Steenbeek, L.M. (2016) Recurrence of Dupuytren’s Disease after treatment with Collagenase Clostridium Histolyticum (CCH) in thumb and fingers. thesis, Medicine.
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Abstract
Purpose To give patients with Dupuytren’s disease in the thumb and fingers the best treatment options, it is not only important to know the treatment efficacy, but also the durability. Especially in Dupuytren’s disease, a progressive disease with a high recurrence rate after treatment, is it necessary to know the rate, time and severity of recurrence. This study will examine the long-term effect of the study “Collagenase Treatment for Dupuytren Disease of the Thumb and First Web”(1) and the initial effect and long-term effect of treatment with Collagenase Clostridium Histolyticum (CCH) for Dupuytren’s contracture in fingers. Methods We prospectively included 11 out of 14 thumbs used in the previous study by Dreise et al.(1), which were treated for a contracture at the metacarpophalangeal (MCP) or interphalangeal (IP) joint of at least 20° total passive extension deficit (TPED) with a palpable cord in the thumb (n = 7) or an adduction contracture of the thumb with palpable cords in the first web (n = 4). The 3 years post-treatment passive extension deficits (PED), TPED and Intermetacarpophalangeal Head Distance (IMD) for all treated thumbs were measured and compared with the pre-treatment and 30 days post-treatment measurement, using the Wilcoxon signed rank test. An analysis of zones was performed for the separate contribution of treatment of a pretendinous cord and a first web cord on both TPED and IMD. Recurrence was defined as a worsening of at least 20° in TPED compared to 30 days post-treatment or as any decrease in IMD compared with pre-treatment and/or secondary surgical/medical intervention. In the part of this follow-up study concerning the fingers, 46 fingers previously treated with CCH for contractures at the MCP or proximal interphalangeal (PIP) joint of at least 20° with a palpable cord in the finger, were included. Subgroups for initial effect were made and classified as ‘successfully treated’, ‘measurable improved’ and ‘not effectively treated’. The 4 years extension deficit was measured and compared to the pre-treatment and 30 days post-treatment measurements for all joints and for each group. The Wilcoxon signed rank test was used to analyze the data. As for the thumbs, recurrence was defined as a worsening of at least 20° in extension deficit compared to 30 days post-treatment and/or secondary surgical/medical intervention. Results We found a mean increase in TPED of 10° at 3 years follow-up compared to 30 days post-treatment. MCP joints had superior results compared to IP joints. IMD was still significantly improved compared to pre-treatment and had just 1 mm worsening compared to 30 days post-treatment. Analysis by treated zones showed a significant improvement of TPED measurements (except for the 3 years follow-up) and a significant durable effect in IMD when patients were treated in a pretendinous cord. Patients treated for a first web cord had no significant results for TPED or IMD. Forty-five percent of all treated thumbs had a recurrence within 3 years. Results of CCH treatment in the fingers were as follows: 61 percent of all joints, 77 percent of MCP joints and 9 percent of PIP joints were treated successfully. Seventy-five percent successfully treated joints had a durable correction, with 8° PED deterioration over a time of 4 years, but still showed 29° PED reduction compared to pre-treatment. MCP joints had more durable correction compared to PIP joints. A recurrence rate of 25 percent was found for successfully treated joints. Most patients had some minor adverse events one day after injection including injection site pain, hematoma and/or bruising, swelling or had a skin rupture due to manipulation of the finger. No serious adverse events occurred in our study. Conclusions Collagenase Clostridium Histolyticum is a reasonable option for treatment for pretendinous cords in thumbs affected with Dupuytren’s disease because it provides acceptable results, is minimally invasive with minor adverse events and has a very short recovery. Treatment with CCH of Dupuytren’s finger contracture satisfies many requirements that are necessary for a good treatment. Those are: 1) correction of finger deformity and range of motion; 2) short recovery with no serious complications and 3) durable effect.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Werker, Professor P.M.N. and Department of Plastic Surgery and Universitair Medisch Centrum Groningen |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:47 |
| Last Modified: | 25 Jun 2020 10:47 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/800 |
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