Morbo di Dupuytren: patologia della mano
Table of Contents
Che cos’è il morbo di Dupuytren?
Il morbo di Dupuytren è una contrattura fibrosa dell’aponeurosi palmare, che genera la progressiva retrazione di uno o più raggi, quindi parte dal palmo della mano e si estende fino alle dita. Colpisce una o entrambe le mani e può riguardare qualsiasi dito. Il morbo di Dupuytren non interessa i tendini ma la loggia volare della mano, quindi intreressa l’aponeurosi palmare superficiale. Il morbo di Dupuytren venne descritto per la prima volta nel 1831 daGuillaume Dupuytren,chirurgo francese.
Chi colpisce il morbo di Dupuytren?
Colpisce con netta prevalenza il sesso maschile (rapporto di 10:1). La sua incidenza tende ad aumentare superati 50 anni di età.La causa del morbo di Dupuytren è ancora sconosciuta, ma nella maggior parte dei pazienti vi è alla base una predisposizione genetica
Quali sono i sintomi del morbo di Dupuytren?
La sintomatologia si manifesta in modo progressivo, inizialmente con la comparsa nel palmo della mano, dipiccoli ispessimenti nodulari sottocutanei o di piccoli retrazioni della cute. In una fase successiva si ha laformazione di cordoni duri e tesiche determinano una flessione delle dita di tipo permanente e che impediscono la completa estensione delle dita coinvolte; tale difficoltà degenera nell’immobilità.
Classificazione
La classificazione del morbo di Dupuytren più utilizzata è quella di Tubiana che distingue 5 gradi:
- Stadio 1: deficit di estensione del dito di 0-45°
- Stadio 2: deficit di estensione del dito di 46-90°
- Stadio 3: deficit di estensione del dito di 91-135°
- Stadio 4: deficit di estensione del dito >135°
Trattamento del morbo di Dupuytren
Il trattamento dipende dalle forme cliniche e dal grado di severità della patologia.Nelle forme esclusivamente nodulari si tende a non intervenire chirurgicamentementre dal grado II è consigliabile la procedura chirurgica.
Iltablet teststabilisce quale sia il momento di intervenire. Si è positivi al test quando non si è più in grado di appoggiare in modo completo il palmo della mano e la superficie palmare delle dita su di una tavola.
I trattamenti non invasivi prevedono procedure quali l’aponeurotomia mediante ago(rottura della corda con inserimento in punti diversi di un ago per via percutanea). Si stanno diffondendo soluzioni farmacologiche mediante sostanze in grado di interrompere per lisi enzimatica la corda aponeurotica (collagenasi). Le procedure chirurgiche prevedono l’asportazione dell’aponevrosi malata (aponevrectomia). Nei casi più severi si deve prevedere il riparo tramiteinnesti o lembi.
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