局部注射富血小板血浆联合双层人工真皮治疗四肢肌腱外露创面的临床疗效

Clinical efficacy of local injection of platelet-rich plasma combined with double-layer artificial dermis in treating wounds with exposed tendon on extremity

目的探讨富血小板血浆(PRP)局部注射联合双层人工真皮治疗四肢肌腱外露创面的临床疗效。方法采用回顾性观察性研究方法。2017年12月—2022年10月贵州中医药大学第二附属医院创伤骨科收治16例、贵阳钢厂职工医院烧伤整形科收治32例符合入选标准的各种原因导致的四肢肌腱外露创面患者,其中男39例、女9例,年龄26~58岁。按照治疗方法将患者分为单纯PRP组、单纯人工真皮组和PRP+人工真皮组,每组16例。分别采用自体PRP、双层人工真皮或两者联合进行创面治疗,并于肉芽组织生长良好后行自体刃厚头皮移植术。Ⅱ期术后7 d,观察患者自体皮成活情况,并计算成活率。记录患者创面愈合时间及住院时间。创面愈合后3、6个月,采用温哥华瘢痕量表(VSS)对瘢痕的色泽、厚度、充血情况、柔软度等进行评分,并计算总分。记录整个治疗过程中,不良反应发生情况。对数据行χ2检验、Fisher确切概率法检验、单因素方差分析、LSD检验、Kruskal-Wallis H检验、Nemenyi法检验、Bonferroni校正。结果Ⅱ期术后7 d,单纯PRP组、单纯人工真皮组和PRP+人工真皮组患者自体皮成活率总体比较,差异无统计学意义(P>0.05)。PRP+人工真皮组患者创面愈合时间、住院时间分别为(20.1±3.0)、(24±4)d,均较单纯PRP组的(24.4±5.5)、(30±8)d明显缩短(P<0.05),也均较单纯人工真皮组的(24.8±4.9)、(32±8)d明显缩短(P<0.05)。创面愈合后3、6个月,PRP+人工真皮组患者瘢痕柔软度得分均明显低于单纯PRP组(Z值分别为12.91、15.69,P<0.05)和单纯人工真皮组(Z值分别为12.50、12.91,P<0.05)。3组患者瘢痕色泽、充血情况、厚度得分和总分比较,差异均无统计学意义(P>0.05)。单纯人工真皮组有1例患者覆盖双层人工真皮后10 d,因局部表皮葡萄球菌感染导致双层人工真皮部分液化脱落,予创面换药,同前再次行人工真皮移植及后续治疗;其余患者治疗过程中均未发生不良反应。结论PRP局部注射联合双层人工真皮治疗四肢肌腱外露创面的疗效确切,不仅可显著缩短创面愈合时间和住院时间,还可在一定程度上改善创面愈合后远期瘢痕柔软度,是一种值得推广应用的临床治疗技术。

Objective To investigate the clinical efficacy of local injection of platelet-rich plasma(PRP)combined with double-layer artificial dermis in treating wounds with exposed tendon on extremity.Methods A retrospective observational study was conducted.From December 2017 to October 2022,16 patients were admitted to Department of Orthopaedic Trauma of the Second Affiliated Hospital of Guizhou University of Traditional Chinese Medicine,and 32 patients were admitted to Department of Burns and Plastic Surgery of Guiyang Steel Factory Staff Hospital.All the patients had wounds with exposed tendon on extremity caused by various reasons and met the inclusion criteria.There were 39 males and 9 females,aged 26 to 58 years.The patients were divided into PRP alone group,artificial dermis alone group,and PRP+artificial dermis group,with 16 patients in each group.The wounds were treated with autologous PRP,double-layer artificial dermis,or thei combination of autologous PRP and double-layer artificial dermis,followed by autologous split-thickness scalp grafting after good growth of granulation tissue.On the 7th day after the secondary surgery,the autograft survival was observed,and the survival rate was calculated.The wound healing time and length of hospital stay of patients were recorded.At 3 and 6 months after wound healing,the Vancouver scar scale(VSS)was used to score the pigmentation,height,vascularity,and pliability of scars,and the total score was calculated.Adverse reactions during the entire treatment process were recorded.Data were statistically analyzed with chi-square test,Fisher's exact probability test,one-way analysis of variance,least significant difference test,Kruskal-Wallis H test,Nemenyi test,and Bonferroni correction.Results On the 7th day after the secondary surgery,there was no statistically significant difference in the autograft survival rate of patients among PRP alone group,artificial dermis alone group,and PRP+artificial dermis group(P>0.05).The wound healing time and length of hospital stay of patients in PRP+artificial dermis group were(20.1±3.0)and(24±4)d,respectively,which were significantly shorter than(24.4±5.5)and(30±8)d in PRP alone group(P<0.05)and(24.8±4.9)and(32±8)d in artificial dermis alone group(P<0.05).At 3 and 6 months after wound healing,the pliability scores of patients in PRP+artificial dermis group were significantly lower than those in PRP alone group(with Z values of 12.91 and 15.69,respectively,P<0.05)and artificial dermis alone group(with Z values of 12.50 and 12.91,respectively,P<0.05).There were no statistically significant differences in pigmentation,vascularity,height scores,and total score of scar of patients among the three groups(P>0.05).In artificial dermis alone group,one patient experienced partial liquefaction and detachment of the double-layer artificial dermis due to local infection of Staphylococcusepidermidis,which received wound dressing change,second artificial dermis transplantation,and subsequent treatment as before.No adverse reactions occurred in the remaining patients during the whole treatment process.Conclusions Local injection of PRP combined with double-layer artificial dermis is effective in treating wounds with exposed tendon on extremity,which can not only significantly shorten wound healing time and length of hospital stay,but also improve scar pliability after wound healing to some extent in the long term.It is a clinically valuable treatment technique that is worth promoting and applying.