Review of Partial Fasciectomy for Dupuytren's Contracture in Southern Chinese Patients

Dupuytren's contracture is a fibroproliferative disease of the palmar fascia producing fascial fibrosis in nodular or cord form, and results in flexion contracture of the involved fingers. In contrast to Western populations, Dupuytren's contracture, especially the severe form of the disease, is not common in Southern Chinese patients: there have been only scant reports from the Southern Chinese region. In addition, the natural history and surgical outcome may be different from those of Western patients. The purpose of our study was to evaluate the clinical outcomes of Southern Chinese patients with Dupuytren's contracture treated with partial fasciectomy through a Bruner's incision. Twenty-nine Chinese patients (45 fingers) with Dupuytren's contracture were reviewed retrospectively from 1999 to 2008. All patients underwent partial fasciectomy performed under general anaesthesia. The ranges of movement of the metacarpophalangeal (MCPJ) and proximal interphalangeal (PIPJ) joints were measured preoperatively and during follow-up to assess the degree of correction after surgery. A total of 34 out of 45 fingers (75.6%) and 30 out of 45 fingers (66.7%) had regained a full range of movement of the MCPJs and PIPJs, respectively. In addition, 26 out of 29 patients (89.6%) had an improvement in extension of their MCPJs, and 20 out of 29 patients (68.9%) showed a gain in extension of their PIPJs. One in 29 patients (3.4%) developed a wound infection and needed further surgery for debridement. One patient had recurrent PIPJ contracture after partial fasciectomy (3.4%). None of our patients had a neurovascular injury or wound healing problem. We conclude that partial fasciectomy with a Bruner's incision yields satisfactory results in Southern Chinese patients that are comparable to results from Western studies.

中文摘要迪皮特朗攣縮症 （Dupuytren's Contracture） 是由手掌筋膜纖維增生化病變形成。它造成結節狀或條索狀纖維增生，並引致有關之手指攣縮。對比起西方國家，迪皮特朗攣縮症（特別是嚴重的類型）在中國南方并不常見。過往有少數研究指出南中國迪皮特朗攣縮症病人的自然史和手術結果可能不同於西方的病人。我們研究的目的是為了評估南中國迪皮特朗攣縮症患者以布魯納切口進行局部間膜切除術的臨床結果。在1999年至2008年間，我們回顧分析了29個中國病人患有迪皮特朗攣縮症的個案(共45隻受影響的手指), 所有患者均在全身麻醉下進行局部筋膜切除術。我們量度了術前及術後掌指關節（MCPJ）及近端指間關節（PIPJ） 的活動幅度然後作出比較來評估手術後的改善幅度。其中34隻受影響的手指（75.6%）於手術後得到MCPJ 活動幅度的完全恢復， 而30隻受影響的手指 （66.7%） 於手術後得到PIPJ 活動幅度的完全恢復。 其中26個病人（89.6%）的MCPJ 的伸展能力於術後得到改善， 而20個病人 （68.9%） 的PIPJ的伸展能力於術後得到改善。在29個病人當中， 其中一人 （3.4%） 出現傷口發炎的併發症而需要進行清創手術，另一人（3.4%）的指節攣縮症狀在術後復發。在我們的病人當中，沒有發生其他併發症，如神經線或血管受損或傷口無法愈合等。我們推斷利用布魯納切口進行局部筋膜切除術來治療南中國病人患有迪皮特朗攣縮症，是可得到滿意的治療效果， 而結果是相當於西方的研究。