■这项研究的目的是在使用胶原酶梭状芽孢杆菌(CCH)的专家的手外科医师之间建立共识建议,以在明确定义的患者人群中适当治疗Dupuytren疾病,疾病严重程度和功能损害程度不同。
■三轮,失明,改良的Delphi过程检查了小组成员的CCH治疗掌指骨(MP)或近端指间(PIP)关节挛缩的方法,涉及一个或两个手指,严重程度不同。与劣质皮肤相关的临床情景,筋膜切除术后留下疤痕,布托尼埃畸形,闭合性囊切开术,和血液稀释剂的使用也提出了小组成员考虑。小组成员使用5点Likert量表或是/否响应提供对临床情景的响应。共识被定义为≥66.7%的小组成员同意或不同意。
■20名小组成员完成了第1轮;20名小组成员中的19名完成了第2轮和第3轮。小组成员就使用CCH治疗表现为单指或两指MP关节挛缩的可触及索和不同程度挛缩的患者达成了高度共识。大多数单指或双指PIP关节挛缩,大多数合并MP和PIP关节挛缩。对PIP关节挛缩的治疗达成了共识,但临床情况与复发性PIP挛缩伴劣质皮肤和/或严重的筋膜切除术后瘢痕相关,布托尼埃畸形,PIP挛缩>70°,闭合性囊切开术,并修改了血液稀释剂的使用,然后大多数(95.3%)的声明在第二轮中达成共识。在第3轮中,开放式答复表明小组成员认为CCH适合大多数Dupuytren病患者。
■具有丰富CCH经验的专家手外科医生的共识性发现表明,CCH在治疗Dupuytren疾病中具有广泛的应用,这些患者具有不同程度的疾病严重程度和功能障碍。
■治疗性V.
UNASSIGNED: The aim of this study was to establish the consensus recommendations among hand surgeons who were experts in the use of collagenase clostridium histolyticum (CCH) on the appropriate treatment of Dupuytren disease in well-defined patient populations with varying degrees of disease severity and functional impairment.
UNASSIGNED: A three-round, blinded, modified Delphi process examined panelists\' approaches to CCH treatment of metacarpophalangeal (MP) or proximal interphalangeal (PIP) joint contractures involving one or two fingers with varying degrees of severity. Clinical scenarios related to poor-quality skin, postfasciectomy scarring, boutonnière deformity, closed capsulotomy, and blood thinner use were also presented for panelist consideration. Panelists provided responses to clinical scenarios using a 5-point Likert scale or a yes/no response. Consensus was defined as ≥66.7% panelist agreement or disagreement.
UNASSIGNED: Twenty panelists completed round 1; 19 of the 20 panelists completed rounds 2 and 3. Panelists achieved a high level of consensus for using CCH for the treatment of patients with palpable cords and varying severity contractures representing one- or two-finger MP joint contractures, most one- or two-finger PIP joint contractures, and most combined MP and PIP joint contractures. Consensus for the treatment of PIP joint contractures was mostly achieved, but clinical scenarios related to recurrent PIP contracture with poor-quality skin and/or significant postfasciectomy scarring, boutonnière deformity, PIP contractures >70°, closed capsulotomy, and blood thinner use were modified, and then most (95.3%) statements reached consensus for agreement in round 2. In round 3, open-ended responses indicated that panelists considered CCH appropriate for most patients with Dupuytren disease.
UNASSIGNED: Consensus-based findings among expert hand surgeons with substantial CCH experience indicated that CCH has a wide-ranging application for the treatment of Dupuytren disease in patients with varying degrees of disease severity and functional impairment.
UNASSIGNED: Therapeutic V.