Handchir Mikrochir Plast Chir 2019; 51(04): 262-274
DOI: 10.1055/a-0627-7333
Consensus Statement
© Georg Thieme Verlag KG Stuttgart · New York

Therapie der Dupuytren’schen Kontraktur mit Kollagenase

Evidenz-basiertes Konsensus Statement[1] chirurgischer Fachgesellschaften ÖsterreichsTherapy of Dupuytren’s contracture with collagenaseEvidence-based Consensus Statement of Austrian Surgical Societies
Werner Girsch
1   LKH - Universitätsklinikum Graz/Klinische Abteilung für Plastische, Ästhetische & Rekonstruktive Chirurgie, Graz
,
Rohit Arora
2   Univ.-Klinik für Unfallchirurgie Innsbruck, Innsbruck
,
Eva-Maria Baur
3   Univ.-Klinik für Plastische, Rekonstruktive und Ästhetische Chirurgie Innsbruck, Innsbruck
,
Markus Gabl
2   Univ.-Klinik für Unfallchirurgie Innsbruck, Innsbruck
,
Dietmar Hager
4   niedergelassener Facharzt für Unfallchirurgie, Linz
,
Thomas Hintringer
5   Krankenhaus der Barmherzigen Schwestern/ Abteilung für Plastische, Ästhetische und Rekonstruktive Chirurgie, Linz
,
Lars-Peter Kamolz
1   LKH - Universitätsklinikum Graz/Klinische Abteilung für Plastische, Ästhetische & Rekonstruktive Chirurgie, Graz
,
Rupert Koller
6   Wilhelminenspital/Abteilung für Plastische und Wiederherstellungschirurgie, Wien
,
Christian Krasny
7   Orthopädisches Spital Speising/I. Orthopädische Abteilung, Wien
,
Martin Leixnering
8   Unfallkrankenhaus Lorenz Böhler/Unfallchirurgie Handchirurgie, Wien
,
Walpurga Lick-Schiffer
9   Landeskrankenhaus Stolzalpe, Stolzalpe
,
Matthias Rab
10   Klinikum Klagenfurt am Wörthersee /Abteilung für Plastische, Ästhetische und Rekonstruktive Chirurgie, Klagenfurt
,
Ingrid Schlenz
6   Wilhelminenspital/Abteilung für Plastische und Wiederherstellungschirurgie, Wien
,
Gottfried Wechselberger
11   Krankenhaus der Barmherzige Brüder Salzburg/Plastische, Rekonstruktive und Ästhetische Chirurgie, Salzburg
,
Gerlinde Weigel
12   Landesklinikum Mistelbach-Gänserndorf, Handzentrum, Mistelbach
,
Armin Zadra
13   Landeskrankenhaus Südsteiermark Standort Bad Radkersburg/Abteilung für Orthopädie, Bad Radkersburg
,
Robert Zimmermann
3   Univ.-Klinik für Plastische, Rekonstruktive und Ästhetische Chirurgie Innsbruck, Innsbruck
› Author Affiliations
Further Information

Publication History

09/07/2017

04/25/2018

Publication Date:
17 October 2018 (online)

Zusammenfassung

Die Dupuytren’sche Kontraktur (DK) oder Morbus Dupuytren ist eine progressive fibroproliferative Erkrankung des palmoplantaren Bindegewebes, bei der es zu einer charakteristischen Knoten- und/oder Strangbildung aus Kollagen kommt. Bei fortschreitender Erkrankung führt die Strangverdickung zu einer Beugekontraktur des betroffenen Fingers, die in einer deutlichen Behinderung der Betroffenen münden kann, insbesondere bei beidseitigem Befall.

Die Erkrankung ist in Europa relativ verbreitet, wobei die Prävalenz in nordischen Ländern am höchsten ist. In Österreich geht man von rund 200 000 Betroffenen aus. Die Inzidenz steigt mit zunehmendem Alter, wobei Männer häufiger und früher erkranken als Frauen.

Die Ätiologie der DK ist nicht vollständig geklärt, scheint jedoch multifaktoriell zu sein, wobei eine genetische Prädisposition als gesichert gilt. Der natürliche Verlauf der Erkrankung kann zwischen relativ gutartig und massiver Progredienz und Rezidivhäufigkeit variieren. Zumeist findet sich ein schubweiser Verlauf.

Die DK ist nicht heilbar; die Behandlungsmethoden reichen von minimalinvasiven bis zu offenen chirurgischen Verfahren. Collagenase Clostridium histolyticum (CCH) ist eine nichtchirurgische, enzymatische Injektionsbehandlung für erwachsene Patienten (≥ 18 Jahre), die in Europa seit 2011 zur Behandlung der DK mit einem tastbaren Strang zugelassen ist. Klinische Studien und praktische Erfahrungen einzelner Zentren bestätigen die Wirksamkeit und Sicherheit der CCH-Behandlung von Beugekontrakturen.

Das vorliegende Konsensus Statement wurde unter der Ägide der Österreichischen Gesellschaft für Handchirurgie und der Mitwirkung der Österreichischen Gesellschaften für Unfallchirurgie, Orthopädie und orthopädische Chirurgie sowie für Plastische, Ästhetische und Rekonstruktive Chirurgie erstellt. Es beschreibt die verschiedenen chirurgischen Verfahren unter besonderer Berücksichtigung der Kollagenase-Behandlung und stellt eine Orientierungshilfe für deren Einsatz dar. Das Statement soll nicht nur den Stand des Wissens der DK-Behandlung abbilden, sondern auch als Richtschnur dienen und zu einem einheitlich hohen Qualitätsstandard der Kontraktur-Behandlung in chirurgischen Zentren und spezialisierten Arztpraxen in ganz Österreich beitragen.

Abstract

Dupuytren’s contracture (DC) or Dupuytren’s disease (DD) is a progressive fibro-proliferative disease of palmoplantar connective tissue, resulting in characteristic nodal and/or cord formation from collagen disposition. When the disease progresses, the thickening and shortening of the cords eventually leads the affected fingers to being pulled into flexion, which may be associated with marked disability, especially with bilateral disease. DD is relatively common in Europe, with the highest prevalence in Nordic countries. In Austria approx. 200 000 people are affected. The incidence increases with increasing age, with men being more often and earlier affected than women. The aetiology of DC is not completely clear, but it seems to be multifactorial; twin and familial studies confirm a genetic predisposition. The natural course of the disease can vary between relatively benign and massive progression and recurrence. In most cases, there is a fluctuating course. The DC is not curable; treatment methods range from minimally invasive to open surgical procedures. Collagenase Clostridium histolyticum (CCH) is a nonsurgical, enzymatic injection treatment for adult patients (≥ 18 years) with a palpable cord and has been approved in Europe since 2011. Clinical studies and practical experience of individual centres confirm the efficacy and safety of CCH treatment of DC. The present consensus statement was prepared under the auspices of the Austrian Society of Hand Surgery with the participation of the Austrian Society for Trauma Surgery, the Society of Orthopaedics and Orthopaedic Surgery as well as the Society for Plastic, Aesthetic and Reconstructive Surgery. On the basis of current literature and the experts’ experience, it describes the various surgical procedures, with particular reference to collagenase treatment and provides guidance for their use. The statement is intended not only to illustrate the state of the art of current treatment, but also to support the achievement of uniform high quality standards in the treatment of DC in surgical centres and specialised medical practices throughout Austria.

Fußnote

1 Konsensus Statement unter der Ägide der Österreichischen Gesellschaft für Handchirurgie unter Mitwirkung der Österreichischen Gesellschaft für Unfallchirurgie, Österreichischen Gesellschaft für Orthopädie und orthopädische Chirurgie sowie der Österreichischen Gesellschaft für Plastische, Ästhetische und Rekonstruktive Chirurgie


 
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