ABSTRACT
Objetivo: El tratamiento con colagenasa Clostridium histolyticum (CCH) ocupa hoy en día una alternativa para la contractura de Dupuytren. Nuestro objetivo es valorar su eficacia a un año en una serie de pacientes consecutivos. Material y método: Estudio prospectivo con seguimiento mínimo de los pacientes de un año. Valoración de resultados y efectos adversos. Resultados: Se incluye un total de 75 articulaciones tratadas en 51 pacientes. La edad media fue de 65,18 años (DE: 7,288) y el 82,7% eran varones. La contractura media inicial de la MCF fue de 34,0 grados (DE: 27,37), de la IFP 41,5 grados (DE: 31,33) y de la afectación combinada (MCF+IFP) de 75,5 grados (DE: 35,2). Se alcanzó la eficacia en 68 pacientes (90,7%). Los efectos adversos fueron leves y autolimitados. La corrección media para la articulación MCF fue de 28,96 grados (DE: 26,90) y para la IFP fue de 28,72 grados (DE: 24,30). La tasa de recidivas fue de 18 (24,0%) articulaciones en 14 pacientes, siendo más frecuentes en los casos graves. El QuickDASH mostró mínimas diferencias medido antes de la intervención y al año. Discusión: Nuestros resultados presentan mejor evolución en los casos leves; la evolución es más favorable y con mayor tasa de éxitos en la articulación MCF. El QuickDASH no es una herramienta útil para la valoración de la contractura de Dupuytren. Conclusiones: El tratamiento con CCH para la CD es un tratamiento efectivo a medio plazo. Presenta peor evolución en afecciones de articulaciones combinadas, 5.o dedo, IFP y casos graves
Aim: Clostridium histolyticum collagenase (CCH) is nowadays an alternative treatment for the contracture of Dupuytren. Our objective is to assess its effectiveness at one year in a series of consecutive patients. Material and method: Prospective study with minimum follow-up of one year. Evaluation of results and adverse effects. Results: A total of 75 joints treated in 51 patients were included. The average age was 65.18years (SD: 7.288) and 82.7% were males. The initial mean contraction of the MCP was 34.0 degrees (SD: 27.37), PIP 41.5 degrees (SD: 31.33) and combined impairment (MCF+IFP) of 75.5 degrees (SD: 35.2). Efficacy was achieved in 68 patients (90.7%). Adverse effects were mild and self-limiting. The mean correction for the MCP joint was 28.96 degrees (SD: 26.90) and for PIP it was 28.72 degrees (SD: 24.30). The recurrence rate was 18 (24.0%) joints in 14 patients, being more frequent in severe cases. QuickDASH score showed minimal differences measured before the intervention and once a year. Discussion: Our results show a better outcome in mild cases; the outcome was more favourable and with a higher success rate in the MCP joint. QuickDASH score is not a useful tool for the assessment of Dupuytren's contracture. Conclusions: Treatment with CCH for Dupuytren's contracture is an effective treatment in the medium term. It has a poorer outcome in combined joint disorders, 5th finger, PIP and severe cases
Subject(s)
Humans , Dupuytren Contracture/therapy , Clostridium histolyticum , Microbial Collagenase/therapeutic use , Prospective Studies , Treatment Outcome , Recovery of FunctionABSTRACT
Aim Clostridium histolyticum collagenase (CCH) is nowadays an alternative treatment for the contracture of Dupuytren. Our objective is to assess its effectiveness at one year in a series of consecutive patients. MATERIAL AND METHOD: Prospective study with minimum follow-up of one year. Evaluation of results and adverse effects. RESULTS: A total of 75 joints treated in 51 patients were included. The average age was 65.18years (SD: 7.288) and 82.7% were males. The initial mean contraction of the MCP was 34.0 degrees (SD: 27.37), PIP 41.5 degrees (SD: 31.33) and combined impairment (MCF+IFP) of 75.5 degrees (SD: 35.2). Efficacy was achieved in 68 patients (90.7%). Adverse effects were mild and self-limiting. The mean correction for the MCP joint was 28.96 degrees (SD: 26.90) and for PIP it was 28.72 degrees (SD: 24.30). The recurrence rate was 18 (24.0%) joints in 14 patients, being more frequent in severe cases. QuickDASH score showed minimal differences measured before the intervention and once a year. DISCUSSION: Our results show a better outcome in mild cases; the outcome was more favourable and with a higher success rate in the MCP joint. QuickDASH score is not a useful tool for the assessment of Dupuytren's contracture. CONCLUSIONS: Treatment with CCH for Dupuytren's contracture is an effective treatment in the medium term. It has a poorer outcome in combined joint disorders, 5th finger, PIP and severe cases.
