糖尿病足溃疡非手术及微创治疗技术的系统综述  

The non-surgical and minimally invasive treatment of diabetic foot ulcers:a systematic review

作　　者：李波 吴丹[2] 孙鹏飞 李亮[2] Li Bo;Wu Dan;Sun Pengfei;Li Liang(Weifang Medical University Clinical Medical College,Weifang 261053,China;Department of Burn Plastic Surgery,Zibo Central Hospital,Zibo 255000,China;Department of Plastic Surgery,Plastic Surgery Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100144,China)

机构地区：[1]潍坊医学院临床医学院,潍坊261053 [2]淄博市中心医院烧伤整形外科,淄博255000 [3]中国医学科学院北京协和医学院整形外科医院整形外科,北京100144

出　　处：《中华整形外科杂志》2024年第9期977-984,共8页Chinese Journal of Plastic Surgery

摘　　要：目的对糖尿病足溃疡(DFUs)的非手术及微创治疗技术进行系统综述, 为整形外科相关疾病的治疗提供循证医学参考。方法使用PubMed、Embase、The Cochrane Library、中国知网、万方和维普等数据库检索非手术及微创治疗DFUs的相关文献, 检索时间设定为建库至2023年9月, 英文检索词包括Diabetic Foot Ulcer、Minimally Invasive Surgical Treatment、Non-surgical Treatment, 中文检索词包括糖尿病足溃疡、微创治疗、非手术治疗。根据纳入文献的研究类型选择相应的工具对纳入文献进行质量评价。观察指标主要包括治疗有效率、截肢率、病死率以及其他与治疗效果相关的指标。采用医学文献王软件筛选文献并提取相关数据进行系统综述。结果最终纳入20篇文献, 分别为来自中国、埃及、美国、瑞典各15、2、2、1篇。高质量文献16篇, 低质量文献4篇。文献中包括非手术治疗技术5项[糖尿病足定制鞋垫、自体富血小板血浆(PRP)外敷治疗、中医中药治疗、外用敷料治疗、负压封闭引流(VSD)技术]和微创治疗技术2项(血管介入技术、骨膜牵张技术)。文献中临床医生根据DFUs患者的具体情况选择合适的治疗技术, 均取得了较好的效果。糖尿病足定制鞋垫主要用于DFUs复发或Wagner 0级患者的治疗, 对于Wagner 1级及以上的DFUs患者, 使用PRP、VSD和血管介入技术的效果更为显著。中医中药也在Wagner 1级及以上DFUs患者的治疗中表现出显著效果。外用敷料治疗常用于DFUs的日常换药, 促进创面的愈合。骨膜牵张技术手术创伤小, 对于严重的DFUs具有显著治疗效果。结论非手术及微创技术治疗DFUs效果良好, 整形外科医师在临床工作中应熟练掌握并根据患者的情况和医疗条件合理选择。Objective To systematically review the non-surgical and minimally invasive treatment techniques for diabetic foot ulcers(DFUs),in order to provide evidence-based medical reference for orthopedic surgeons in the treatment of diabetic foot ulcers.Methods Chinese and English databases such as PubMed,Embase,The Cochrane Library,CNKI,Wanfang and VIP were utilized to search the literature related to non-surgical and minimally invasive treatment of diabetic foot ulcers.The retrieval time was set to September 2023.The key words were Diabetic Foot Ulcer,Minimally Invasive Surgical Treatment,Non-surgical Treatment.According to the research type of the included literature,the quality of the included literature was evaluated by selecting corresponding tools.The outcome measures mainly included treatment response rate,amputation rate,mortality rate and other measures related to treatment effect.The Medical Literature King software was used to screen literatures and extract relevant data for systematic review.Results In this study,20 articles were included.There were 15 studies from China,2 studies from Egypt,2 studies from the United States,and 1 study from Sweden.There were 16 high quality literatures and 4 low quality literatures.Among them,there were five non-surgical treatment techniques of diabetic foot ulcers,including customized diabetic foot insoles,autologous platelet-rich plasma(PRP),Chinese medicine treatment,external dressing therapy,and vacuum sealing drainage(VSD)technology.There were two minimally invasive treatment techniques for diabetic foot ulcer,including vascular intervention technology and periosteal distraction technology.The plastic surgeon should choose the appropriate treatment technique according to the specific situation of the patient with DFUs.Diabetes custom insoles were mainly used in the treatment of patients with recurrent DFUs or Wagner grade 0.For DFUs patients with Wagner grade 1 and above,the effect of PRP,VSD and vascular intervention techniques were more significant.Traditional Chinese

关 键 词：糖尿病足 溃疡 微创治疗 整形外科 

分 类 号：R587.2[医药卫生—内分泌] R658.3[医药卫生—内科学]