胫骨骨膜牵张术联合富血小板血浆对治疗糖尿病足溃疡的疗效观察

Therapeutic effect of tibial periosteal distraction combined with platelet-rich plasma on diabetic foot ulcer

目的评价胫骨骨膜牵张术联合富血小板血浆(PRP)治疗糖尿病足溃疡的临床疗效。方法选择2022年1月15日至2023年4月30日于山东中医药大学附属医院创面修复与整形外科及北大医疗鲁中医院烧伤与创面修复中心接受综合基础治疗的26例Wagner分级为2~4级的糖尿病足患者,按照是否使用富血小板血浆随机分为胫骨骨膜牵张组(对照组)和胫骨骨膜牵张术联合PRP组(观察组),每组13例。对照组单纯采用胫骨骨膜牵张术联合常规清创换药,观察组为胫骨骨膜牵张术联合常规清创换药联合PRP治疗。通过记录两组患者治疗前和治疗后1、2、4、6周的趾端血氧饱和度、足温、踝肱指数(ABI)、创面面积、疼痛数字分级评分法(NRS)评分、Bates Jensen创面评分(BWAT)、糖尿病特异性生活质量量表评分(DSQL)、治疗后6周的创面愈合率、计算机断层血管造影(CTA)评估患肢血运情况、临床疗效以及治疗期间不良反应,对两组患者的临床疗效进行评价。结果两组患者治疗后各时间点的指端氧饱和度、足温、ABI、创面面积、NRS评分、BWAT评分、DSQL评分较治疗前均改善(P<0.05)。观察组在治疗后各时间点的创面面积、NRS评分、BWAT评分、DSQL评分均明显低于对照组(P<0.05)。随访至治疗后6周,两组下肢CTA均可见下肢远端小血管和牵张区域侧支循环的形成,部分血管向远端延伸,两组间差异无统计学意义(P>0.05)。观察组在创面愈合率和临床疗效方面优于对照组(P<0.05)。两组均未出现严重的不良反应。结论胫骨骨膜牵张术联合富血小板血浆疗法能够更好地促进糖尿病足溃疡愈合,缓解疼痛,提高患者的生活质量。

Objective To evaluate the clinical efficacy of tibial periosteal distraction combined with platelet-richplasma(PRP)in the treatment of diabetic foot ulcer.Methods From January 15,2022 to April 30,2023,a total of 26 diabetic foot patients with Wagner grade 2 to 4 received comprehensive basic treatment at the Department of Wound Repair and plastic Surgery the Hospital Affiliated to Shandong University of Traditional Chinese Medicine and Peking University Care Luzhony Hospital Burn and Wound Repair Center.They were divided into tibial periosteal stretch group(control group)and tibial periosteal stretch combined with PRP group(observation group)according to random number table,with 13 cases in each group.Tibial periosteal stretch group was treated with tibial periosteal distraction plus routine debridement and dressing change.Tibial periosteal stretch combined with PRP group was treated with tibial periosteal distraction and routine debridement and dressing change with PRP.The numerical oxygen saturation,foot temperature,ankle-brachial index,wound area,numerical rating scale(NRS)score and Bates-Jense wound assessment tool(BWAT),diabetes-Specific quality of life scale(DSQL)score of the two groups were recorded before treatment and 1,2,4,and 6 weeks after treatment and wound healing rate at 6 weeks after treatment,computed tomogrophy angiography(CTA)assessment of blood flow of affected limb,clinical efficacy and adverse reactions during treatment were also recorded.The clinical efficacy of the two groups of patients was evaluated.Results After treatment,oxygen saturation,foot temperature,ankle-brachial index wound area,NRS score,BWAT score and DSQL score of both groups were improved compared with those before treatment(P<0.05).The wound volume,NRS score,BWAT score and DSQL score of tibial periosteal stretch combined with PRP group were significantly lower than those of tibial periosteal stretch group at each time point after treatment(P<0.05).Follow-up to 6 weeks after treatment,CTA of lower limbs in both showed the formation of small blood vessels and collateral circulation in the stretch area of lower limbs,and some blood vessels extended to the distal end,with no significant difference between the two groups(P>0.05).The wound healing rate and clinical efficacy of tibial periosteal stretch combined with PRP group were better than those of tibial periosteal stretch group(P<0.05).There were no serious adverse reactions in both groups.Conclusion Tibial periosteal distraction combined with platelet-rich plasma(PRP)therapy can better promote the healing of diabetic foot ulcer,relieve pain and improve the quality of life of patients.