重复胶原酶治疗双膝挛缩的疗效。

IF 2.1 2区医学 Q2 ORTHOPEDICS

Journal of Hand Surgery-American Volume Pub Date : 2024-12-01 DOI:10.1016/j.jhsa.2023.03.026

Joseph M. Legato MD , Meera K. Gill DO , Nino A. Coutelle MD , Jason A. Nydick DO

{"title":"重复胶原酶治疗双膝挛缩的疗效。","authors":"Joseph M. Legato MD , Meera K. Gill DO , Nino A. Coutelle MD , Jason A. Nydick DO","doi":"10.1016/j.jhsa.2023.03.026","DOIUrl":null,"url":null,"abstract":"<div><h3>Purpose</h3><div><span>Injectable collagenase </span><em>Clostridium histolyticum</em><span> has been an effective and well-tolerated nonsurgical treatment option for the management of Dupuytren contracture<span><span> of the hand. The purpose of this study was to determine the efficacy of collagenase injection and </span>adverse event rate in patients who had undergone previous collagenase treatment.</span></span></div></div><div><h3>Methods</h3><div><span><span>A retrospective chart review was performed on 332 patients treated with collagenase injection for Dupuytren contracture by three fellowship-trained hand surgeons at a single institution from 2009 to 2019. Fifty-nine joints in 45 patients underwent repeat collagenase therapy for recurrent contracture in the same digit. Pretreatment and posttreatment total metacarpophalangeal and </span>proximal interphalangeal joint </span>flexion contractures were recorded, with complete correction defined as <5° residual digital flexion contracture. Postmanipulation skin tears and adverse events were recorded. A comparison was made between average contracture improvement after initial collagenase injection and that after repeat injection.</div></div><div><h3>Results</h3><div>Forty-five patients with an average duration of 30 months (range, 6–73 months) between initial and repeat collagenase therapies were identified. The mean improvement after first collagenase injection was 45° ± 24° (39° for metacarpophalangeal joint and 50° for proximal interphalangeal joint) compared with a mean improvement of 43° ± 23° (41° for metacarpophalangeal joint and 44° for proximal interphalangeal joint) after second injection. Although similar complete correction rates and skin tear rates (32.2 % for initial and 30.5% for repeat) were observed between initial (80%) and repeat injections (73%), the occurrence of adverse events was 3 times higher (3.4% for initial and 10.2% for repeat) in the latter group.</div></div><div><h3>Conclusions</h3><div>Collagenase treatment of Dupuytren contracture yields effective total flexion contracture correction. Repeat collagenase treatment of previously treated digits yields similar deformity correction and complete correction rates but a higher incidence of adverse events.</div></div><div><h3>Type of study/level of evidence</h3><div>Therapeutic IV.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"49 12","pages":"Pages 1271.e1-1271.e4"},"PeriodicalIF":2.1000,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Outcomes Following Repeat Collagenase Treatment of Dupuytren Contracture\",\"authors\":\"Joseph M. Legato MD , Meera K. Gill DO , Nino A. Coutelle MD , Jason A. Nydick DO\",\"doi\":\"10.1016/j.jhsa.2023.03.026\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Purpose</h3><div><span>Injectable collagenase </span><em>Clostridium histolyticum</em><span> has been an effective and well-tolerated nonsurgical treatment option for the management of Dupuytren contracture<span><span> of the hand. The purpose of this study was to determine the efficacy of collagenase injection and </span>adverse event rate in patients who had undergone previous collagenase treatment.</span></span></div></div><div><h3>Methods</h3><div><span><span>A retrospective chart review was performed on 332 patients treated with collagenase injection for Dupuytren contracture by three fellowship-trained hand surgeons at a single institution from 2009 to 2019. Fifty-nine joints in 45 patients underwent repeat collagenase therapy for recurrent contracture in the same digit. Pretreatment and posttreatment total metacarpophalangeal and </span>proximal interphalangeal joint </span>flexion contractures were recorded, with complete correction defined as <5° residual digital flexion contracture. Postmanipulation skin tears and adverse events were recorded. A comparison was made between average contracture improvement after initial collagenase injection and that after repeat injection.</div></div><div><h3>Results</h3><div>Forty-five patients with an average duration of 30 months (range, 6–73 months) between initial and repeat collagenase therapies were identified. The mean improvement after first collagenase injection was 45° ± 24° (39° for metacarpophalangeal joint and 50° for proximal interphalangeal joint) compared with a mean improvement of 43° ± 23° (41° for metacarpophalangeal joint and 44° for proximal interphalangeal joint) after second injection. Although similar complete correction rates and skin tear rates (32.2 % for initial and 30.5% for repeat) were observed between initial (80%) and repeat injections (73%), the occurrence of adverse events was 3 times higher (3.4% for initial and 10.2% for repeat) in the latter group.</div></div><div><h3>Conclusions</h3><div>Collagenase treatment of Dupuytren contracture yields effective total flexion contracture correction. Repeat collagenase treatment of previously treated digits yields similar deformity correction and complete correction rates but a higher incidence of adverse events.</div></div><div><h3>Type of study/level of evidence</h3><div>Therapeutic IV.</div></div>\",\"PeriodicalId\":54815,\"journal\":{\"name\":\"Journal of Hand Surgery-American Volume\",\"volume\":\"49 12\",\"pages\":\"Pages 1271.e1-1271.e4\"},\"PeriodicalIF\":2.1000,\"publicationDate\":\"2024-12-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Hand Surgery-American Volume\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0363502323001806\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Hand Surgery-American Volume","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0363502323001806","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ORTHOPEDICS","Score":null,"Total":0}

引用次数: 0

摘要

目的：注射溶组织梭菌胶原酶是一种有效且耐受性良好的非手术治疗手部Dupuytren挛缩的方法。本研究的目的是确定先前接受过胶原酶治疗的患者注射胶原酶的疗效和不良事件发生率。方法：回顾性分析2009 - 2019年同一医院3名研修手外科医师接受胶原酶注射治疗Dupuytren挛缩的332例患者的资料。45例患者59个关节因同一指复发性挛缩而接受重复胶原酶治疗。记录治疗前和治疗后掌指关节和近端指间关节屈曲挛缩，并将完全矫正定义为：结果：45例患者首次和重复胶原酶治疗的平均持续时间为30个月（范围6-73个月）。第一次注射胶原酶后平均改善45°±24°（掌指关节39°，近指关节50°），第二次注射后平均改善43°±23°（掌指关节41°，近指关节44°）。虽然在首次注射（80%）和重复注射（73%）之间观察到相似的完全矫正率和皮肤撕裂率（初次注射32.2%，重复注射30.5%），但后者的不良事件发生率高3倍（初次注射3.4%，重复注射10.2%）。结论：胶原酶治疗可有效矫正全屈曲挛缩。对先前治疗过的手指进行重复胶原酶治疗可获得相似的畸形矫正和完全矫正率，但不良事件发生率较高。研究类型/证据水平：治疗性IV。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

查看原文本刊更多论文

Outcomes Following Repeat Collagenase Treatment of Dupuytren Contracture

Purpose

Injectable collagenase Clostridium histolyticum has been an effective and well-tolerated nonsurgical treatment option for the management of Dupuytren contracture of the hand. The purpose of this study was to determine the efficacy of collagenase injection and adverse event rate in patients who had undergone previous collagenase treatment.

Methods

A retrospective chart review was performed on 332 patients treated with collagenase injection for Dupuytren contracture by three fellowship-trained hand surgeons at a single institution from 2009 to 2019. Fifty-nine joints in 45 patients underwent repeat collagenase therapy for recurrent contracture in the same digit. Pretreatment and posttreatment total metacarpophalangeal and proximal interphalangeal joint flexion contractures were recorded, with complete correction defined as <5° residual digital flexion contracture. Postmanipulation skin tears and adverse events were recorded. A comparison was made between average contracture improvement after initial collagenase injection and that after repeat injection.

Results

Forty-five patients with an average duration of 30 months (range, 6–73 months) between initial and repeat collagenase therapies were identified. The mean improvement after first collagenase injection was 45° ± 24° (39° for metacarpophalangeal joint and 50° for proximal interphalangeal joint) compared with a mean improvement of 43° ± 23° (41° for metacarpophalangeal joint and 44° for proximal interphalangeal joint) after second injection. Although similar complete correction rates and skin tear rates (32.2 % for initial and 30.5% for repeat) were observed between initial (80%) and repeat injections (73%), the occurrence of adverse events was 3 times higher (3.4% for initial and 10.2% for repeat) in the latter group.

Conclusions

Collagenase treatment of Dupuytren contracture yields effective total flexion contracture correction. Repeat collagenase treatment of previously treated digits yields similar deformity correction and complete correction rates but a higher incidence of adverse events.

Type of study/level of evidence

Therapeutic IV.

求助全文

通过发布文献求助，成功后即可免费获取论文全文。去求助

来源期刊

Journal of Hand Surgery-American Volume 医学-外科

CiteScore

3.20

自引率

10.50%

发文量

402

审稿时长

12 weeks

期刊介绍： The Journal of Hand Surgery publishes original, peer-reviewed articles related to the pathophysiology, diagnosis, and treatment of diseases and conditions of the upper extremity; these include both clinical and basic science studies, along with case reports. Special features include Review Articles (including Current Concepts and The Hand Surgery Landscape), Reviews of Books and Media, and Letters to the Editor.