Dent Craig, Coutelle Nino, Gill Meera, Simon Peter, Doarn Michael, Nydick Jason
Foundation for Orthopaedic Research and Education, Tampa, FL.
Broward Health Orthopaedic Surgery, Fort Lauderdale, FL.
J Hand Surg Am. 2025 May;50(5):547-553. doi: 10.1016/j.jhsa.2025.01.023. Epub 2025 Mar 6.
Dupuytren contracture is a fibroproliferative disorder forming fascial cords in the hand. Collagenase clostridium histolyticum (CCH) is an alternative treatment to surgery. Current recommendations include nighttime extension orthosis after CCH for 4 months. Our purpose was to evaluate the effectiveness of night orthosis following CCH treatment.
The study was a prospective, randomized, controlled trial at a single institution. Patients with Dupuytren contracture of one or more digits treated with CCH from May 2021 to 2023 were screened. Eighty patients were enrolled and randomized between groups (a nighttime orthosis or no nighttime orthosis). The orthosis group was instructed to wear an extension orthosis nightly until 4 months. Baseline, postmanipulation, and 1-month, and 4-month flexion contractures were collected. QuickDASH (Disabilities of the Arm, Shoulder, and Hand) and splint compliance surveys were collected at 1 and 4 months. Skin tears and adverse events were recorded.
There were 39 orthosis patients, and 40 nonorthosis patients who received CCH treatment. A total of 119 joints were treated, including 66 metacarpophalangeal (MCP) and 53 proximal interphalangeal (PIP) joints. Seventy-six and 69 patients completed 1- and 4-month follow-up. Baseline characteristics were similar between two groups. Mean baseline flexion contracture for all joints was 48° and 55° for the orthosis and nonorthosis groups, respectively. The orthosis group had significantly lower residual contracture at 4 months (11° vs 20°). No difference was found at any time for MCP joints. PIP joints in the orthosis group had significantly lower contracture at 1 and 4 months (13° vs 28°; 19° vs 36°). Reported compliance with orthosis was 79% at least "Most of the Time" at 1 month and 52% at least "Half of the Time" at 4 months.
Our study suggests greater benefit of night orthosis for PIP joint contractures. We recommend night orthosis after CCH treatment of PIP joint contractures and optional use for MCP contractures.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic II.
杜普伊特伦挛缩是一种在手部形成筋膜索带的纤维增生性疾病。溶组织梭状芽孢杆菌胶原酶（CCH）是手术的一种替代治疗方法。目前的建议包括CCH治疗后夜间使用伸展矫形器4个月。我们的目的是评估CCH治疗后夜间矫形器的有效性。
该研究是在单一机构进行的一项前瞻性、随机、对照试验。对2021年5月至2023年接受CCH治疗的一个或多个手指患有杜普伊特伦挛缩的患者进行筛查。80名患者入组并随机分组（夜间使用矫形器组或不使用夜间矫形器组）。矫形器组被指示每晚佩戴伸展矫形器直至4个月。收集基线、手法治疗后、1个月和4个月时的屈曲挛缩情况。在1个月和4个月时收集QuickDASH（手臂、肩部和手部功能障碍）和夹板依从性调查结果。记录皮肤撕裂和不良事件。
有39名使用矫形器的患者和40名未使用矫形器的患者接受了CCH治疗。共治疗了119个关节，包括66个掌指关节（MCP）和53个近端指间关节（PIP）。76名和69名患者完成了1个月和4个月的随访。两组的基线特征相似。矫形器组和未使用矫形器组所有关节的平均基线屈曲挛缩分别为48°和55°。矫形器组在4个月时的残余挛缩明显更低（11°对20°）。MCP关节在任何时候均未发现差异。矫形器组的PIP关节在1个月和4个月时的挛缩明显更低（13°对28°；19°对36°）。据报告，在1个月时至少“大部分时间”佩戴矫形器的依从率为79%，在4个月时至少“一半时间”佩戴的依从率为52%。
我们的研究表明夜间矫形器对PIP关节挛缩有更大益处。我们建议在CCH治疗PIP关节挛缩后使用夜间矫形器，对于MCP关节挛缩可酌情使用。
研究类型/证据水平：治疗性II级。
