摘要
目的对比分析富血小板纤维蛋白(platelet-rich fibrin,PRF)联合小腿胫后动脉穿支螺旋桨皮瓣与单独小腿胫后动脉穿支螺旋桨皮瓣治疗对下肢软组织缺损愈合进程、愈合因子、创面转归的影响。方法采取回顾性队列研究的方法,选取自2020年1月至2023年3月,右江民族医学院附属医院收治的105例下肢软组织缺损患者进行观察性研究。根据治疗方法不同分为对照组53例(小腿胫后动脉穿支螺旋桨皮瓣)、观察组52例(PRF联合小腿胫后动脉穿支螺旋桨皮瓣)。比较两组皮瓣成活、并发症发生情况及皮瓣大小、换药次数、创面愈合进程;两组手术前后疼痛程度[视觉模拟评分(visual analogue score,VAS)]、创面引流液中创面愈合因子水平;两组功能预后。结果两组患者均保肢成功,皮瓣全部成活,无血管危象发生;观察组皮瓣边缘部分坏死发生率(0)低于对照组(11.32%),P<0.05;观察组换药次数、创面愈合时间、住院时间低于对照组(P<0.05);观察组术后3、5、10、15d的VAS评分分别为(3.78±0.44)分、(2.68±0.51)分、(1.83±0.37)分、(0.81±0.17)分,分别低于对照组的(4.30±0.59)分、(3.24±0.69)分、(2.09±0.42)分、(1.35±0.31)分,差异有统计学意义(P<0.05);观察组术后5d碱性成纤维细胞生长因子、血管内皮生长因子、转化生长因子-β1、血小板源性生长因子水平分别为(16.78±2.67)pg/ml、(3.08±0.74)pg/ml、(0.56±0.11)pg/ml、(28.03±4.27)pg/ml,高于对照组的(13.19±2.55)pg/ml、(2.03±0.56)pg/ml、(0.41±0.09)pg/ml、(20.79±5.56)pg/ml,差异有统计学意义(P<0.05);两组功能预后优良率比较,差异无统计学意义(P>0.05)。结论两种方案治疗下肢软组织缺损患者,在皮瓣成活率、功能预后方面的作用效果相当,但采用PRF治疗可明显减少换药次数,缩短创面愈合时间、住院时间,并可减轻疼痛程度,可能与调节愈合因子表达有关。
Objective To compare and analyze the effects of platelet-rich fibrin(PRF)combined with posterior tibial artery per-forator propeller flap and posterior tibial artery perforator flap alone on the healing process,healing factors and wound outcome of lower limb soft tissue defects.Methods A retrospective cohort study was conducted,selecting 105 patients with lower limb soft tissue defects treated at the Affiliated Hospital of Youjiang Medical University for Nationalities from January 2020 to March 2023 for observational research.Based on different treatment methods,the patients were divided into a control group of 53 cases(using the posterior tibial artery perforator propellerflap)and an observation group of 52 cases(using PRF in conjunction with the posterior tibial artery perforator propeller flap).The survival of the flaps,occurrence of complications,flap size,number of dressing changes,and the wound healing process were compared be-tween the two groups.Additionally,the preoperative and postoperative pain levels(visual analogue score,VAS),the levels of healing factors in the drainage fluid from the wounds,and functional outcomes were assessed.Results Both groups of patients successfully preserved their limbs,with all flaps surviving and no vascular crises occurring.The incidence of necrosis at the flap margins in the observation group(0)was lower than that in the control group(11.32%),with P<0.05.The observation group had fewer dressing changes,shorter wound heal-ing times,and shorter hospital stays compared to the control group(P<0.05).The VAS scores for the observation group at postoperative days 3,5.10,and 15 were(3.78±0.44),(2.68±0.51),(1.83±0.37),and(0.81±0.17)respectively,which were significantly lower than the control group's scores of(4.30±0.59),(3.24±0.69),(2.09±0.42),and(1.35±0.31)(P<0.05).At postoperative day 5,the levels of basic fibroblast growth factor,vascular endothelial growth factor,transforming growth factor-β1,and platelet-derived growth factor in the observation group were(16.78±2.67)pg/ml,(3.08±0.74)pg/ml,(0.56±0.11)pg/ml,and(28.03±4.27)pg/ml respectively,significantly higher than those in the control group at(13.19±2.55)pg/ml,(2.03±0.56)pg/ml,(0.41±0.09)pg/ml,and(20.79±5.56)pg/ml(P<0.05).There was no statistically significant difference in the comparison of functional prognosis rates between the two groups(P>0.05).ConclusionThe effects of two treatment plans for patients with lower limb soft tissue defects are comparable in terms of flap survival rates and functional prognosis.However,the use of PRF treatment can significantly reduce the frequency of dressing changes,shorten wound healing time and hospital stay,and alleviate pain levels,likely related to the modulation of healing factor expression.
作者
梁飞腾
李树霄
韦雪含
卢柳
唐强
LIANG Feiteng;LI Shuxiao;WEI Xuehan;LU Liu;TANG Qiang(Department of Medical Cosmetology,Afiliated Hospital of Youjiang Medical University for Nationalities,Baise 533000,China)
出处
《中国美容整形外科杂志》
2025年第6期362-365,384,共5页
Chinese Journal of Aesthetic and Plastic Surgery
基金
2021年国家自然科学基金地区基金(82160907)。
关键词
下肢软组织缺损
富血小板纤维蛋白
小腿胫后动脉穿支螺旋桨皮瓣
创面愈合
预后
疼痛程度
Lower soft tissue defect
Platelet rich fibrin
Propeller flap with perforating branch of posterior tibial artery in the low-er leg
Wound healing
Prognosis
Pain intensity
