Five-Year Results of a Randomized Clinical Trial on Treatment in Dupuytren's Disease: Percutaneous Needle Fasciotomy versus Limited Fasciectomy
Five-Year Results of a Randomized Clinical Trial on Treatment in Dupuytren's Disease: Percutaneous Needle Fasciotomy versus Limited Fasciectomy
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DOI：
10.1097/prs.0b013e31823aea95
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发表时间：
2012-02-01
影响因子：
3.6
通讯作者：
Werker, Paul M. N.
中科院分区：
文献类型：
--
作者：
van Rijssen, Annet L.;ter Linden, Hein;Werker, Paul M. N.
背景：治疗Dupuytren病的方法越来越多，表明有必要进行比较研究。方法：将111例(115只患手)患者随机分为经皮针刺筋膜切开术和有限筋膜切除术两组，每组115只手。分别于术后1周、6周、6个月、1、2、3、4、5年进行随访检查。结果参数为总的被动伸展缺陷、患者满意度、屈曲和敏感度。此外，还记录了疾病扩展情况。主要终点是复发，定义为总的被动伸展功能缺陷增加超过30度。结果：针刺筋膜切开组5年后复发率(84.9%)显著高于有限筋膜切除术组(20.9%)(p<；0.001)，且针刺筋膜切开组复发率明显提前(p=0.001)。治疗时年龄越大，复发率越低(p=0.005)。其他素质特征均不影响复发。两组患者的满意度都很高，但有限筋膜切除术组患者满意度明显更高。结论：经皮针刺筋膜切开术是老年Dupuytren病患者和那些愿意接受早期复发的患者的首选治疗方法，具有恢复快、并发症发生率低、侵袭性小等优点。(最后一次。重新构造外科129：469,2012)临床问题/证据水平：治疗性，II。
Background: The increasing number of methods for treating Dupuytren's disease indicates a need for comparative studies. In this article, the 5-year follow-up results of a randomized controlled study that compared percutaneous needle fasciotomy and limited fasciectomy are presented.Methods: One hundred eleven patients with 115 affected hands with a minimal passive extension deficit of 30 degrees were assigned randomly to the two groups. Follow-up examinations were performed at 1 and 6 weeks; 6 months; and 1, 2, 3, 4, and 5 years. Outcome parameters were total passive extension deficit, patient satisfaction, flexion, and sensibility. Furthermore, disease extension was recorded. The primary endpoint was recurrence, defined as an increase of total passive extension deficit of greater than 30 degrees. Ninety-three patients reached this endpoint.Results: The recurrence rate after 5 years in the needle fasciotomy group (84.9 percent) was significantly higher than in the limited fasciectomy group (20.9 percent) (p < 0.001), and occurred significantly sooner in the needle fasciotomy group (p = 0.001). Older age at the time of treatment decreased the recurrence rate (p = 0.005). No other diathesis characteristics influenced recurrence. Patient satisfaction was high in both groups but was significantly higher in the limited fasciectomy group. Nevertheless, many patients (53 percent) preferred percutaneous needle fasciotomy in case of recurrence.Conclusions: Percutaneous needle fasciotomy is the preferred treatment for elderly patients with Dupuytren's disease and for those willing to accept a possible early recurrence in the context of the advantages, such as fast recovery, a low complication rate, and minimal invasiveness. (Plast. Reconstr. Surg. 129: 469, 2012.)CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.