Download PDF
Handchir Mikrochir Plast Chir 2011; 43(05): 269-274
DOI: 10.1055/s-0031-1286314
Übersichtsarbeit
Georg Thieme Verlag KG Stuttgart · New York

Kollagenase Clostridium histolyticum im Management der Dupuytrenschen Kontraktur

Collagenase Clostridum histolyticum in the Management of Dupuytren’s Contracture
L. Holzer
1   Deutsch-Ordens-Spital Friesach, Abteilung für Chirurgie, Friesach, Österreich
,
G. Holzer
2   Medizinische Universität Wien, Universitätsklinik für Orthopädie, Wien, Österreich
› Author Affiliations
Further Information

Publication History

eingereicht 22 May 2011

akzeptiert 18 August 2011

Publication Date:
20 September 2011 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Die Dupuytrensche Kontraktur ist eine proliferative, fibröse Hyperplasie der Palmaraponeurose mit Knoten- und Strangbildung. In der Behandlung der Dupuytrenschen Kontraktur ist die chirurgische Therapie derzeit Mittel der Wahl. Kürzlich wurde Kollagenase Clostridium histolyticum als medikamentöse Methode zur Behandlung der Dupuytrenschen Kontraktur zugelassen. Kollagenase Clostridium histolyticum wird direkt in die Dupuytren-Stränge injiziert und nach 24 Stunden durch manuelle Rupturierung die Kontraktur aufgedehnt. Kollagenase Clostridium bewirkt einen Abbau von Kollagen, wobei neurovaskuläre Strukturen jedoch verschont werden. In 2 klinischen Phase-III-Studien konnte gezeigt werden, dass Kontrakturen durch die Anwendung von Kollagenase Clostridium histolyticum wirksam reduziert werden können. Langzeitergebnisse bezüglich Effektivität und Nebenwirkungen sowie Vergleichsstudien mit chirurgischen Methoden liegen bisher nicht vor. Diese Arbeit bietet einen Überblick über Kollagenase Clostridium histolyticum und deren Rolle im Management der Dupuytrenschen Kontraktur. Indikation, technisches Vorgehen, Behandlungsergebnisse und Komplikationen werden dargestellt.

Abstract

Dupuytren’s contracture is a fibroproliferate disease of the palmar aponeurosis with a formation of nodules and cords. Surgical treatment is the gold standard for Dupuytren’s contracture at the moment. A short while ago Collagenase clostridium histolyticum was licensed as a non-surgical method to treat Dupuytren’s contracture. Collagenase clostridium histolyticum is injected directly into the Dupuytren’s cord and after 24 h the contracture is distended by manual rupturing. Collagenase clostridium histolyticum causes a depletion of collagen, however neurovascular structures are spared. 2 clinical phase III studies showed that contractures could be effectively reduced when using Collagenase clostridium histolyticum. However, there are no long-term results regarding effectiveness and side effects, or comparative studies using surgical methods. This paper presents a review of Collagenase clostridium histolyticum and its role in the management of Dupuytren’s contracture. Indication, technical procedure, treatment results and complications are described.

Schlüsselwörter

Dupuytrensche Kontraktur - Kollagenase - Clostridium histolyticum

Key words

Dupuytren’s contracture - collagenase - Clostridium histolyticum
 

  • Literatur

  • 1 Rayan GM. Dupuytren disease: Anatomy, pathology, presentation, and treatment. J Bone Joint Surg [Am] 2007; 89: 189 -198
    CrossrefPubMedSearch in Google Scholar
  • 2 Swartz WM, Lalonde DH. Dupuytren’s disease. Plast Reconstr Surg 2008; 121: 1-10
    PubMedSearch in Google Scholar
  • 3 Shaw Jr RB, Chong AK, Zhang A et al. Dupuytren’s disease: history, diagnosis, and treatment. Plast Reconstr Surg 2007; 120: 44e-54e
    CrossrefPubMedSearch in Google Scholar
  • 4 Loos B, Puschkin V, Horch RE. 50 years experience with Dupuytren’s contracture in the Erlangen University Hospital – a retrospective analysis of 2919 operated hands from 1956 to 2006. BMC Musculoskelet Disord 2007; 8: 60
    CrossrefPubMedSearch in Google Scholar
  • 5 Al-Qattan MM. Factors in the pathogenesis of Dupuytren’s contracture. J Hand Surg [Am] 2006; 31: 1527-1534
    PubMedSearch in Google Scholar
  • 6 Kloen P, Jennings CL, Gebhardt MC et al. Transforming Growth Factor-Beta: Possible Roles in Dupuytren’s Contracture. J Hand Surg [Am] 1995; 20: 101-108
    PubMedSearch in Google Scholar
  • 7 Kloen P. New insights in the Development of Dupuytren’s Contracture: A Review. Br J Plast Surg 1999; 52: 629-635
    CrossrefPubMedSearch in Google Scholar
  • 8 Hurst LC, Badalamente MA. Nonoperative treatment of Dupuytren’s disease. Hand Clin 1999; 15: 97-107
    PubMedSearch in Google Scholar
  • 9 Rayan GM. Nonoperative treatment of Dupuytren’s disease. J Hand Surg [Am] 2008; 33: 1208-1210
    PubMedSearch in Google Scholar
  • 10 MacLennon J, Mandl I, Howes E. Bacterial Digestion of Collagen. J Clin Invest 1953; 32: 1317-1322
    CrossrefPubMedSearch in Google Scholar
  • 11 Matsushita O, Jung CM, Katayama S et al. Gene duplication and multiplicity of collagenases in Clostridium histolyticum. J Bacteriol 1999; 181: 923-933
    PubMedSearch in Google Scholar
  • 12 Matsushita O, Okabe A. Clostridial hydrolytic enzymes degrading extracellular components. Toxicon 2001; 39: 1769-1780
    CrossrefPubMedSearch in Google Scholar
  • 13 Wolters GH, Vos-Scheperkeuter GH, Lin HC et al. Different roles of class I and class II Clostridium histolyticum collagenase in rat pancreatic islet isolation. Diabetes 1995; 44: 227-233
    CrossrefPubMedSearch in Google Scholar
  • 14 Vos-Scheperkeuter GH, van Suylichem PT, Vonk MW et al. Histochemical analysis of the role of class I and class II Clostridium histolyticum collagenase in the degradation of rat pancreatic extracellular matrix for islet isolation. Cell Transplant 1997; 6: 403-412
    CrossrefPubMedSearch in Google Scholar
  • 15 Starkweather KD, Lattuga S, Hurst LC et al. Collagenase in the treatment of Dupuytren’s disease: an in vitro study. J Hand Surg [Am] 1996; 21: 490-495
    PubMedSearch in Google Scholar
  • 16 Gelbard MK, Walsh R, Kaufman JJ. Collagenase for PeyExperimental Studies. Urol Res 1982; 10: 135-140
    PubMedSearch in Google Scholar
  • 17 Badalamente MA, Hurst LC. Enzyme injection as a nonoperative treatment for Dupuytren’s disease. Drug Delivery: Journal of Delivery and Targeting of Therapeutic Agents 1996; 3: 35-40
    PubMedSearch in Google Scholar
  • 18 Mandl I. ed Collagenase Comes of Age. Collagenase. New York: Gordon & Breach Science Publishers; 1972
  • 19 Sussman BJ. Experimental intervertebral discolysis. A critique of collagenase and chymopapain applications. Clin Orthop Relat Res 1971; 80: 181-190
    CrossrefPubMedSearch in Google Scholar
  • 20 Bromley JW, Varma AO, Santoro AJ. Double-blind evaluation of collagenase injections for herniated lumbar discs. Spine 1984; 9: 486-488
    CrossrefPubMedSearch in Google Scholar
  • 21 Klasen HJ. A review on the nonoperative removal of necrotic tissue from burn wounds. Burns 2000; 26: 207-222
    CrossrefPubMedSearch in Google Scholar
  • 22 Kang N, Sivakumar B, Sanders R et al. Intra-lesional injections of collagenase are ineffective in the treatment of keloid and hypertrophic scars. J Plast Reconstr Aesthet Surg 2006; 59: 693-699
    CrossrefPubMedSearch in Google Scholar
  • 23 Gelbard MK, Lindner A, Kaufman JJ. The use of Collagenase in the Treatment of Peyronie’s Disease. J Urol 1985; 134: 280-283
    PubMedSearch in Google Scholar
  • 24 Gelbard MK, James K, Riach P et al. Collagenase versus Placebo in the Treatment of Peyronie’s Disease: A Double Blind Study. J Urol 1993; 149: 56-58
    PubMedSearch in Google Scholar
  • 25 Badalamente MA, Hurst LC. Enzyme injection as nonsurgical treatment of Dupuytren’s disease. J Hand Surg [Am] 2000; 25: 629-636
    PubMedSearch in Google Scholar
  • 26 Badalamente MA, Hurst LC, Hentz VR. Collagen as a clinical target: nonoperative treatment of Dupuytren’s disease. J Hand Surg [Am] 2002; 27: 788-798
    PubMedSearch in Google Scholar
  • 27 Badalamente MA, Hurst LC. Efficacy and safety of injectable mixed collagenase subtypes in the treatment of Dupuytren’s contracture. J Hand Surg [Am] 2007; 32: 767-774
    PubMedSearch in Google Scholar
  • 28 Hurst LC, Badalamente MA, Hentz VR et al. Injectable collagenase clostridium histolyticum for Dupuytren’s contracture. N Engl J Med 2009; 361: 968-979
    CrossrefPubMedSearch in Google Scholar
  • 29 Gilpin D, Coleman S, Hall S et al. Injectable collagenase Clostridium histolyticum: a new nonsurgical treatment for Dupuytren’s disease. J Hand Surg [Am] 2010; 35: 2027-2038
    PubMedSearch in Google Scholar
  • 30 Crean SM, Gerber RA, Hellio Le Graverand MP et al. The efficacy and safety of fasciectomy and fasciotomy for Dupuytren’s contracture in European patients: a structured review of published studies. J Hand Surg Eur Vol 2011; Mar 7 [Epub ahead of print]
    PubMedSearch in Google Scholar
  • 31 Foucher G, Medina J, Navarro R. Percutaneous needle aponeurotomy: complications and results. J Hand Surg [Br] 2003; 28: 427-431
    PubMedSearch in Google Scholar
  • 32 Watt AJ, Curtin CM, Hentz VR. Collagenase injection as nonsurgical treatment of Dupuytren’s disease: 8-year follow-up. J Hand Surg [Am] 2010; 35: 534-539
    PubMedSearch in Google Scholar
  • 33 Holzer LA, Holzer G. Injectable collagenase clostridium histolyticum for Dupuytren’s contracture. N Engl J Med 2009; 361: 2579
    PubMedSearch in Google Scholar