Systematic review of non-surgical treatments for early Dupuytren’s disease

摘要: Dupuytren’s disease is a common fibrotic disorder of the palm characterized by development progressive flexion deformities in digits, leading to significant functional impairment. Surgical excision remains most treatment. However, this only indicated patients with established contractures rather than those early disease. Early generally presence palmar nodules limited or no contracture fingers. The ideal treatment would be directed at prevent future deterioration. Various non-surgical modalities have been described but there currently systematic assessment role and efficacy these treatments Using PICOS analysis we reviewed publications studies who had received physical therapies, pharmacological treatment, radiotherapy. Following PRISMA guidelines titles abstract were screened using predefined criteria identify reporting outcomes specifically relating In absence definition included if DD was clinically, digital not exceeding 30°, Tubiana grades N 1, which reported identifiable data. Studies excluded data for could extracted analysis. review, 26 identified analyzed evaluate effect therapy (n = 11), (n = 5) radiotherapy (n = 10) on comprised 20 case series, 1 cohort study remainder studies. All graded level evidence 4 5 assessed Oxford Centre Evidence Based Medicine grading. Narrative descriptions are presented. Physical therapies robustly assessed, objective measures under powered, providing insufficient efficacy. Intralesional steroid injection appeared lead softening retard progression lacked rigorous evaluation poorly designed. There an urgent need adequately powered double blinded randomized trials affects 4 % population. protocol registered ( CRD42015008986 16 November 2015) PROSPERO international prospective register reviews.