一期双层人工真皮联合VSD在下肢大面积骨/肌腱外露创面中的应用研究

Study on application of one-stage double-layer artificial dermis combined with VSD in treatment of large-area bone/tendon exposure wounds of lower limbs

目的研究一期双层人工真皮联合封闭式负压引流(VSD)在下肢大面积骨/肌腱外露创面中的应用价值。方法选择2021年3月—2022年3月就诊于该院的60例下肢大面积骨/肌腱外露创面患者纳入本研究,均接受一期双层人工真皮联合VSD治疗,于治疗1个月后评估创面的愈合效果,根据治疗效果分为有效组与无效组,采用酶联免疫吸附法测定二组治疗前及治疗1个月后的创面渗液血管内皮生长因子(VEGF)、基质金属蛋白酶-13(MMP-13)、基质金属蛋白酶组织抑制剂-1(TIMP-1)水平,经Pearson相关性分析MMP-13、TIMP-1、VEGF之间的相关性,采用受试者工作特征曲线(ROC)分析创面渗液MMP-13、TIMP-1、VEGF水平及联合对疗效的预测价值。结果60例下肢大面积骨/肌腱外露创面患者中经一期双层人工真皮联合VSD治疗有效38例(63.33%),无效22例(36.67%);无效组、有效组治疗前的创面渗液VEGF、MMP-13、TIMP-1水平比较,差异无统计学意义(P>0.05);无效组治疗后的创面渗液VEGF水平较有效组低,MMP-13、TIMP-1水平较有效组高(P<0.05);经Pearson相关性分析发现,创面渗液VEGF水平与MMP-13、TIMP-1呈负相关(r<0,P<0.05),MMP-13与TIMP-1呈正相关(r>0,P<0.05);ROC曲线结果发现,创面渗液VEGF、MMP-13、TIMP-1水平单独及联合预测下肢大面积骨/肌腱外露创面疗效的AUC为0.860(95%CI:0.745~0.975)、0.840(95%CI:0.738~0.942)、0.853(95%CI:0.757~0.950)、0.994(95%CI:0.981~1.000)。结论一期双层人工真皮联合VSD在下肢大面积骨/肌腱外露创面患者的治疗中疗效较佳,可有效改善MMP-13、TIMP-1、VEGF水平表达,而通过对上述指标的联合监测可有效预测疗效,为临床制定诊疗方案、改善预后提供参考。

Objective To study application value of one-stage double-layer artificial dermis combined with closed negative pressure drainage(VSD)in treatment of large-area bone/tendon exposure wounds of lower limbs.Methods From March 2021 to March 2022,sixty patients with large-area bone/tendon exposure wounds of lower limbs were selected and included in this study.They all received one-stage double-layer artificial dermis combined with VSD,and the healing effect of wounds was evaluated after one month of treatment.According to treatment effect,two groups were divided into effective group and ineffective group.The levels of vascular endothelial growth factor(VEGF),matrix metalloproteinase-13(MMP-13)and tissue inhibitor of matrix metalloproteinase-1(TIMP-1)in wound effusive fluid of two groups were measured by enzyme-linked immunosorption assay before treatment and one month after treatment.The correlation among MMP-13,TIMP-1 and VEGF was analyzed by Pearson correlation,and MMP-1 in wound exudates was analyzed by ROC.Results Among 60 patients with large bone/tendon exposure of lower limbs,38 cases(63.33%)were effective and 22 cases(36.67%)were ineffective after one-stage double-layer artificial dermis combined with VSD.There was no significant difference in levels of VEGF,MMP-13 and TIMP-1 between ineffective group and effective group before treatment(P>0.05).After treatment,the levels of VEGF,MMP-13 and TIMP-1 in ineffective group were lower than those in effective group(P<0.05).Pearson correlation showed that the level of VEGF in wound exudate was negatively correlated with MMP-13 and TIMP-1(r<0,P<0.05),and MMP-13 was positively correlated with TIMP-1(r>0,P<0.05).The ROC curve showed that AUC levels of VEGF,MMP-13 and TIMP-1 in wound exudation alone and in combination were 0.860(95%CI:0.745~0.975),0.840(95%CI:0.738~0.942),0.853(95%CI:0.757~0.950)and 0.994(95%CI:0.981~1.000)respectively.Conclusion One-stage double-layer artificial dermis combined with VSD is effective in the treatment of patients with large bone/tendon exposure wounds of lower limbs,which can effectively improve the expression of MMP-13,TIMP-1 and VEGF.The combined monitoring of the above indexes can effectively predict the curative effect and provide reference for making clinical diagnosis and treatment plans and improving prognosis.