Therapie des Morbus Dupuytren mit Injektion von Kollagenase in Deutschland – Ergebnisse und Komplikationen an 110 Gelenken

Abstract

Since 2011, a new minimally-invasive treatment for Dupuytren's disease has been available in the form of injectable collagenase (Xiapex®, Pfizer). Our aim is to report about the results and adverse effects of injectable collagenase for the treatment of Dupuytren's disease in Germany. We treated 78 patients (61 male, 17 female) with 87 injections in 87 digits (little finger n = 40, ring finger n = 37, middle finger n = 8 and index n = 2). We documented the range of motion before treatment, after 6 weeks and after 6 months. We were able to include 39 patients (32 male, 7 female) in the 6-month follow-up. The initial correction in MCP joints (n = 26) was from an average 51° to 0° (p< 0.05). After 6 months there was an average reduction of contracture in MCP joints (n = 16) from 52° to 0° (p < 0.05). The initial correction in PIP joints (n = 28) was from an average of 63° to 15° (p < 0.05). After 6 months, PIP joints (n = 12) exhibited an average correction from 70° auf 40° (p < 0.05). In combined contractures of MCP und PIP joints (n = 33), there was a mean reduction from 96° to 13° (p < 0.05). In the 6-month follow-up, the correction of combined contractures (n = 16) was from 91° to 61° (p < 0.05). Common adverse effects were local oedema (n = 36), followed by haematoma (n = 25), temporary livid discolouration (n = 17) and skin tears (n=16). There were no severe complications such as tendon ruptures, vessel or nerve injuries. The most severe complications comprised 4 little skin defects that healed with conservative wound care. Our results are comparable with previous international studies. Very good success has been achieved with single injection treatment for high-grade preoperative contractures in MCP joints, while treatment success for combined contractures of MCP and PIP joints has been satisfactory. There have been no severe complications. Common adverse effects have been similar to previous studies. In our opinion, collagenase injection is a safe and efficient treatment for Dupuytren's disease. Further studies are needed to compare long-term efficacy with percutaneous needle aponeurotomy und partial fasciectomy.