Dupuytren Kontraktürü: Parsiyel Fasiektomi Uygulanan 32 Hastanın Retrospektif Analizi

Öz

Dupuytren kontraktürü nedeniyle parsiyel fasiektomi uyguladığımız 32 hastanın demografik ve klinik özellikleri, fonksiyonel sonuçları, komplikasyon ve nüks oranları güncel literatür eşliğinde tartışıldı. Çalışmamızda; erkek/kadın oranı: 7/1, hastalığın başlangıcındaki ortalama yaş 55.4±7.1, cerrahi esnasındaki ortalama yaş 60.4±8.1 olarak tespit edildi. 7 hastada (%21.875) aile öyküsü, 22 hastada (%68.75) sigara kullanımı, 6 hastada (%18,75) düzenli alkol kullanımı, 10 hastada (%31,25) tip 2 diyabet, 2 hastada (%6.25) karaciğer hastalığı, 1 hastada (%3.125) epilepsiye bağlı uzun süre barbitürat kullanımı gibi etiyolojik faktörler mevcuttu. En sık etkilenen parmak 26 hasta (%81.25) ile yüzük parmağı olup, 18 hastada (%56.25) küçük parmak, 8 hastada (%25) orta parmak, 1 hastada (%3.125) işaret parmağı tutulumu vardı. Ameliyat öncesi, ortalama total pasif ekstansiyon kaybı (TPEK) 89.68º±30.29, ameliyat sonrası ortalama TPEK 6.09º±6.44 olarak bulundu. Ameliyat sonrası ortalama total ekstansiyon kazancı %93.2 olarak bulundu. Ortalama takip süresi 70±44 ay olup, bu süre içerisinde 1 hastada (%3.125) nüks görüldü. 2 hastada pansumanlara sekonder iyileşen cilt nekrozu, 1 hastada geçici hipoestezi olmak üzere toplam 3 hastada (%9.375) komplikasyon meydana geldi. MKF ve PİP eklem kontraktüründe yeterli düzelme sağlaması, komplikasyon ve nüks oranlarının düşük olması nedeniyle parsiyel fasiektomi dupuytren kontraktürünün cerrahi tedavisinde etkili ve güvenilir bir yöntemdir.

Anahtar Kelimeler

• Dupuytren Hastalığı,Kontraktür,Parsiyel fasiektomi

Dupuyten’ s Contracture: Retrospective Analysis of 32 Patients Operated by Partial Fasciectomy

Öz

Demographic and clinical features of 32 patients diagnosed with dupuytren contracture and operated by partial fasciectomy were included in this study.  Functional results, complications and recurrence rates were discussed with current literature. In our study male/female ratio was 7/1, mean age at onset of disease was 55.4±7.1, mean age at surgery was 60.4±8.1. There were etiological factors such as a family history in 7 patients (21.875%), smoking in 22 patients (68.75%), regular alcohol use in 6 patients  (%18,75), type 2 diabetes in 10 patients (31.25%), hepatic disease in 2 patients (6.25%), long term barbiturate use for epilepsy in 1 patients (3.125%). The most often involved finger was the ring finger in 26 patients (81.25%), the small finger in 18 patients  (56.25%), middle finger in 8 patients (25%) and index finger in 1 patient (3.125%). The pre-operative mean total passive extension deficit (TPEK) was 89.68º ± 30.29, the post-operative mean TPED was 6.09º ± 6.44. The post-operative mean total extension gain was 93.2%. The mean follow-up was 70±44 months, 1 patient (3.125%) had a recurrence in this period. The overall complications occured in 3 patients (9.375%), including skin necrosis in 2 patients (treated with dressings) and temporary hypoesthesia in 1 patient. The partial faciectomy is an effective and reliable method for the surgical treatment of dupuyren contracture because of improvement enough correction in the MCF and PIP joint contracture, the low rate of complication and recurrence rates.

Anahtar Kelimeler

• Dupuytren’ s disease,Contracture,Partial Fasciectomy

Kaynakça

1. 1. Thurston A. Dupuytren's disease or Cooper's contracture? Kenneth Fitzpatrick Russell Memorial Lecture. ANZ J Surg 2003;73(7):529-35.
2. 2. Townley WA, Baker R, Sheppard N, Grobbelaar AO. Dupuytren's contracture unfolded. BMJ 2006;332(7538):397-400.
3. 3. Hindocha S. Risk Factors, Disease Associations, and Dupuytren Diathesis. Hand Clin 2018;34(3):307-14
4. 4. Rayan GM. Clinical presentation and types of Dupuytren’s disease. Hand Clinic 1999;15(1):87-96.
5. 5. Geoghegan JM, Forbes J, Clark DI, Smith C, Hubbard R. Dupuytren's disease risk factors. J Hand Surg Br 2004;29(5):423-6.
6. 6. Luck JV. Dupuytren's contracture; a new concept of the pathogenesis correlated with surgical management. J Bone Joint Surg Am 1959:41(4):635-64.
7. 7. Tubiana R. Evaluation of deformities in Dupuytren’s disease. Ann Chir Main 1986;5(1):5-11.
8. 8. McGrouther DA. Dupuytren’s contracture. In: Green’s operative hand surgery. 6th ed. Philadelphia: Elsevier; 2005.159-85.

9. 9. Smith AC. Diagnosis and indications for surgical treatment. Hand Clin. 1991;7(4):635-42.
10. 10. Crean SM, Gerber RA, Graverand MP, Boyd DM, Cappelleri JC. The efficacy and safety of fasciectomy and fasciotomy for Dupuytren’s contracture in European patients: a structured review of published studies. J Hand Surg Eur 2011;36(5):396-407.
11. 11. Desai SS, Hentz VR. The treatment of Dupuytren disease. J Hand Surg Am 2011; 36(5):936-42.
12. 12. Eaton C. Percutaneous fasciotomy for Dupuytren’s contracture. J Hand Surg Am 2011;36(5):910-5.
13. 13. Becker GW, Davis TR. The outcome of surgical treatments for primary Dupuytren’s disease-a systematic review. J Hand Surg Eur 2010;35(8):623-6.
14. 14. Au-Yong IT, Wildin CJ, Dias JJ, Page RE. A review of common practice in Dupuytren surgery. Tech Hand Up Extrem Surg 2005;9(4):178-87.
15. 15. van Rijssen AL, Werker PM. Percutaneous needle fasciotomy in dupuytren's disease. J Hand Surg Br 2006;31(5):498-501.
16. 16. Wilson GR. Current surgical treatment of Dupuytren’s disease. Br J Clin Pract 1997;51(2):106-10.
17. 17. Bryan AS, Ghorbal MS. The long-term results of closed palmar fasciotomy in the management of Dupuytren’s contracture. J Hand Surg Br 1988;13(3):254-6.
18. 18. Foucher G, Medina J, Navarro R. Percutaneous needle aponeurotomy: complications and results. J Hand Surg Br 2003;28(5):427-31.
19. 19. Coert JH, Nérin JP, Meek MF. Results of partial fasciectomy for Dupuytren disease in 261 consecutive patients. Ann Plast Surg 2006;57(1):13-7.
20. 20. Werker PM, Pess GM, van Rijssen AL, Denkler K. Correction of contracture and recurrence rates of Dupuytren contracture following invasive treatment: the importance of clear definitions. J Hand Surg Am 2012;37(10):2095-105.
21. 21. Dias JJ, Braybrooke J. Dupuytren’s contracture: an audit of the outcomes of surgery. J Hand Surg Br 2006;31(5):514-21.
22. 22. Dias JJ, Singh HP, Ullah A, Bhowal B, Thompson JR. Patterns of recontracture after surgical correction of Dupuytren disease. J Hand Surg Am 2013;38(10):1987-93.
23. 23. Tonkin MA, Burke FD, Varian JPW. Dupuytren’s contracture: a comparative study of fasciectomy and dermofasciectomy in one hundred patients. J Hand Surg Br 1984;9(2):156-62.
24. 24. Mäkelä EA, Jaroma H, Harju A, Anttila S, Vainio J. Dupuytren’s contracture: the long-term results after day surgery. J Hand Surg Br 1991;16(3):272-4.
25. 25. Anwar MU, Al Ghazal SK, Boome RS. Results of surgical treatment of Dupuytren’s disease in women: a review of 109 consecutive patients. J Hand Surg Am 2007;32(9):1423-8.
26. 26. Kitridis D, Karamitsou P, Giannaros I, Papadakis N, Sinopidis C, Givissis P. Dupuytren’s disease: limited fasciectomy, night splinting, and hand exercises-long-term results. Eur J Orthop Surg Traumatol 2018;doi:10.1007/s00590-018-2340-6. [Epub ahead of print]
27. 27. Dias JJ, Aziz S. Fasciectomy for Dupuytren Contracture. Hand Clin 2018;34(3):351-66.
28. 28. van Rijssen AL, Gerbrandy FS, Ter Linden H, Klip H, Werker PM. A comparison of the direct outcomes of percutaneous needle fasciotomy and limited fasciectomy for Dupuytren’s disease: a 6-week followup study. J Hand Surg Am 2006;31(5):717-25.
29. 29. Chen NC, Srinivasan RC, Shauver MJ, Chung KC. A systematic review of outcomes of fasciotomy, aponeurotomy, and collagenase treatments for Dupuytren’s contracture. Hand 2011;6(3):250-5.
30. 30. Bryan AS, Ghorbal MS. The long-term results of closed palmar fasciotomy in the management of Dupuytren’s contracture. J Hand Surg Br 1998;13(3):254-6.
31. 31. Moermans JP. Long-term results after segmental aponeurectomy for Dupuytren’s disease. J Hand Surg Br 1996;21(6):797-800.
32. 32. Clibbon JJ, Logan AM. Palmar segmental aponeurectomy for Dupuytren’s disease with metacarpophalangeal fexion contracture. J Hand Surg Br 2001;26(4):360-1.
33. 33. Armstrong JR, Hurren JS, Logan AM. Dermofasciectomy in the management of Dupuytren’s disease. J Bone Joint Surg Br 2000;82(1):90-4.
34. 34. Abbott K, Denney J, Burke FD, McGrouther DA. A review of attitudes to splintage in Dupuytren’s contracture. J Hand Surg Br 1987;12(3):326-8.