生肌液复合封闭负压引流技术对创面Ⅰ型和Ⅲ型胶原代谢的影响

Metabolism of collagen Ⅰ and Ⅲ during wound healing using Shengjiye and vacuum assisted closure

背景:在创面愈合过程中起主要作用的是Ⅰ、Ⅲ型胶原,Ⅰ型胶原起支架作用,Ⅲ型胶原决定胶原纤维的弹性好坏。目的:拟验证生肌液和封闭负压引流技术相结合对实验动物创面Ⅰ、Ⅲ型胶原的影响。设计、时间及地点:随机对照动物实验,于2006-05/10在河南省正骨研究院生物医学工程研究室完成。材料:清洁级SD大鼠100只,体质量(220±20)g,制备大鼠皮肤切除伤模型。生肌液和麻油煎剂均由本院制剂室规范制备。方法:100只大鼠随机区组法分为5组,每组20只。模型组:等待创面自然愈合;麻油组:将麻油纱布敷于创面上。生肌液组:将生肌液纱布敷于创面上;封闭负压引流组:给予创面封闭负压引流治疗;生肌液复合封闭负压引流组:给予创面封闭负压引流治疗,停止负压吸引后,立即从注药管注入生肌液。各组大鼠随机分4批麻醉后处死(每次5只,10个创面)用于取材。主要观察指标:创面愈合时间;免疫组织化学法观察愈合组织中Ⅰ、Ⅲ型胶原的含量及比例。结果:纳入SD大鼠100只,除模型组及生肌液组各有1只动物死亡外,其余动物均进入结果分析。①生肌液复合封闭负压引流组及封闭负压引流组较其他各组愈合时间明显缩短(P<0.05)。②创面形成后第3天生肌液组Ⅰ型胶原含量最低(P<0.05);生肌液复合封闭负压引流组Ⅲ型胶原含量最高。第6天,生肌液复合封闭负压引流组Ⅲ型胶原的含量仍高于生肌液组(P<0.05)。创面完全愈合后,生肌液复合封闭负压引流组Ⅲ型胶原的含量明显高于封闭负压引流组(P<0.05)。③造模后第3天Ⅲ/Ⅰ比值以生肌液组为高(P<0.05);造模后第6天,封闭负压引流组Ⅲ/Ⅰ比值最低(P<0.05)。创面愈合后,生肌液复合封闭负压引流组和生肌液组Ⅲ/Ⅰ比值无明显差别,均呈比较理想的状态。结论:生肌液复合封闭负压引流可以优化创面胶原构成并提高创面的愈合质量;对创面Ⅰ、Ⅲ型胶原代谢的影响可能是其重要干预途径。

BACKGROUND： Wound healing attributes to type Ⅰ and Ⅲ collagen, the former as the scaffold and the latter determines the elasticity of collagen fibers. OBJECTIVE： To study the effect on type Ⅰ and Ⅲ collagen by using Shengjiye and vacuum assisted closure （VAC） for wound healing. DESIGN, TIME AND SETTING： Randomized control animal experiments were carried out at Department of Biomedical Engineering, Henan Institute of Traditional Chinese Orthopedics and Traumatology （Henan, China） from May to October in 2006. MATERIALS： One hundred SD rats of clean grade and weighing （220＋-20） g were recruited to prepare the models of skin excision. Shengjiye and sesame oil decoction were produced in this unit. METHODS： One hundred SD rats were randomized into five groups： model group, the wounds healed naturally; sesame oil group, the wounds were covered with sesame oil gauze; Shengjiye group, the wounds were covered with Shengjiye gauze; VAC group, the wounds were dealt with VAC; Shengjiye with VAC group, the wounds were dealt with VAC and Shengjiye was applied while negative pressure stopped. Each group had 20 animals, which were anesthetized to death in four batches, 5 animals one time with ten wounds. MAIN OUTCOME MEASURES： Wound healing time; Immunohistochemistry method was used to determine the content and percentage of type Ⅰ and Ⅲcollagen. RESULTS： Except one animal of model group and one animal of Shengjiye group died, other animals were involved in result analysis. The mean healing time of the Shengjiye with VAC group and VAC group was remarkably shorter than other groups （P 〈 0.05）. On the third day, the content of type Ⅰ collagen in Shengjiye group was the lowest （P 〈 0.05）; Type Ⅲ collagen content in Shengjiye with VAC group was higher than that in other groups. On the sixth day, type Ⅲ collagen content in Shengjiye with VAC group was still higher than that in Shengjiye group （P 〈 0.05）. At healing time, the type Ⅲ collagen content in Shengjiye with VAC group was evidently higher than that in VAC group （P 〈 0.05）. On the third day, the ratio of collagen Ⅲ content to collagen Ⅰ content in Shengjiye with VAC group was higher than that in other groups （P 〈 0.05）. On the sixth day, the ratio in VAC group was lower than that in other groups （P 〈 0.05）. At healing time, Shengjiye with VAC group and Shengjiye group had a reasonable ratio of collagen Ⅲ content to collagen Ⅰ content, there was no significant difference between them. CONCLUSION： Shengjiye combined with VAC can optimize the collagen constitution in wounds and promote wound quality; It is possibly an important intervention method that the effect of collagen Ⅲ to collagen Ⅰ.