A comparison of the direct outcomes of percutaneous needle fasciotomy and limited fasciectomy for Dupuytren's disease: A 6-week follow-up study
A comparison of the direct outcomes of percutaneous needle fasciotomy and limited fasciectomy for Dupuytren's disease: A 6-week follow-up study
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DOI：
10.1016/j.jhsa.2006.02.021
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发表时间：
2006-05-01
影响因子：
1.9
通讯作者：
Werker, Paul M. N.
中科院分区：
文献类型：
--
作者：
van Rijssen, Annet L.;Gerbrandy, Feike S. J.;Werker, Paul M. N.
目的：经皮针筋膜切开术（PNF）作为治疗Dupuytren病的需求正在增加，因为其侵入性有限，结局良好，并发症数量有限，恢复快，患者总体满意度。这个随机对照试验的目的是测试这些短期的期望是否是合理的，通过比较这种治疗与有限的筋膜切除术（LF）方面these aspects.Methods：我们处理了166射线：88 PNF和78 LF。第1周和第6周时的总被动伸展功能障碍（TPED）改善是主要结局参数;患者满意度、手功能恢复和并发症发生率是次要结局参数。我们使用残疾的手臂，肩，手问卷来衡量残疾的上肢治疗前后和所有的不良反应和并发症recorded.Results：整体TPED改善是最好的6周。PNF组TPED改善63%，LF组改善79%，差异具有统计学意义。PNF组和LF组近端指间关节的结果均比掌指关节和远端指间关节差。术前分类为Tubiana I期和II期的射线在这些治疗之间没有差异，但对于高于II期的射线，LF作为治疗方式明显上级PNF。LF组的严重并发症发生率为5%，PNF组为0%。患者满意度几乎相同，但PNF组治疗后的直接手功能被认为更好，患者经历的不适程度也更好。这是强调残疾的手臂，肩膀和手的PNF组，这是显着低于LF组在所有的时间点measured.Conclusions：在短期内，在案件与TPED 90度或更少的PNF是一个很好的治疗替代LF治疗Dupuytren病。
Purpose: The demand for percutaneous needle fasciotomy (PNF) as treatment for Dupuytren's disease is increasing because of its limited invasiveness, good outcome, limited number of complications, quick recovery, and overall patient satisfaction. This randomized controlled trial was designed to test whether these short-term expectations are sound by comparing this treatment with limited fasciectomy (LF) with regard to these aspects.Methods: We treated 166 rays: 88 by PNF and 78 by LF. Total passive extension deficit (TPED) improvement at I week and at 6 weeks were the primary outcome parameters; patient satisfaction, hand-function recovery, and complication rate were secondary outcome parameters. We used the Disabilities of the Arm, Shoulder, and Hand questionnaire to measure disabilities of the upper extremity before and after treatment and all adverse effects and complications were recorded.Results: Overall TPED improvement was best at 6 weeks. In the PNF group TPED improved by 63% versus 79% in the LF group; this difference was statistically significant. Results at the proximal interphalangeal joint were worse than those at the metacarpophalangeal and distal interphalangeal joints for both the PNF and LF groups. The rays classified before surgery as Tubiana stages I and II showed no difference between these treatments, but for rays higher than stage II LF clearly was superior to PNF as a treatment modality. The rate of major complications in the LF group was 5% versus 0% in the PNF group. Patient satisfaction was almost equal but direct hand function after treatment was considered better in the PNF group, as was the degree of discomfort that patients experienced. This was underscored by the Disabilities of the Arm, Shoulder, and Hand scores in the PNF group, which were significantly lower than those in the LF group at all time points measured.Conclusions: In the short term and in cases with a TPED of 90 degrees or less PNF is a good treatment alternative to LF for treatment of Dupuytren's disease.