富血小板血浆治疗下肢慢性难愈合伤口47例随访研究

FOLLOW-UP STUDY ON PLATELET-RICH PLASMA IN REPAIRING CHRONIC WOUND NONUNION OF LOWER LIMBS IN 47 CASES

目的探讨富血小板血浆(platelet-rich plasma,PRP)对下肢慢性难愈合伤口的修复作用。方法2007年5月-2007年11月,采用PRP注射治疗下肢慢性难愈合伤口47例。男41例,女6例;年龄15～68岁,平均43.2岁。原发疾病:胫腓骨骨折20例,跟骨骨折4例,跖骨骨折1例,下肢多发开放性骨折3例,胫骨骨髓炎10例,股骨骨髓炎1例,足踝部软组织损伤4例,截肢术后感染2例,足部矫形术后感染及跟腱修补术后感染各1例。外院治疗后2～4个月创口未愈合转入合并骨折未愈合23例,细菌培养结果阳性38例。患者予2次清创加自体PRP伤口内注射,每次间隔2个月。结果患者均于首次注射PRP后获随访,随访时间4个月。首次注射PRP2个月后,34例伤口明显缩小,坏死组织及脓苔清除,组织色泽健康,血供良好,外露骨或肌肉组织被新生肉芽组织覆盖。4个月随访时,无肌肉和骨组织外露患者,创面覆盖率79.3%±18.0%,总治愈率29.8%。治疗前创口体积(11.8±5.6)mL,治疗后为(2.5±2.7)mL,创口体积缩小(9.3±4.9)mL,治疗前后创口体积比较差异有统计学意义(P<0.05)。术前23例合并骨折未愈合者,随访4个月时骨折完全愈合9例,骨痂生长明显增多12例,无明显改变2例,均无骨髓炎征象加重。细菌培养阳性结果15例。结论PRP能有效促进软组织缺损修复,加速下肢慢性难愈合伤口愈合。

Objective To study the effect of platelet-rich plasma （PRP） on repairing chronic wounds of lower limbs. Methods From May 2007 to November 2007, 47 patients suffering from chronic wounds of lower limbs were treated. There were 41 males and 6 females, aged from 15 to 68 years （43.2 years on average）. The disease was caused by tibiofihula fracture in 20 cases, calcaneus fracture in 4 cases, metatarsal fracture in 1 case, multiple open fracture of lower limbs in 3 cases, tibia osteomyel itis in 10 cases, femur osteomyelitis in 1 case, soft tissue injury of ankle in 4 cases, infection after amputation in 2 cases, infection after foot orthomorphia in 1 case, and infection after calcaneus tendon neoplasty in 1 case. Their chronic wounds did not healed after 2 to 4 months of therapy. Among them, chronic wounds complicated with fracture nonunion in 23 cases and positive bacterial culture result in 38 cases. Debridement and autogenous PRP gel injection were applied every 2 months and for twice. Results The patients were followed up for 4 months after the first PRP injection. Two months after the first PRP injection, chronic wounds contracted significantly in 34 patients with purulence and necrosis tissue cleaned up, circulation of soft tissue improved and exposed bone or muscle tissue covered by neogenetic granulation. No patient was completely cured. Two months after the second PRP injection, the average coverage rate was 79.3% ± 18.0%, the total cure rate was 29.8%. The volume of the chronic wounds decreased by （9.3 ± 4.9） mL after PRP therapy （2.5 ± 2.7） mL when compared with （11.8 ± 5.6） mL of before therapy, showing significant difference （P 〈 0.05）. X-ray photograph showed that among the 23 cases of fracture nonunion, fracture healed completely in 9 cases; bony callus formation increased obviously in 12 cases; no significant change was observed in 2 cases. No aggravated sign of osteomyelitis was notified. Positive results of bacterial culture reduced to 15 cases. Conclusion PRP efficiently enhances the recovery of soft tissue defect and speeds up the chronic wounds healing of lower 1 imbs.