富血小板纤维蛋白在合并潜行皮下窦道的慢性创面治疗中的临床应用

Clinical application of platelet-rich fibrin in chronic wounds combined with subcutaneous stalking sinus

目的探讨富血小板纤维蛋白（PRF）治疗各种原因所致合并潜行皮下窦道的慢性创面的临床疗效。方法2015年6月-2017年2月，笔者单位收治符合入选标准的72例由各种原因所致合并潜行皮下窦道的慢性创面患者，对其临床资料进行回顾性分析。根据患者接受的治疗分为PRF组39例和常规换药组33例。PRF组患者创面在清创后应用PRF填充潜行皮下窦道1次或2次，表面以凡士林油纱及无菌敷料包扎，每2～3天换药1次。常规换药组患者创面在清创后以碘伏浸润纱条填充引流，常规无菌敷料包扎，每0．5～2．0天换药1次。记录2组患者手术次数、换药次数、创面分泌物细菌培养转阴时间、潜行皮下窦道闭合时间、创面完全愈合时间。对数据行X2检验及独立样本t检验。结果2组患者手术次数相近（t=0．565，P〉0．05）。PRF组患者换药次数为（6．4±2．1）次，明显少于常规换药组的（19．2±6．2）次，t=12．107，P〈0．01；创面分泌物细菌培养转阴时间为（15±5）d，明显短于常规换药组的（25±9）d，t=6．087，P〈0．01；潜行皮下窦道闭合时间为（12±5）d，明显短于常规换药组的（24±8）d，t=7．315，P〈0．01；创面完全愈合时间为（23±7）d，明显短于常规换药组的（35±10）d，t=5．924，P〈0．01。2组患者慢性创面全部完全愈合，出院后随访4～12个月，未再发生破溃或形成新的窦道。结论应用PRF治疗由各类原因导致的合并潜行皮下窦道的慢性创面，创面愈合迅速，疗效确切，操作简便，值得临床推广使用。

Objective To investigate the clinical effect of platelet-rich fibrin （PRF） in the treat- ment of chronic wounds combined with subcutaneous stalking sinus caused by various kinds of reasons. Methods The clinical data of 72 patients with chronic wounds and combined with subcutaneous stalking si- nus caused by various kinds of reasons admitted to our unit from June 2015 to February 2017, conforming to the study criteria, were collected and retrospectively analyzed. Patients were divided into group PRF （ n = 39） and routine dressing change （RDC） group （ n = 33） according to their treatment. The subcutaneous stalking sinuses of patients in group PRF were filled with PRF 1 or 2 times after debridement, while the sur- face of wound was covered by vaseline gauze and aseptic dressing, and dressing change was performed once per 2 - 3 days. The wounds of patients in group RDC were filled with iodine gauze after debridement of wounds and wrapped up with conventional aseptic dressing, and dressing change was performed once per 0.5 - 2.0 days. The times of operation, the times of dressing change, the time for negative-conversing of bacteria culture in the secretion of wound, the time of subcutaneous stalking sinus closure, and the complete healing time of wounds of patients in two groups were recorded. Data were processed with Chi-square test and independent sample t test. Results The operation times of patients in two groups were close （ t = 0. 565, P 〉 0.05 ）. The dressing changes of patients in group PRF were （6.4±2.1 ） times, significantly less than （ 19.2±6.2） times in group RDC, t = 12. 107, P 〈 0.01. The time for negative-conversing of bacteria cul- ture in the secretion of wound of patients in group PRF was （15±5） d, significantly shorter than （25±9） d in group RDC, t = 6. 087, P 〈 0.01. The time of subcutaneous stalking sinus closure of patients in group PRFwas （12±5） d, significantly shorter than （24±8） dingroup RDC,t =7.315,P 〈0.01. Thecom-plete healing time of wounds of patients in group PRF was （23±7） d, significantly shorter than （35±10） d in group RDC, t = 5. 924, P 〈 0.01. All the chronic wounds of patients in two groups were completely healed, and there were no break or new sinus formed during the follow-up of 4 -12 months after discharge. Conclusions The application of PRF in the treatment of chronic wounds combined with subcutaneous stal- king sinus caused by various reasons can bring about rapidly healing of wounds, definite effect, and conven- ient operation, thus is worth promoting and applying in clinic.