血小板富集凝胶对骨科难愈性创面的疗效及抑菌作用  

CLINICAL AND ANTIBACTERIAL EFFECTS OF PLATELET-RICH PLASMA ON ORTHOPEDIC REFRACTORY WOUNDS

作　　者：高文华[1] 张宏亮 胡玉庆 樊安末 刘景焕 刘学亮[1] GAO Wenhua;ZHANG Hongliang;HU Yuqing;FAN Anmo;LIU Jinghuan;LIU Xueliang(Department of Third Orthopaedic,Jizhong Energy Xingtai Mining Group General Hospital,Xingtai 054000,China)

机构地区：[1]冀中能源邢台矿业集团总医院骨三科,河北邢台054000

出　　处：《青岛大学学报（医学版）》2018年第5期528-531,共4页Journal of Qingdao University(Medical Sciences)

基　　金：邢台市科技计划项目(2017ZC050)

摘　　要：目的探讨血小板富集凝胶(PRP)治疗骨科难愈性创面的效果及其抑菌作用。方法选择我院骨科慢性难愈性创面病人34例,记录并分析病人PRP治疗过程中创面体积、创面覆盖率、创面愈合情况以及细菌感染情况。采用PRP和贫血小板血浆(PPP)对金黄色葡萄球菌进行抑菌试验,观察细菌减少情况。结果治疗3个月后病人创面Ⅰ级愈合19例(55.8%),Ⅱ级愈合7例(20.6%),Ⅲ级愈合8例(23.5%)。治疗前及治疗1周、2周、4周、3个月后的创面体积呈下降趋势,创面覆盖率呈上升趋势(F=6.493、7.238,P<0.05)。治疗3个月后,创面细菌培养阳性的病人占23.5%,显著低于治疗前的85.3%,差异有统计学意义(χ~2=70.125,P<0.01)。采用PRP和PPP孵育的金黄色葡萄球菌在培养2、4、6、8、12、24h时细菌减少比例呈先升高后减低的趋势,在6h时达到高峰,随后逐渐降低,差异有统计学意义(F_(时间)=8.923,P<0.01);PPP组的细菌减少比例较PRP组低,差异有统计学意义(F_(组间)=9.382,P<0.01)。结论采用PRP治疗骨科难愈性创面具有促进创面愈合、抗感染的作用,值得临床合理选择应用。Objective To investigate the clinical and antibacterial effects of platelet-rich plasma （PRP） in the treatment of orthopedic refractory wounds. Methods A total of 34 patients with chronic refractory wounds who were treated in Department of Orthopedics in our hospital were enrolled. Wound volume, wound coverage, healing, and wound bacterial infection during PRP treatment were recorded and analyzed. PRP and platelet-poor plasma （PPP） were used to perform an antibacterial test on Staphylococcus aureus to observe the reduction of bacteria. Results After 3 months of treatment, of all patients, 19（55.8%） achieved grade Ⅰ healing, 7（20.6%） achieved grade Ⅱ healing, and 8（23.5%） achieved grade Ⅲ healing. Wound volume gradually decreased after 1,2, and 4 weeks and 3 months of treatment, and wound coverage tended to increase （ F =6.493 and 7.238, P 〈 0.05 ）. The proportion of patients with a positive bacterial culture decreased significantly from 85.3% before treatment to 23.5% after 3 months of treatment （ χ ^2=70.125, P 〈0.01）. The bacterial reduction rate of Staphylococcus aureus incubated with PRP and PPP first increased and then decreased during culture （2,4,6,8,12, and 24 h）, reaching the peak at 6 hours and then gradually decreasing （ F time =8.923, P 〈0.01）, and the PPP group had a significantly lower bacterial reduction rate than the PRP group （ F group = 9.382, P 〈0.01）. Conclusion In the treatment of orthopedic refractory wounds, PRP can promote wound healing and eliminate infection and thus holds promise for clinical application.

关 键 词：富血小板血浆 凝胶类 伤口愈合 治疗结果 抑菌作用 

分 类 号：R632[医药卫生—外科学] R457.14[医药卫生—临床医学]