局限性掌筋膜切除术联合z -成形术治疗Dupuytren病56例回顾性分析。

IF 1 4区医学 Q4 ORTHOPEDICS

Hand Surgery & Rehabilitation Pub Date : 2025-09-01 DOI:10.1016/j.hansur.2025.102206

Nathan Guez , Octave Dhellemmes , Alexandre Bazeli , Francesco Monti , Isabelle Auquit-Auckbur

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引用次数: 0

摘要

简介：筋膜切除术是治疗Dupuytren病掌指索的金标准。当屈曲挛缩在掌指关节（MCP）处占主导地位时，可以在手掌进行节段性腱膜切除术并进行z形成形术。本研究的主要目的是评估这种有限手术对MCP扩展的改善。次要目的是评估长期并发症和复发率。材料与方法：回顾性研究2014 - 2023年间单纯掌段筋膜切除术z -成形术患者。掌筋膜切除术用于单纯或显性MCP Dupuytren挛缩的患者。局部筋膜切除术实现了MCP关节的完全伸展。一种或多种z型塑料可实现无张力伤口闭合。对患者进行复查，记录伸展缺损、并发症和复发情况。结果：回顾46例患者（56条手术射线），平均随访时间26个月（10-60个月）。术前MCP延伸缺损平均为48.4°。在最后随访时，平均MCP挛缩为6.1°，改善率为87%。11例复发，5例术后出现复杂的局部疼痛综合征，1例神经失用症自行消退。讨论：节段性掌筋膜切除术和z -成形术显示了MCP延伸的显著改善。并发症似乎比扩展掌指筋膜切除术少，复发率低于胶原酶或筋膜切开术。结论：有限掌筋膜切除术联合z -成形术是治疗以MCP屈曲挛缩为主要或唯一表现的Dupuytren病的一种简单、安全、有效的治疗方法。

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Limited palmar fasciectomy combined with Z-plasty for Dupuytren’s disease: A 56 cases review

Introduction

Fasciectomy is the gold standard for treating palmodigital cords in Dupuytren's disease. When flexion contracture predominates at the metacarpophalangeal (MCP) joint, a segmental aponeurectomy in the palm combined with a Z-plasty can be performed.

The primary objective of this study was to evaluate the improvement in MCP extension achieved by this limited procedure. The secondary objectives were to assess long-term complications and recurrence rates.

Materials and methods

A retrospective study was conducted on patients who underwent pure palmar segmental fasciectomy with Z-plasty between 2014 and 2023. Palmar fasciectomy was performed on patients with exclusive or predominant MCP Dupuytren's contracture. This local fasciectomy procedure achieved full MCP joint extension. One or more Z-plasties enabled tension-free wound closure. Patients were reviewed, and extension deficit, complications, and recurrence were noted.

Results

46 patients (56 operated rays) were reviewed, with a mean follow-up period of 26 months (range 10–60 months). The mean preoperative MCP extension deficit was 48.4°. At the final follow-up, the mean MCP contracture was 6.1°, representing an improvement rate of 87%. Eleven patients experienced recurrence, five developed complex regional pain syndrome after surgery and one had neurapraxia that resolved spontaneously.

Discussion

Segmental palmar fasciectomy and Z-plasty demonstrated substantial improvement in MCP extension. Complications appear to be fewer than with extended palmo-digital fasciectomy, and the recurrence rate is lower than with collagenase or fasciotomy.

Conclusion

Limited palmar fasciectomy combined with Z-plasty is a simple, safe and effective treatment option for patients with MCP flexion contracture as the predominant or exclusive manifestation of Dupuytren’s disease.

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来源期刊

Hand Surgery & Rehabilitation Medicine-Surgery

CiteScore

1.70

自引率

27.30%

发文量

审稿时长

49 days

期刊介绍： As the official publication of the French, Belgian and Swiss Societies for Surgery of the Hand, as well as of the French Society of Rehabilitation of the Hand & Upper Limb, ''Hand Surgery and Rehabilitation'' - formerly named "Chirurgie de la Main" - publishes original articles, literature reviews, technical notes, and clinical cases. It is indexed in the main international databases (including Medline). Initially a platform for French-speaking hand surgeons, the journal will now publish its articles in English to disseminate its author''s scientific findings more widely. The journal also includes a biannual supplement in French, the monograph of the French Society for Surgery of the Hand, where comprehensive reviews in the fields of hand, peripheral nerve and upper limb surgery are presented. Organe officiel de la Société française de chirurgie de la main, de la Société française de Rééducation de la main (SFRM-GEMMSOR), de la Société suisse de chirurgie de la main et du Belgian Hand Group, indexée dans les grandes bases de données internationales (Medline, Embase, Pascal, Scopus), Hand Surgery and Rehabilitation - anciennement titrée Chirurgie de la main - publie des articles originaux, des revues de la littérature, des notes techniques, des cas clinique. Initialement plateforme d''expression francophone de la spécialité, la revue s''oriente désormais vers l''anglais pour devenir une référence scientifique et de formation de la spécialité en France et en Europe. Avec 6 publications en anglais par an, la revue comprend également un supplément biannuel, la monographie du GEM, où sont présentées en français, des mises au point complètes dans les domaines de la chirurgie de la main, des nerfs périphériques et du membre supérieur.