外科序列疗法治疗糖尿病足溃疡创面疗效观察

Curative observation in the treatment of diabetic foot ulcer with sequence therapy

目的探讨分次清创生物辅料覆盖结合负压封闭引流延期植皮技术治疗糖尿病足溃疡创面的临床效果。方法选取我院2012年5月—2015年6月期间收治的76例糖尿病足溃疡患者,按照手术时机不同将其分为观察组以及对照组,每组38例,对照组进行彻底清创Ⅰ期植皮或者皮瓣转移修复创面,观察组进行分次简易清创之后异种脱细胞真皮基质敷料(ADM)覆盖创面结合负压封闭引流技术培育肉芽组织,延期自体皮移植修复。对比2组患者的临床治疗效果。结果观察组患者住院时间、住院费用以及肢体保留率明显好于对照组,差异具有统计学意义(P<0.05)。结论应用分次简易清创异种脱细胞真皮基质敷料(ADM)覆盖结合负压封闭引流技术培育肉芽组织,延期手术移植自体薄中厚皮片的外科序列疗法治疗糖尿病足溃疡患者能明显提高治愈率,降低截肢率。

Objective To investigate the effects of biological materials covering combined with vacuum sealing drainage and skin grafting technique in the treatment of diabetic foot ulcer.Methods 76 cases of diabetic foot ulcer patients in our hospital from May 2012 to June 2015 were divided into observation and control group according to different time of surgery, and each group had 38 cases. The control group were taken thorough debridement or skin graft to repair the wound. Heterogeneous acellular dermal matrix （ADM） was used to cover the wound after several simple debridement in the observation group, while vacuum sealing drainage for the purpose of cultivating granulation tissue was combined. Delayed skin grafting was used when the would was well prepared. Clinical therapeutic effects were compared between two groups.Results After treatment, patients in observation group spent less time in hospital, and burdened less hospitalization expenses, and gained a higher limb retention rate. （P〈0.05）.Conclusion Application of heterogeneous acellular dermal matrix （ADM） to cover the wound combined with vacuum sealing drainage cound cultivate granulation tissue. Sequence therapy of delayed surgery to transplant autologous thin split skin graft in the treatment of diabetic foot ulcer patients cound significantly improve the cure rate and reduced the rate of amputation.