Kollagenase Clostridium histolyticum im Management der Dupuytrenschen Kontraktur

Zusammenfassung

Die Dupuytrensche Kontraktur ist eine proliferative, fibröse Hyperplasie der Palmaraponeurose mit Knoten- und Strangbildung. In der Behandlung der Dupuytrenschen Kontraktur ist die chirurgische Therapie derzeit Mittel der Wahl. Kürzlich wurde Kollagenase Clostridium histolyticum als medikamentöse Methode zur Behandlung der Dupuytrenschen Kontraktur zugelassen. Kollagenase Clostridium histolyticum wird direkt in die Dupuytren-Stränge injiziert und nach 24 Stunden durch manuelle Rupturierung die Kontraktur aufgedehnt. Kollagenase Clostridium bewirkt einen Abbau von Kollagen, wobei neurovaskuläre Strukturen jedoch verschont werden. In 2 klinischen Phase-III-Studien konnte gezeigt werden, dass Kontrakturen durch die Anwendung von Kollagenase Clostridium histolyticum wirksam reduziert werden können. Langzeitergebnisse bezüglich Effektivität und Nebenwirkungen sowie Vergleichsstudien mit chirurgischen Methoden liegen bisher nicht vor. Diese Arbeit bietet einen Überblick über Kollagenase Clostridium histolyticum und deren Rolle im Management der Dupuytrenschen Kontraktur. Indikation, technisches Vorgehen, Behandlungsergebnisse und Komplikationen werden dargestellt.

Abstract

Dupuytren’s contracture is a fibroproliferate disease of the palmar aponeurosis with a formation of nodules and cords. Surgical treatment is the gold standard for Dupuytren’s contracture at the moment. A short while ago Collagenase clostridium histolyticum was licensed as a non-surgical method to treat Dupuytren’s contracture. Collagenase clostridium histolyticum is injected directly into the Dupuytren’s cord and after 24 h the contracture is distended by manual rupturing. Collagenase clostridium histolyticum causes a depletion of collagen, however neurovascular structures are spared. 2 clinical phase III studies showed that contractures could be effectively reduced when using Collagenase clostridium histolyticum. However, there are no long-term results regarding effectiveness and side effects, or comparative studies using surgical methods. This paper presents a review of Collagenase clostridium histolyticum and its role in the management of Dupuytren’s contracture. Indication, technical procedure, treatment results and complications are described.

Schlüsselwörter

Dupuytrensche Kontraktur - Kollagenase - Clostridium histolyticum

Key words

Dupuytren’s contracture - collagenase - Clostridium histolyticum

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