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DOI: 10.1055/a-2055-1592
Mittelfristige Ergebnisse nach perkutaner Nadelfasziotomie bei Morbus Dupuytren
Medium-term Results after percutaneous Needle Fasciotomy in Dupuytren’s Disease
Zusammenfassung
Hintergrund Der Morbus Dupuytren führt bei betroffenen Patienten häufig zu einer zunehmenden Extensionseinschränkung der Finger. Da die Inzidenz im Alter zunimmt, ist auf Grund des demographischen Wandels mit einer Zunahme von diesen Dupuytren’schen Kontrakturen zu rechnen. Deshalb besteht weiterhin der Bedarf an einer einfachen und patientenorientierten Behandlung.In dieser Studie wurden die kurz- und mittelfristigen Ergebnisse nach perkutaner Nadelfasziotomie (PNF) untersucht.
Patienten und Methoden An der Studie nahmen insgesamt 40 Patienten teil, bei denen 65 Finger mittels PNF behandelt wurden. Es wurde das totale passive Extensionsdefizit (TPED), das passive Extensionsdefizit der einzelnen Gelenke (PED), der Buck-Gramcko-Score, die Rezidivrate, der DASH-score und die Patientenzufriedenheit untersucht. Hierbei wurde ein Rezidiv als Verschlechterung des TPED um 30° oder mehr definiert. Das mittlere Patientenalter betrug 65,9 Jahre. Die Mehrzahl der Patienten war männlich (82%).
Ergebnisse Direkt nach der Intervention zeigt sich eine signifikante Verbesserung der Streckfähigkeit (TPED vor PNF 74,6°±41,1 Standardabweichung (SD) auf 32,8°±29,0 SD nach Intervention), die sich bei der Nachuntersuchung nach 30,2±13,9 SD Monaten im Durchschnitt wieder leicht verschlechtert zeigte (TPED 52,7°±40,2 SD). Die Rezidivrate betrug 29,7%, wobei ein höheres Tubiana-Stadium vor der Prozedur mit einer signifikant höheren Redzivrate einherging. Trotzdem zeigte sich eine hohe Patientenzufriedenheit und fast alle Patienten würden retrospektiv die PNF erneut durchführen lassen.
Schlussfolgerung Die PNF stellt weiterhin trotz relativ hoher Redzidivrate eine effektive und patientenorientierte Behandlung der Dupuytren’schen Kontraktur dar.
Abstract
Background Dupuytren’s disease often leads to an increasing limitation in finger extension in affected patients. As the incidence rises with age, the number of cases is expected to rise in the future due to the demographic change. Therefore, an easy and patient-oriented treatment is required. In the following study, we investigated the short and medium-term results after percutaneous needle fasciotomy (PNF).
Patients and Methods Overall, 65 fingers of 40 patients were treated with PNF. We evaluated the total passive deficit of extension (TPED), the passive deficit of extension of the joints (PED), the Buck-Gramcko score, rate of recurrence, DASH score and patient satisfaction. The average age of the patients was 65,9 years. Most of the patients (82%) were male.
Results Directly after the PNF, extension in the treated fingers improved significantly (TPED before PNF 74,6°±41,1 SD to 32,8°±29,0 SD after the procedure). By the time of the follow-up examination (30,2±13,9 SD months), TPED had increased again (52,7°±40,2 SD). The rate of recurrence was 29,7%, and a higher Tubiana stage before the procedure correlated significantly with a higher recurrence rate. Nevertheless, patients demonstrated a very high level of satisfaction with the procedure and almost all patients would choose to undergo PNF again.
Conclusion Although it is associated with a relatively high recurrence rate, PNF represents an effective and patient-oriented treatment of Dupuytren’s contracture.
Publication History
Received: 26 February 2022
Accepted: 19 November 2022
Article published online:
10 July 2023
© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).
Georg Thieme Verlag KG
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Literatur
- 1 Hahn P. Epidemiologie des Morbus Dupuytren. Orthopade 2017; 46: 298-302
- 2 Lee K-H, Kim J-H, Lee C-H. et al. The Epidemiology of Dupuytren’s Disease in Korea. A Nationwide Population-based Study. J Korean Med Sci 2018; 33: e204
- 3 Coulibaly NF, Doumbia MM, Dembele B. et al. Dupuytren’s disease. A reality in Black Africa. Hand Surg Rehabil 2020; 39: 448-453
- 4 Feldman G, Rozen N, Rubin G. Dupuytren’s Contracture. Current Treatment Methods. Isr Med Assoc J 2017; 19: 648-650
- 5 Eaton C, Seegenschmiedt MH, Bayat A. et al. Dupuytren’s Disease and Related Hyperproliferative Disorders. Berlin, Heidelberg: Springer Berlin Heidelberg; 2012
- 6 Dibenedetti DB, Nguyen D, Zografos L. et al. Prevalence, incidence, and treatments of Dupuytren’s disease in the United States. Results from a population-based study. Hand (N Y) 2011; 6: 149-158
- 7 Kadhum M, Smock E, Khan A. et al. Radiotherapy in Dupuytren’s disease. A systematic review of the evidence. J Hand Surg Eur Vol 2017; 42: 689-692
- 8 Hurst LC, Badalamente MA, Hentz VR. et al. Injectable collagenase clostridium histolyticum for Dupuytren’s contracture. N Engl J Med 2009; 361: 968-979
- 9 Foucher G, Medina J, Navarro R. Percutaneous needle aponeurotomy. Complications and results. J Hand Surg Br 2003; 28: 427-431
- 10 Pess GM, Pess RM, Pess RA. Results of needle aponeurotomy for Dupuytren contracture in over 1,000 fingers. J Hand Surg Am 2012; 37: 651-656
- 11 van Rijssen AL, Ter Linden H, Werker PMN. Five-year results of a randomized clinical trial on treatment in Dupuytren’s disease. Percutaneous needle fasciotomy versus limited fasciectomy. Plast Reconstr Surg 2012; 129: 469-477
- 12 Bainbridge C, Dahlin LB, Szczypa PP. et al. Current trends in the surgical management of Dupuytren’s disease in Europe. An analysis of patient charts. Eur Orthop Traumatol 2012; 3: 31-41
- 13 Layton T, Nanchahal J. Recent advances in the understanding of Dupuytren’s disease. F1000Res 2019; 8
- 14 Patel MI, Patel IA. Percutaneous needle fasciotomy for Dupuytren’s disease. A one-stop approach incidentally suited to the era of COVID-19. J Plast Reconstr Aesthet Surg 2020; 73: 2086-2102
- 15 Moog P, Buchner L, Cerny MK. et al. Analysis of recurrence and complications after percutaneous needle fasciotomy in Dupuytren’s disease. Arch Orthop Trauma Surg 2019; 139: 1471-1477
- 16 Zachrisson A, Sörensen AI, Strömberg J. Needle fasciotomy for Dupuytren’s contracture- a prospective cohort study of 58 fingers with a median follow-up of 6.5 years. J Plast Surg Hand Surg 2020; 54: 89-93
- 17 Hovius SER, Zhou C. Advances in Minimally Invasive Treatment of Dupuytren Disease. Hand Clin 2018; 34: 417-426
- 18 Therkelsen LH, Skov ST, Laursen M. et al. Percutaneous needle fasciotomy in Dupuytren contracture. A register-based, observational cohort study on complications in 3,331 treated fingers in 2,257 patients. Acta Orthop 2020; 91: 326-330