Bhat Anil K, Navaneeth P K, Pai G Mithun
Department of Hand Surgery, Kasturba Medical College, Manipal, India.
Manipal Academy of Higher Education, Manipal, 576104, India.
Musculoskelet Surg. 2025 Mar 31. doi: 10.1007/s12306-025-00899-5.
Over the past three decades, percutaneous needle aponeurotomy (PNA) for Dupuytren's disease has become increasingly prevalent and offers numerous potential benefits. However, significant rates of recurrences are observed in literature. We aimed to evaluate the effectiveness of our technical modifications of percutaneous needle aponeurotomy that significantly separates the cord in the palm and digits, thereby minimizing recurrences.
We treated 23 consecutive patients with our modified technique. We use a larger-bore needle in the dorsovolar direction which involves a more controlled extensive disruption of the cord under local anesthesia. The mean total passive extension deficit (TPED) and the Dupuytren's contracture-specific Unité rhumatologique desaffections de la main (URAM) scores were calculated at final follow-up.
Twenty-three patients underwent the procedure, involving 28 affected hands and 38 fingers, including 22 ring fingers, 6 little fingers, and 10 middle fingers. The average follow-up period was 22 months, ranging from 12 to 28 months. At presentation, the mean total passive extension deficit TPED was 50°. At the time of the final follow-up, the mean (TPED) was 10°, with a mean percent correction of 83% which was found to be statistically significant. This included 82% correction at the metacarpophalangeal joint and 81% at the proximal interphalangeal joint. Only four experienced recurrences, accounting for 14.2% of the total with a mean TPED of 30°. Lower URAM score indicated a significant short-term functional improvement.
Our modified PNA technique enhances cord division in the palm and fingers, leading to improved contracture correction and lower recurrence rates. However, further studies with larger cohorts and control groups are needed to validate these findings.
在过去三十年中，用于治疗杜普伊特伦挛缩症的经皮针状腱膜切开术（PNA）越来越普遍，且具有诸多潜在益处。然而，文献中观察到复发率较高。我们旨在评估对经皮针状腱膜切开术进行技术改良后的效果，该改良技术能显著分离手掌和手指处的条索，从而将复发率降至最低。
我们采用改良技术连续治疗了23例患者。我们在掌背方向使用更大孔径的针，这在局部麻醉下能更可控地广泛破坏条索。在最终随访时计算平均总被动伸展缺损（TPED）和杜普伊特伦挛缩症特有的手部风湿病单位（URAM）评分。
23例患者接受了该手术，涉及28只患手和38根手指，其中包括22根环指、6根小指和10根中指。平均随访期为22个月，范围在12至28个月之间。就诊时，平均总被动伸展缺损TPED为50°。在最终随访时，平均TPED为10°，平均矫正百分比为83%，具有统计学意义。其中掌指关节矫正率为82%，近端指间关节矫正率为81%。只有4例出现复发，占总数的14.2%，平均TPED为30°。较低的URAM评分表明短期功能有显著改善。
我们改良的PNA技术增强了手掌和手指处条索的分离效果，使挛缩矫正效果更好，复发率更低。然而，需要更大样本队列和对照组的进一步研究来验证这些结果。
