, 95% CI [0.01, 0.73], = 0.02) compared to CCH. However, there were no significant differences in skin tears, recurrence, reintervention, extension deficit, or residual flexion at metacarpal and proximal interphalangeal joints ( > 0.05). Patient-reported outcomes, including QuickDASH and URAM scores, also showed no significant differences. Eleven studies involving 1443 patients were analysed, and most were at a low-to-moderate risk of bias, as assessed using the Cochrane or Newcastle-Ottawa tools. While PNF showed fewer minor complications, overall clinical and patient-reported outcomes were comparable between the treatments. These findings highlight the need to tailor treatment choices to patient preferences and clinical context.
掌腱膜挛缩症(DD)的微创治疗方法,如经皮针状筋膜切开术(PNF)和溶组织梭状芽孢杆菌胶原酶(CCH),已成为开放性手术的替代方案。本荟萃分析从并发症、患者满意度、临床结局和复发率等方面对这些治疗方法进行了比较。按照PRISMA指南,通过主要数据库检索了截至2024年6月的相关研究,该研究已在PROSPERO上注册。使用Review Manager 5.4进行的统计分析发现,与CCH相比,PNF术后水肿(RR = 0.15,95% CI [0.09, 0.27],P < 0.00001)、淋巴结病(RR = 0.09,95% CI [0.02, 0.38],P = 0.0010)和瘙痒(RR = 0.1,95% CI [0.01, 0.73],P = 0.02)的发生率较低。然而,在皮肤撕裂、复发、再次干预、伸展功能障碍或掌指关节和近端指间关节的残余屈曲方面,两者无显著差异(P > 0.05)。患者报告的结局,包括QuickDASH和URAM评分,也无显著差异。分析了涉及1443例患者的11项研究,使用Cochrane或纽卡斯尔-渥太华工具评估,大多数研究存在低至中度的偏倚风险。虽然PNF的轻微并发症较少,但两种治疗方法的总体临床结局和患者报告的结局相当。这些发现强调了根据患者偏好和临床情况调整治疗选择的必要性。