负压引流辅助治疗骨与软组织感染的机制

Mechanism of negative pressure wound therapy in the auxiliary treatment of bone and soft tissue infection

背景:随着国内人口老龄化进程的加快,骨与软组织感染的发病率也随之升高。骨与软组织感染可累及包括骨膜、骨皮质、骨松质和骨髓在内的所有骨组织及周围软组织,如糖尿病足、骨髓炎、手术切口感染和关节假体周围感染等均属此范畴,由于其发病机制复杂且治疗困难,因而越来越受到临床关注。负压创面治疗技术是近年来用于伤口治疗的新兴技术,尤其在骨与软组织感染领域疗效显著。目的:综述近年国内外负压创面治疗技术治疗骨与软组织感染的研究进展。方法:检索1990-2022年在PubMed、Web of Science数据库和中国知网发表的相关中英文文献,英文检索词“negative pressure wound therapy,vacuum assisted closure,negative pressure,osteomyelitis,bone infection”;中文检索词“负压伤口疗法,局部负压疗法,负压包扎,负压封闭技术,机械力,骨髓炎,骨感染”。共检索到711篇相关文献,其中65篇文献符合纳入标准。结果与结论:①负压创面治疗技术作为一种创面辅助治疗方式,相对于单一作用的传统敷料,其稳定创面、减轻水肿、降低细菌载荷、刺激肉芽组织和血管生成、改善组织灌注、调控末梢神经、调节生物免疫、促进成骨细胞增殖和分化的多重作用机制,能够更好地管理骨与软组织感染等复杂创面;②现有的大量基础及临床研究结果表明负压创面治疗技术在辅助治疗骨与软组织感染中具有显著的安全性及有效性。

BACKGROUND:As the population ages at an accelerated rate in China,the incidence of bone and soft tissue infections is likewise on the rise.Bone and soft tissue infections can involve all bone and surrounding soft tissues,including the periosteum,cortex,cancellous bone and bone marrow.Examples of such infections include diabetes foot,osteomyelitis,surgical incision infection,and infection around joint prostheses.Owing to the intricate pathogenesis and challenging treatment,it has become increasingly noteworthy in clinical settings.Negative pressure wound therapy is a modern wound treatment which has been gaining popularity,especially in the area of bone and soft tissue infection.OBJECTIVE:To analyze the global research progress in the utilization of negative pressure wound therapy for treating bone and soft tissue infection in recent years.METHODS:Relevant articles in Chinese and English published in PubMed,Web of Science,and CNKI from 1990 to 2022 were retrieved.Search terms were“negative pressure wound therapy,vacuum assisted closure,negative pressure,osteomyelitis,bone infection”in English and Chinese,separately.A total of 711 articles were initially retrieved,out of which 65 articles were included for further review.RESULTS AND CONCLUSION:Negative pressure wound therapy,as an auxiliary approach to treating wounds,has a range of positive effects such as stabilizing wounds,diminishing edema,decreasing bacterial load,encouraging granulation tissue and angiogenesis,enhancing tissue perfusion,modulating peripheral nerves,modulating biological immunity and promoting the growth and differentiation of osteoblasts.This is a more effective method for managing complex wounds,such as bone and soft tissue infections,than traditional dressings with one-dimensional benefits.Numerous studies,both basic and clinical,have demonstrated the safety and efficacy of negative pressure wound therapy in the auxiliary treatment of bone and soft tissue infections.