Clinical Outcomes of Collagenase Injections in Management of Dupuytren Contracture of the Proximal Interphalangeal Joint

Q3 Medicine Journal of Hand Surgery Global Online Pub Date : 2024-09-01 DOI:10.1016/j.jhsg.2024.05.009

Craig Dent MS , Nino Coutelle MD , Andrew Moore MD , Matthew Nester BS , Peter Simon PhD , Jason A. Nydick DO

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Abstract

Purpose

Dupuytren contracture is characterized by the formation of cords and nodules in the palm. Surgical release has historically been the definitive treatment. Collagenase clostridium histolyticum (CCH) has been used successfully as an alternative to surgery. The treatment of proximal interphalangeal (PIP) contractures is the most challenging. The purpose of this study was to evaluate CCH treatment for Dupuytren contracture of the PIP joint.

Methods

A retrospective chart review was performed for CCH treatment of Dupuytren contracture at a single institution from January 2010 to April 2023. Data collected included pretreatment/posttreatment total flexion contracture and adverse events. Contractures were analyzed both by severity (high >40° and low <40°) and type (isolated PIP; combined metacarpophalangeal and PIP).

Results

A total of 304 patients with 470 PIP joints treated were included. Digits with isolated and combined contractures each had an average pre-CCH treatment contracture of 51 (±23) degrees. Postmanipulations the contractures were 6 (±13) and 7 (±16) degrees, respectively. Clinical success (<5° residual contracture) and improvement (>50% correction of contracture) were associated with low severity contractures at postmanipulation. There were 256 adverse events recorded (54.5%), including 187 skin tears (39.8%), 68 cases of lymphadenopathy (14.5%), and one injection site infection (0.2%). High severity and combined contractures were independently associated with an increased incidence of skin tears upon manipulation.

Conclusions

Collagenase clostridium histolyticum treatment is effective for isolated or combined PIP joint contractures. Adverse events were associated with more severe contractures. Given the degree of improvement based on contracture severity, earlier intervention may provide better correction of contracture.

Type of study/level of evidence

Therapeutic III.

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胶原酶注射治疗近端指间关节杜普伊特伦挛缩症的临床疗效

目的杜普伊特伦挛缩症的特点是在手掌中形成索状和结节。手术松解历来是最终的治疗方法。胶原酶组织溶解梭菌（CCH）已成功用于替代手术。近端指间挛缩（PIP）的治疗最具挑战性。本研究的目的是评估CCH治疗PIP关节杜普伊特伦挛缩的效果。研究方法对2010年1月至2023年4月期间一家医疗机构采用CCH治疗杜普伊特伦挛缩的病历进行了回顾性分析。收集的数据包括治疗前/治疗后的总屈曲挛缩和不良事件。挛缩按严重程度（40°和40°）和类型（孤立PIP；掌指关节和PIP联合）进行分析。孤立挛缩和合并挛缩的手指在接受 CCH 治疗前的平均挛缩度为 51 (±23) 度。治疗后的挛缩度分别为 6 (±13) 度和 7 (±16) 度。临床成功（残余挛缩 5 度）和改善（挛缩矫正 50%）与术后挛缩严重程度低有关。共记录了 256 例不良事件（54.5%），包括 187 例皮肤撕裂（39.8%）、68 例淋巴结病（14.5%）和 1 例注射部位感染（0.2%）。结论：胶原酶溶解梭菌治疗对孤立或合并的 PIP 关节挛缩有效。不良事件与更严重的挛缩有关。鉴于挛缩严重程度的改善程度，早期干预可能会更好地矫正挛缩。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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