PDF(Pubmed)
Abstract：
Background Dupuytren\'s disease decreases quality of life significantly and often requires surgical treatment, nevertheless there is no actual gold standard. The aim of this study was to introduce the use of minimally invasive pull-through technique. Methods From 2016 to 2020, 52 patients suffering from Dupuytren\'s contracture were treated with the minimally invasive pull-through technique. We evaluated the improvement in range of motion, pain, disability, and quality of life in the long term. Total extension deficit, quick disabilities of the arm, shoulder, and hand (QuickDASH), and EuroQol five dimensions-five levels index were systematically scored before each surgical intervention and reevaluated after 24 months. Results Fourteen patients (26.9%) had already received a previous intervention (percutaneous needle aponeurotomy or collagenase Clostridium histolyticum ). The mean preoperative total active extension deficit was 84.0 ± 23.3 degrees (55-130 degrees). Mean follow-up was 36 months. There were no cases of tendon rupture or neurovascular injury. Total active extension deficit at the final follow-up was 3.4 ± 2.3 degrees (0-12 degrees). The mean active range of motion of the MCP and PIP joints were, respectively, 90.5 ± 3.3 degrees (85-96 degrees) and 82.7 ± 2.5 degrees (80-87 degrees). At 24 months after cord excision, a mean 10.7 points improvement in the QuickDASH questionnaire was registered ( p < 0.001). Pull-through technique was equally effective both on patients with a primary or a recurrent disease. Eight patients (15.4%) had a recurrence of disease in the metacarpophalangeal joint or proximal interphalangeal joint. Conclusion The pull-through technique is a simple, accessible, and effective technique for the treatment of Dupuytren\'s contracture. The use of palmar mini-incisions combined with minimal dissection has a low risk of iatrogenic injury to the neurovascular bundles and tendons, and has a low risk of recurrence rate. This study reflects level of evidence IV.
摘要：
背景：Dupuytren病显著降低生活质量，通常需要手术治疗，然而，没有实际的金本位制。这项研究的目的是介绍微创穿刺技术的使用。方法2016年至2020年,对52例Dupuytren挛缩症患者采用微创穿刺技术进行治疗。我们评估了运动范围的改善，疼痛,残疾,和长期生活质量。总延期赤字，手臂快速残疾，肩膀,和手（QuickDASH），在每次手术干预前，对EuroQol5个维度-5个水平指数进行系统评分，并在24个月后重新评估。结果14例患者（26.9％）已经接受了先前的干预（经皮穿刺穿刺或胶原酶溶组织梭菌）。术前平均总主动延伸缺陷为84.0±23.3度（55-130度）。平均随访36个月。无肌腱断裂或神经血管损伤病例。最终随访时的总主动延伸缺陷为3.4±2.3度（0-12度）。MCP和PIP关节的平均活动范围为，分别,90.5±3.3度（85-96度）和82.7±2.5度（80-87度）。脐带切除术后24个月，QuickDASH问卷平均改善10.7分(p<0.001).牵拉技术对原发性或复发性疾病的患者同样有效。8例患者（15.4％）在掌指关节或近端指间关节复发。结论拉穿技术是一种简单，可访问,治疗Dupuytren挛缩的有效技术。使用掌侧小切口结合最小夹层对神经血管束和肌腱造成医源性损伤的风险较低，复发率低。这项研究反映了证据水平IV。
