一步离心法制备富血小板凝胶修复颅骨外露创面的应用研究  

Platelet-rich gel in repair of skull-exposed wounds

作　　者：王攀[1] 王建柏[1] 徐炎安[1] Wang Pan;Wang Jianbai;Xu Yanan(Department of Traumatology,Chongqing Emergency Medical Center/The Fourth People’s Hospital of Chongqing,Chongqing 400014,China)

机构地区：[1]重庆市急救医疗中心创伤科/重庆市第四人民医院,重庆400014

出　　处：《创伤外科杂志》2024年第5期340-344,共5页Journal of Traumatic Surgery

基　　金：重庆市科卫联合课题(2021MSXM315)。

摘　　要：目的探讨一步离心法制备富血小板凝胶(PRG)治疗头皮缺损伴颅骨外露创面的临床效果。方法回顾性分析2018年9月—2022年3月重庆市急救医疗中心创伤科收治的14例头皮缺损伴颅骨外露创面,男性12例,女性2例;年龄43~86岁,平均62.8岁;创面面积3.0 cm×4.0 cm~7.0 cm×6.0 cm,常规治疗4周创面仍未愈合。采集患者外周静脉血通过一步离心法制备PRG。治疗前常规行头皮清创,清创完成后直接将PRG覆盖于创面表面,凝胶表面再覆盖油纱,最外层利用水凝胶敷料封闭创面。每3d更换新的PRG直至创面全部愈合。测量PRG长度、评估血小板浓度变化,记录创面愈合时间和治疗次数。检测治疗前及治疗后3dVAS、WBC、CRP、PCT及局部皮温。结果一步离心法所制备的PRG长度(3.09±0.09)cm,血小板浓度提高(2.43±0.07)倍。经5~14次自体PRG治疗后,患者创面全部愈合,平均治疗(8.9±2.4)次,平均创面愈合时间(26.8±7.2)d。治疗前后患者VAS、WBC、CRP、降钙素原(PCT)以及局部皮温比较差异无统计学意义(P>0.05)。结论真空采血管一步离心法能够成功制备富血小板凝胶,并能够促进头皮缺损伴颅骨外露创面的愈合。Objective To investigate the clinical outcome of platelet-rich gel(PRG)prepared using the one-step centrifugation method in the treatment of scalp defects combined with skull-exposed wounds.Methods From Sep.2018 to Mar.2022,14 patients with scalp defects accompanied by skull exposure admitted to Chongqing Emergency Medical Center were enrolled.There were 12 males and 2 females,aged 43-86 years(mean 62.8 years).The wound size ranged from 3.0 cm×4.0 cm to 7.0 cm×6.0 cm,which failed to heal after 4 weeks of conventional treatment.Venous blood was collected from the patients,and PRG was prepared using the one-step centrifugation method.Before treatment,routine scalp debridement was performed.After that,the PRG was directly applied to the surface of the wound.The gel surface was covered with oil gauze,and the outermost layer was sealed with a hydrogel dressing.The PRG was replaced every 3 days until the wound completely healed.The length of the PRG was measured,and the change in platelet concentration was assessed.Additionally,the visual analog scale(VAS)scores,white blood cell(WBC)count,C-reactive protein(CRP),procalcitonin(PCT)levels,and local skin temperature were measured before and 3 days after treatment.Results The length of the PRG prepared by the one-step centrifugation method was measured to be(3.09±0.09)cm,and the platelet concentration was increased by(2.43±0.07)folds.After 5-14 times of autologous PRG treatment,all the 14 patients achieved complete healing.The average frequency of treatment was 8.9±2.4 and the wound healing time was(26.8±7.2)d.There were no significant differences observed in VAS scores,WBC count,CRP levels,PCT levels,and topical skin temperature of the wounds before and after treatment.Conclusion PRG can be successfully prepared using a one-step centrifugation method with a vacuum negative pressure tube.Moreover,it has been demonstrated to effectively promote the healing of scalp defects in combination with skull exposure.

关 键 词：颅骨外露 头皮缺损 富血小板凝胶 创面愈合 

分 类 号：R622[医药卫生—整形外科]