自体富血小板血浆凝胶联合皮瓣移植修复对难愈性创面的治疗效果
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摘要
目的探讨自体富血小板血浆凝胶(PRP)联合皮瓣移植修复对难愈性创面的治疗效果。方法选择本院2016年4月至2017年2月收治的60例骨外伤难愈性创面患者作为观察组,另选择2016年4月前已出院的60例骨外伤难愈性创面患者作为对照组。所有患者于入院时均进行清创、消毒,观察组采用PRP贴敷,之后进行皮肌瓣移植,对照组未采用PRP治疗,直接进行皮肌瓣移植。观察所有患者创面的换药次数、创周炎症反应、创面平均愈合时间及后期手术成功率。计量资料采用t检验与方差分析,计数资料采用χ~2检验,重复观察资料采用重复方差分析。结果观察组渗湿纱布层数(20.5±1.6)层,低于对照组的(23.3±6.1)层,2组比较差异具有统计学意义(t=-3.439,P=0.001);观察组平均愈合时间(25±2)d,低于对照组的(43±5)d,2组比较差异具有统计学意义(t=-25.891,P=0.000);观察组换药次数(7.1±1.0)次,低于对照组的(9.3±1.4)次,差异有统计学意义(t=-9.905,P=0.000);观察组有5例发生创周炎症反应,低于对照组的18例,2组比较差异有统计学意义(χ~2=9.090,P=0.003);观察组皮肌瓣存活数为55例,高于对照组的41例,2组比较差异有统计学意义(χ~2=10.208,P=0.001)。观察组与对照组的平均愈合率在不同时间点呈上升趋势。观察组的平均愈合率在各时间点均高于对照组,2组比较差异有统计学意义(P<0.05)。结论 PRP联合皮瓣移植对难愈性创面具有较好的治疗效果。
Objective To investigate the clinical effect of platelet-rich plasma combined with flap transplantation in treatment of refractory wounds.Methods Sixty patients of refractory wounds who were admitted into our hospital from April 2016 to February 2017 were enrolled in the observation group,and another sixty patients with refractory wounds who had been discharged from the hospital before April 2016 were treated as the control group.All the patients accepted debridement and disinfection.Then the observation group were managed with PRP and flap transplantation,while the control group were treated with flap transplantation directly without PRP.Observed the frequency of dressing changes,rate of wound infection,healing time and recovering rate of the two groups.Measurement data were analyzed with t inspection and analysis of variance,and count data were compared by χ~2 test,and repeat data was analyzed with repeat data variance analysis.Results After one weeks' treatment,the number of wet gauze layers were(20.5 ± 1.6) in the observation group,which was less than(23.3 ± 6.1) in the control group with statistically significant difference(t =-3.439,P = 0.001).The healing time of the observation group was(25 ± 2) d,which was shorter than(43 ± 5) d in the control group(t =-25.891,P = 0.000).The frequency of dressing changes was(7.1 ± 1.0) times in observation group,which was less than(9.3 ± 1.4) times in the control group(t =-9.905,P = 0.000).There were 5 cases of inflammation reaction in the observation group,which was less than 18 cases in the control group(χ~2= 9.090,P = 0.003).The cases of the skin flap survival in the observation group was 55,which was more than 41 cases in the control group,and the difference of the two groups was statistically significant(χ~2= 10.208,P = 0.001).The average healing rate of the two groups both increased at different time points.And the average healing rate of the observation group was higher than that in the control group at different time points,and the difference was statistically significant(P < 0.05).Conclusion Platelet-rich plasma can remarkably shorten the healing time,improve healing rate,reduce frequency of dressing change and promote wound healing for refractory wound.
Objective To investigate the clinical effect of platelet-rich plasma combined with flap transplantation in treatment of refractory wounds.Methods Sixty patients of refractory wounds who were admitted into our hospital from April 2016 to February 2017 were enrolled in the observation group,and another sixty patients with refractory wounds who had been discharged from the hospital before April 2016 were treated as the control group.All the patients accepted debridement and disinfection.Then the observation group were managed with PRP and flap transplantation,while the control group were treated with flap transplantation directly without PRP.Observed the frequency of dressing changes,rate of wound infection,healing time and recovering rate of the two groups.Measurement data were analyzed with t inspection and analysis of variance,and count data were compared by χ~2 test,and repeat data was analyzed with repeat data variance analysis.Results After one weeks' treatment,the number of wet gauze layers were(20.5 ± 1.6) in the observation group,which was less than(23.3 ± 6.1) in the control group with statistically significant difference(t =-3.439,P = 0.001).The healing time of the observation group was(25 ± 2) d,which was shorter than(43 ± 5) d in the control group(t =-25.891,P = 0.000).The frequency of dressing changes was(7.1 ± 1.0) times in observation group,which was less than(9.3 ± 1.4) times in the control group(t =-9.905,P = 0.000).There were 5 cases of inflammation reaction in the observation group,which was less than 18 cases in the control group(χ~2= 9.090,P = 0.003).The cases of the skin flap survival in the observation group was 55,which was more than 41 cases in the control group,and the difference of the two groups was statistically significant(χ~2= 10.208,P = 0.001).The average healing rate of the two groups both increased at different time points.And the average healing rate of the observation group was higher than that in the control group at different time points,and the difference was statistically significant(P < 0.05).Conclusion Platelet-rich plasma can remarkably shorten the healing time,improve healing rate,reduce frequency of dressing change and promote wound healing for refractory wound.
引文
[1]吕国忠,杨敏烈.进一步重视慢性难愈性创面成因分析与非手术治疗[J].中华烧伤杂志,2017,33(2):68-71.doi:10.3760/cma.j.issn.1009-2587.2017.02.002.
[2]李传吉.难愈性创面研究新进展与临床治疗方法[J].宁夏医学杂志,2017,39(4):289-290.doi:10.13621/j.1001-5949.2017.04.0289.
[3]朱雁,杨晓凤,赖国霞,等.采用改良封闭式负压吸引技术联合皮瓣移植治疗深度慢性难愈性创面临床疗效[J].中医临床研究,2017,9(6):109-110.doi:10.3969/j.issn.1674-7860.2017.06.050.
[4]王淑君,朱培元.血小板胶促进创面愈合的研究进展[J].医学研究生学报,2017,30(3):333-336.doi:10.16571/j.cnki.1008-8199.2017.03.024.
[5]潘红娟,汪丽,刘铁梅.富血小板血浆成分及其作用的研究新进展[J].中国输血杂志,2016,29(12):1408-1412.doi:10.13303/j.cjbt.issn.1004-549x.2016.12.030.
[6]陈志军,杨彪,张大华.PRP联合闭合复位空心螺钉内固定治疗股骨颈骨折[J].局解手术学杂志,2016,25(3):195-198.doi:10.11659/jjssx.10E015133.
[7]许贤君.自体富血小板血浆凝胶促深Ⅱ度烧伤创面组织修复和再生的效果观察[J].广西医学,2016,38(7):1015-1017.doi:10.11675/j.issn.0253-4304.2016.07.37.
[8]李明,章军辉,李淑敏,等.应用自体富血小板血浆治疗慢性难愈性创面的实验研究[J].中华关节外科杂志(电子版),2016,10(6):34-39.doi:10.3877/cma.j.issn.1674-134X.2016.06.008.
[9]王春华,方林森,余又新,等.组织瓣修复下肢深度创面的效果及功能康复分析[J].中华烧伤杂志,2015,31(4):297-300.doi:10.3760/cma.j.issn.1009-2587.2015.04.017.
[10]杨伟,代天均,陈亮,等.口外三角瓣联合口轮匝肌解剖复位矫正大口畸形的临床应用[J].局解手术学杂志,2015,24(4):384-386.doi:10.11659/jjssx.11E014007.
[11]喻石,李玉环,刘毅,等.负压封闭技术治疗难愈性创面的护理体会[J].创伤外科杂志,2016,18(10):627-628.doi:10.3969/j.issn.1009-4237.2016.10.017.
[12]吕国忠,杨敏烈.进一步重视慢性难愈性创面成因分析与非手术治疗[J].中华烧伤杂志,2017,33(2):68-71.doi:10.3760/cma.j.issn.1009-2587.2017.02.002.
[13]李钢,李小兵,刘子健,等.改良肩胛皮瓣修复难愈性创面效果观察[J].中华烧伤杂志,2014,30(3):219-222.doi:10.3760/cma.j.issn.1009-2587.2014.03.009.
[14]姜晓文.烧伤患者慢性难愈合创面的临床处理与效果研究[J].河南医学研究,2017,26(9):1653-1654.doi:10.3969/j.issn.1004-437X.2017.09.072.
[15]Reurink G,Goudswaard GJ,Moen MH,et al.Platelet-rich plasma injections in acute muscle injury[J].New England J Med,2014,370(26):2546-2547.doi:10.1056/NEJMc1402340.
[16]Russo F,D’Este M,VadalàG,et al.Platelet rich plasma and hyaluronic acid blend for the treatment of osteoarthritis:Rheological and biological evaluation[J].Plo S One,2016,11(6):e0157048.doi.org/10.1371/journal.pone.0157048.
[17]Filardo G,Di Matteo B,Di Martino A,et al.Platelet-rich plasma intraarticular knee injections show no superiority versus viscosupplementation:a randomized controlled trial[J].Am J Sports Med,2015,43(7):1575-1582.doi:10.1177/0363546515582027.
[18]赵月强,朱占永,李爱林,等.富血小板血浆治疗慢性难愈性创面的临床研究[J].临床外科杂志,2016,24(3):175-178.doi:10.3969/j.issn.1005-6483.2016.03.005.
[19]向登,林炎水,贺军,等.富血小板血浆对股骨颈骨折愈合及股骨头坏死治疗效果的影响[J].西部医学,2017,29(1):130-105.doi:10.3969/j.issn.1672-3511.2017.01.022.
[20]Mishra AK,Skrepnik NV,Edwards SG,et al.Efficacy of platelet-rich plasma for chronic tennis elbow:a double-blind,prospective,multicenter,randomized controlled trial of 230 patients[J].Am J Sports Med,2014,42(2):463-471.doi:10.1177/0363546513494359.
[21]Riboh JC,Saltzman BM,Yanke AB,et al.Effect of leukocyte concentration on the efficacy of platelet-rich plasma in the treatment of knee osteoarthritis[J].Am J Sports Med,2016,44(3):792-800.doi:10.1177/0363546515580787.
[22]袁南兵,王椿,王艳,等.自体富血小板凝胶在糖尿病难治性皮肤溃疡中的初步应用[J].四川大学学报(医学版),2007,38(5):900-903.doi:10.3969/j.issn.1672-173X.2007.05.041.
[23]杨永熙,冯佳雄,黄晓涛,等.富血小板血浆治疗慢性难愈性伤口的临床研究[J].中国基层医药,2016,23(11):1637-1640.doi:10.3760/cma.j.issn.1008-6706.2016.11.009.
[24]Bottegoni C,Dei Giudici L,Salvemini S,et al.Homologous platelet-rich plasma for the treatment of knee osteoarthritis in selected elderly patients:an open-label,uncontrolled,pilot study[J].Therapeutic advances Musculoskeletal Disease,2016,8(2):35-41.doi:10.1177/1759720X16631188.
[2]李传吉.难愈性创面研究新进展与临床治疗方法[J].宁夏医学杂志,2017,39(4):289-290.doi:10.13621/j.1001-5949.2017.04.0289.
[3]朱雁,杨晓凤,赖国霞,等.采用改良封闭式负压吸引技术联合皮瓣移植治疗深度慢性难愈性创面临床疗效[J].中医临床研究,2017,9(6):109-110.doi:10.3969/j.issn.1674-7860.2017.06.050.
[4]王淑君,朱培元.血小板胶促进创面愈合的研究进展[J].医学研究生学报,2017,30(3):333-336.doi:10.16571/j.cnki.1008-8199.2017.03.024.
[5]潘红娟,汪丽,刘铁梅.富血小板血浆成分及其作用的研究新进展[J].中国输血杂志,2016,29(12):1408-1412.doi:10.13303/j.cjbt.issn.1004-549x.2016.12.030.
[6]陈志军,杨彪,张大华.PRP联合闭合复位空心螺钉内固定治疗股骨颈骨折[J].局解手术学杂志,2016,25(3):195-198.doi:10.11659/jjssx.10E015133.
[7]许贤君.自体富血小板血浆凝胶促深Ⅱ度烧伤创面组织修复和再生的效果观察[J].广西医学,2016,38(7):1015-1017.doi:10.11675/j.issn.0253-4304.2016.07.37.
[8]李明,章军辉,李淑敏,等.应用自体富血小板血浆治疗慢性难愈性创面的实验研究[J].中华关节外科杂志(电子版),2016,10(6):34-39.doi:10.3877/cma.j.issn.1674-134X.2016.06.008.
[9]王春华,方林森,余又新,等.组织瓣修复下肢深度创面的效果及功能康复分析[J].中华烧伤杂志,2015,31(4):297-300.doi:10.3760/cma.j.issn.1009-2587.2015.04.017.
[10]杨伟,代天均,陈亮,等.口外三角瓣联合口轮匝肌解剖复位矫正大口畸形的临床应用[J].局解手术学杂志,2015,24(4):384-386.doi:10.11659/jjssx.11E014007.
[11]喻石,李玉环,刘毅,等.负压封闭技术治疗难愈性创面的护理体会[J].创伤外科杂志,2016,18(10):627-628.doi:10.3969/j.issn.1009-4237.2016.10.017.
[12]吕国忠,杨敏烈.进一步重视慢性难愈性创面成因分析与非手术治疗[J].中华烧伤杂志,2017,33(2):68-71.doi:10.3760/cma.j.issn.1009-2587.2017.02.002.
[13]李钢,李小兵,刘子健,等.改良肩胛皮瓣修复难愈性创面效果观察[J].中华烧伤杂志,2014,30(3):219-222.doi:10.3760/cma.j.issn.1009-2587.2014.03.009.
[14]姜晓文.烧伤患者慢性难愈合创面的临床处理与效果研究[J].河南医学研究,2017,26(9):1653-1654.doi:10.3969/j.issn.1004-437X.2017.09.072.
[15]Reurink G,Goudswaard GJ,Moen MH,et al.Platelet-rich plasma injections in acute muscle injury[J].New England J Med,2014,370(26):2546-2547.doi:10.1056/NEJMc1402340.
[16]Russo F,D’Este M,VadalàG,et al.Platelet rich plasma and hyaluronic acid blend for the treatment of osteoarthritis:Rheological and biological evaluation[J].Plo S One,2016,11(6):e0157048.doi.org/10.1371/journal.pone.0157048.
[17]Filardo G,Di Matteo B,Di Martino A,et al.Platelet-rich plasma intraarticular knee injections show no superiority versus viscosupplementation:a randomized controlled trial[J].Am J Sports Med,2015,43(7):1575-1582.doi:10.1177/0363546515582027.
[18]赵月强,朱占永,李爱林,等.富血小板血浆治疗慢性难愈性创面的临床研究[J].临床外科杂志,2016,24(3):175-178.doi:10.3969/j.issn.1005-6483.2016.03.005.
[19]向登,林炎水,贺军,等.富血小板血浆对股骨颈骨折愈合及股骨头坏死治疗效果的影响[J].西部医学,2017,29(1):130-105.doi:10.3969/j.issn.1672-3511.2017.01.022.
[20]Mishra AK,Skrepnik NV,Edwards SG,et al.Efficacy of platelet-rich plasma for chronic tennis elbow:a double-blind,prospective,multicenter,randomized controlled trial of 230 patients[J].Am J Sports Med,2014,42(2):463-471.doi:10.1177/0363546513494359.
[21]Riboh JC,Saltzman BM,Yanke AB,et al.Effect of leukocyte concentration on the efficacy of platelet-rich plasma in the treatment of knee osteoarthritis[J].Am J Sports Med,2016,44(3):792-800.doi:10.1177/0363546515580787.
[22]袁南兵,王椿,王艳,等.自体富血小板凝胶在糖尿病难治性皮肤溃疡中的初步应用[J].四川大学学报(医学版),2007,38(5):900-903.doi:10.3969/j.issn.1672-173X.2007.05.041.
[23]杨永熙,冯佳雄,黄晓涛,等.富血小板血浆治疗慢性难愈性伤口的临床研究[J].中国基层医药,2016,23(11):1637-1640.doi:10.3760/cma.j.issn.1008-6706.2016.11.009.
[24]Bottegoni C,Dei Giudici L,Salvemini S,et al.Homologous platelet-rich plasma for the treatment of knee osteoarthritis in selected elderly patients:an open-label,uncontrolled,pilot study[J].Therapeutic advances Musculoskeletal Disease,2016,8(2):35-41.doi:10.1177/1759720X16631188.