PDF(Pubmed)
Abstract：
Dupuytren\'s disease (DD) is a fibroproliferative disorder that manifests as an abnormal growth of myofibroblasts, causing nodule formation and contractures and affecting digit function. If left untreated, these contractures can lead to a loss of mobility and potentially impact hand function. This systematic review critically compares and evaluates the existing literature on the complications and patient satisfaction following injectable collagenase Clostridium histolyticum (CCH) versus limited fasciectomy (LF) for DD. We performed a comprehensive search of the PubMed, Medical Literature Analysis and Retrieval System Online (MEDLINE), The Cochrane Library, and Excerpta Medica database (EMBASE) databases from 2006 to August 2023. This research targeted all clinical studies involving adults who underwent injectable collagenase and/or limited fasciectomy in the management of DD. Out of the 437 identified studies, only 53 were considered eligible for our analysis, and merely 14 met our inclusion criteria. These selected studies encompassed a total of 967 patients with 1,344 treated joints, with an average follow-up duration of 19.22 (ranging from one to 84.06) months. Within this cohort, 498 joints from 385 patients underwent LF, while 846 joints from 491 patients received CCH injections. Notably, among the 491 patients treated with CCH, 1,060 complications were reported, averaging 2.15 complications per patient, with the most common being contusion/bruising/hematoma/ecchymosis (22.54%), and edema/swelling (18.96%). In contrast, among the 385 patients treated with LF, only 97 complications were reported, translating to 0.25 complications per patient, with the most frequent being paraesthesia or numbness (23.7%), scar sequelae like skin laceration, tear, fissure, or hypertrophic scar (23.7%), and neuropraxia or nerve injury (22.6%). Our meta-analysis indicates that paraesthesia or numbness is more frequently observed in LF than CCH injections, although without statistical significance, with a risk ratio (RR) of 0.39 (95% confidence interval (CI) 0.13-1.18, p-value 0.1). However, scar sequelae (hypertrophic scar, skin laceration, tear, or fissure) show a contrasting pattern, being more commonly associated with CCH injections than LF, with an RR of 1.98 (95% CI 0.26-14.85, p-value 0.51), which, upon eliminating the source of heterogeneity, becomes statistically significant, with an RR of 4.98 (95% CI 1.40-17.72, p-value 0.01). Our data revealed a higher frequency of complications with CCH compared to LF, although more severe adverse effects were observed in the LF group, such as neuropraxia or nerve injury. Scar sequelae were more common with CCH injections. Despite both treatments showing increased patient satisfaction at the final follow-up, CCH injection resulted in earlier improvements in satisfaction.
摘要：
Dupuytren病（DD）是一种纤维增生性疾病，表现为肌成纤维细胞的异常生长，导致结节形成和挛缩并影响手指功能。如果不及时治疗，这些挛缩可导致丧失活动能力,并可能影响手功能.本系统综述严格地比较和评估了可注射胶原酶溶组织梭状芽胞杆菌（CCH）和有限筋膜切除术（LF）后DD的并发症和患者满意度的现有文献。我们对PubMed进行了全面搜索，医学文献在线分析和检索系统（MEDLINE），科克伦图书馆,和ExcerptaMedica数据库（EMBASE）数据库从2006年到2023年8月。这项研究针对所有涉及在DD管理中接受可注射胶原酶和/或有限筋膜切除术的成年人的临床研究。在437项确定的研究中，只有53人被认为符合我们的分析条件，只有14个符合我们的入选标准。这些选定的研究包括总共967名患者，1,344个接受治疗的关节，平均随访时间为19.22个月（1至84.06个月）。在这个群体中，385名患者的498个关节接受了LF，而491名患者的846个关节接受了CCH注射。值得注意的是,在接受CCH治疗的491名患者中，报告了1,060例并发症，平均每个患者2.15个并发症，最常见的是挫伤/瘀伤/血肿/瘀斑（22.54%），水肿/肿胀（18.96%）。相比之下,在接受LF治疗的385例患者中，仅报告了97例并发症，转化为每名患者0.25个并发症，最常见的是感觉异常或麻木(23.7%)，疤痕后遗症如皮肤撕裂，眼泪，裂隙,或肥厚性瘢痕（23.7%），和神经失用症或神经损伤(22.6%)。我们的荟萃分析表明，在LF中比CCH注射更频繁地观察到感觉异常或麻木，虽然没有统计学意义，风险比（RR）为0.39（95%置信区间（CI）0.13-1.18，p值0.1）。然而,疤痕后遗症（肥厚性疤痕，皮肤撕裂,眼泪，或裂缝)显示出对比图案，比LF更常见地与CCH注入相关，RR为1.98(95%CI0.26-14.85，p值0.51)，which,在消除异质性的根源后，变得具有统计学意义，RR为4.98（95%CI1.40-17.72，p值0.01）。我们的数据显示，与LF相比，CCH并发症的频率更高，尽管在LF组中观察到更严重的不良反应，如神经失用症或神经损伤。CCH注射更常见疤痕后遗症。尽管两种治疗方法在最后的随访中都显示出患者满意度的提高，CCH注入导致满意度的早期提高。
