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Therapie des Morbus Dupuytren mit Kollagenase Clostridium histolyticum

Treatment of Dupuytren’s disease with collagenase Clostridium histolyticum

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Zusammenfassung

Hintergrund

Der Morbus Dupuytren als benigne fibroproliferative Erkrankung mit strangartiger Verdickung der Kollagenfasern der Palmaraponeurose führt zu schwerwiegenden Funktionseinschränkungen im Bereich der Hand.

Fragestellung

Untersuchung des Stellenwertes der nichtoperativen Behandlung der Dupuytren-Kontraktur mittels injizierbarer Kollagenase Clostridium histolyticum (CCH)

Material und Methode

Beobachten von 120 Patienten, die mittels injizierbarer CCH behandelt wurden. Dokumentieren des Bewegungsumfangs präinterventionell, des Bewegungsumfangs 12 Monate postinterventionell sowie von sämtlichen unerwünschten Nebenwirkungen.

Ergebnisse

Es wurde eine Kohorte von 120 Patienten (107 Männer, 13 Frauen) untersucht (durchschnittliches Lebensalter 62 Jahre, Spanne 30–84 Jahre). Es wurden zu 49 % Kleinfinger, zu 44 % Ringfinger, zu 4 % Mittelfinger und zu 3 % Zeigefinger behandelt. Es wurde in 71 % der Fälle eine komplette Stranglösung, in 26 % eine teilweise Stranglösung und in 3 % keine Veränderung erreicht. Die durchschnittliche Beugekontraktur für das Fingergrundgelenk betrug vor Behandlung 37° (Spanne 25–100°) und 51° (Spanne 30–97°) für das Fingermittelgelenk. Die durchschnittliche Beugekontraktur für das Fingergrundgelenk betrug nach 12 Monaten 9° (Spanne 0–25°) und 21° (Spanne 10–36°) für das Fingermittelgelenk. Unerwünschte Nebenwirkungen traten in den ersten 3 Monaten bei 96 % der Patienten auf. Es traten keine Beugesehnenrupturen, Nervenverletzungen oder allergische Reaktionen auf.

Abstract

Background

Dupuytren’s disease as a benign fibroproliferative disease leads to hyperplasia of the collagen fibers of the fascia of the palm, which can result in severe impairment of the functionality of the hand.

Objectives

Examination of the significance of non-operative treatment of Dupuytren’s disease with injectable collagenase clostridium histolyticum (CCH)

Methods

Observation of 120 patients treated with injectable collagenase. Documentation of the range of motion before the intervention, 12 months after the intervention, and documentation of any adverse events.

Results

All in all, 120 patients were treated (107 male, 13 female) (mean age 62 years, range 30–84 years). In 49% the little finger, in 44% the ring finger, in 4% the middle finger, and in 3% the index finger were treated. Full release was accomplished in 71%, partial release in 26%, and no change in 3% of the patients. The median contracture before the treatment was 37° for the metacarpophalangeal (MP) joint (range 25–100°) and 51° for the proximal interphalangeal (PIP) joint (range 30–97°). After 12 months, the mean contracture for the MP joint was 9° (range 0–25°) and 21° (range 10–36°) or the PIP joint. Adverse events occurred in 96% of patients within 3 months after treatment. No tendon ruptures, anaphylactic reactions, nerve, or ligament injuries were observed.

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Authors and Affiliations

  1. Department für Unfallchirurgie, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich

    M. Keller,  R. Arora, G. Schmiedle & T. Kastenberger

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  1. M. Keller
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  2. R. Arora
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  3. G. Schmiedle
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  4. T. Kastenberger
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Corresponding author

Correspondence to R. Arora.

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Interessenkonflikt

Das Department für Unfallchirurgie (Medizinische Universität Innsbruck) erhielt von der Firma Swedish Orphan Biovitrum GmbH finanzielle Unterstützung für die Erstellung einer nicht-interventionellen Studie (Register). Darüber hinaus geben M. Keller, R. Arora, G. Schmiedle und T. Kastenberger an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Keller, M., Arora, R., Schmiedle, G. et al. Therapie des Morbus Dupuytren mit Kollagenase Clostridium histolyticum . Orthopäde 46, 321–327 (2017). https://doi.org/10.1007/s00132-017-3386-6

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  • DOI: https://doi.org/10.1007/s00132-017-3386-6

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