负压创面治疗结合植皮术修复糖尿病足溃疡的临床研究

Clinical study on repairing diabetic foot ulcer with negative pressure wound therapy and autologous skin graft

目的:通过与生物敷料覆盖结合植皮术比较,探讨负压创面治疗(NPWT)结合植皮术修复糖尿病足溃疡的临床疗效与优势。方法:回顾分析2010年6月～2012年1月入院治疗的18例糖尿病足溃疡患者,根据治疗方法不同分为两组。两组患者性别、年龄、病程、溃疡面积等一般资料比较,差异无统计学意义(P>0.05),具有可比性。生物敷料覆盖组(对照组)10例患者,入院后行清创,创面覆盖生物敷料(异种脱细胞真皮基质),换药至创基肉芽新鲜,再予以植皮术。NPWT组8例患者,入院后行清创,应用封闭负压引流技术(VSD),酌情更换VSD至创基肉芽新鲜后,再予以植皮术,术后继续应用VSD。观察记录两组创基准备时间、植皮成活例数、住院天数及溃疡复发例数,并进行统计学分析。结果:对照组:创基准备时间为(25.8±12.4)天,植皮术后2周4例患者创面移植皮片完全成活,6例患者经二次植皮或换药愈合,住院时间(42.7±26.7)天,出院后随访6个月,5例患者创面溃疡复发。NPWT组:创基准备时间(14.7±13.1)天,植皮术后2周8例患者创面植皮完全成活,住院时间(29.6±12.3)天,随访6个月无溃疡复发。与对照组比较,NPWT组患者创基准备与住院时间显著缩短(P<0.01),植皮成活率显著增高(P<0.05),出院后溃疡复发率显著降低(P<0.05)。结论:应用NPWT修复糖尿病足溃疡的疗效明显优于生物敷料覆盖技术。NPWT可缩短糖尿病足溃疡创基准备和住院时间,确保植皮成活,防止溃疡复发。

Objective To investigate the effectiveness and advantage of negative pressure wound therapy （NPWT） combined with autologous skin graft on repairing diabetic foot ulcer by comparing with biological dressing cover. Methods Between June 2010 and January 2012,18 patients with diabetic foot ulcer were retrospectively analyzed,and they were divided into two groups according to different treatment. No significant difference was found in gender, age,course, ulcer size between 2 groups （P〉0.05）.Ten cases in biological dressing cover group （control group） were performed debridement after admission,and then wound was covered with xenogenic acellular dermis matrix （ADM）, dressing to forming fresh wound granular tissue, finally skin grafting. Eight cases in NPWT group were performed debridement after admission, and then covered with vaccum sealing drainage （VSD） until to forming fresh wound bed, finally skin grafting, and VSD was continued post-operation. The time of wound bed preparation and hospitalization, case number of graft take and ulcer recurrence were obsevered and recorded, and these data were statically analyzed. Results In control group, wound bed preparation time was （25.8±12.4）d, and skin graft in 4 patients reached complete take after operation, wound healing via second graft or dressing change in 6 patients, the time of hospitalization being （42.7±26.7）days,wound ulcer recurring in 5 patients 6 month follow-up after discharge from hospital. In NPWT group, wound bed preparation time was （14.7±13.1）d,and skin graft in 8 patients all reached complete take after operation,the time of hospitalization being （29.6±12.3）days,no wound ulcer recurring 6 month follow-up.Compared with control group, the days of wound bed preparation and hospitalization were significantly shortened （P〈0.01）,simultaneously the rate of skin graft take being significantly increased （P〈0.05）,the rate of ulcer recurrence being significantly decreased （P〈0.05）. Conclusion The treatment effectiveness of NPWT on repairing diabetic foot ulcer is obviously superior to the biological dressing technology.Application of NPWT can shorten the time of wound bed preparation and hospitalization of the patient with diabetic foot ulcer,and ensure the skin graft survival,preventing the recurrence of ulcer wound.