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邮票植皮联合负压封闭引流技术治疗糖尿病足部溃疡的效果观察
毛幸
蔡晓斌
吴炳林
刘舜平
蓝益南
江洵
作者及单位信息
·
DOI： 10.3760/cma.j.cn341190-20240712-00896
Efficacy of stamp skin grafting combined with vacuum sealing drainage in the treatment of diabetic foot ulcers
Mao Xing
Cai Xiaobin
Wu Binglin
Liu Shunping
Lan Yinan
Jiang Xun
Authors Info & Affiliations
Mao Xing
Department of Hand Repair and Reconstruction Surgery, Lishui Central Hospital, Lishui 323000, Zhejiang Province, China
Cai Xiaobin
Department of Hand Repair and Reconstruction Surgery, Lishui Central Hospital, Lishui 323000, Zhejiang Province, China
Wu Binglin
Department of Hand Repair and Reconstruction Surgery, Lishui Central Hospital, Lishui 323000, Zhejiang Province, China
Liu Shunping
Department of Hand Repair and Reconstruction Surgery, Lishui Central Hospital, Lishui 323000, Zhejiang Province, China
Lan Yinan
Department of Hand Repair and Reconstruction Surgery, Lishui Central Hospital, Lishui 323000, Zhejiang Province, China
Jiang Xun
Department of Hand Repair and Reconstruction Surgery, Lishui Central Hospital, Lishui 323000, Zhejiang Province, China
·
DOI： 10.3760/cma.j.cn341190-20240712-00896
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摘要

目的观察邮票植皮联合负压封闭引流（VSD）技术对糖尿病足部溃疡（DFU）的临床效果。

方法选取2020年1月至2022年12月丽水市中心医院收治的DFU患者80例为研究对象进行前瞻性研究，根据随机数字表法分为观察组和对照组，各40例；对照组采用VSD技术治疗；观察组给予邮票植皮联合VSD技术治疗；比较两组围手术期指标（创面愈合时间、住院时间、换药次数、肉芽组织生长进度）、疼痛情况［采用视觉模拟评分（VAS）评估］、足背血流动力学（足背动脉内径、动脉血流速度）、足部功能（采用Maryland足功能评分评估）和术后并发症发生情况。

结果观察组创面愈合时间、住院时间分别为（21.54±5.32）d、（27.08±5.97）d，短于对照组的（26.69±5.66）d、（31.49±6.80）d（ t=4.19、3.08，均 P < 0.05）。观察组换药次数为（5.11±1.14）次，少于对照组的（8.07±1.59）次（ t=9.56， P < 0.001）。观察组肉芽组织生长进度为（3.12±0.64）mm，快于对照组的（2.09±0.48）mm（ t=8.14， P < 0.001）；观察组术后1、2、3个月VAS评分分别为（3.52±0.65）分、（2.33±0.42）分、（1.40±0.26）分，低于对照组的（3.96±0.71）分、（2.74±0.44）分、（1.78±0.34）分（ t=2.89、4.26、5.615，均 P < 0.05）；术后3个月，观察组足背动脉内径、动脉血流速度分别为（2.64±0.44）mm、（36.42±6.28）cm/s，高于对照组的（2.18±0.41）mm、（30.97±5.33）cm/s（ t=4.83、4.18，均 P < 0.001）；术后3个月，观察组疼痛、足部功能、外观、活动度评分分别为（39.28±6.70）分、（48.10±7.22）分、（7.94±1.54）分、（12.15±2.35）分，高于对照组的（33.46±6.89）分、（43.08±6.68）分、（5.38±1.06）分、（10.69±2.16）分（ t=3.83、3.22、8.66、2.89，均 P < 0.05）；两组皮片坏死/移位、血肿积液、感染、溃疡复发等术后并发症总发生率比较，差异无统计学意义（ P > 0.05）。

结论邮票植皮联合VSD技术可显著加快DFU患者创面愈合，降低术后疼痛，改善足背血流动力学，提高足部功能，且安全性较好。

糖尿病足;负压伤口疗法;皮肤移植;疼痛测定;血流动力学
ABSTRACT

ObjectiveTo investigate the clinical efficacy of stamp skin grafting combined with vacuum sealing drainage in the treatment of diabetic foot ulcers.

MethodsA prospective study was conducted involving 80 patients with diabetic foot ulcers admitted to Lishui Central Hospital from January 2020 to December 2022. The patients were divided into an observation group and a control group, with 40 patients in each group, using a random number table method. The control group received treatment with vacuum-sealing drainage technology, while the observation group was treated with stamp skin grafting combined with vacuum sealing drainage. The two groups were compared based on several perioperative indicators, including wound healing time, length of hospital stay, number of dressing changes, and progress of granulation tissue growth. Pain levels were assessed using the Visual Analog Scale. Additionally, dorsalis pedis blood flow dynamics were evaluated, focusing on the diameter of the dorsalis pedis artery and arterial blood flow velocity. Foot function was assessed using the Maryland Foot Function Scale. The occurrence of postoperative complications was recorded.

ResultsThe wound healing time and length of hospital stay in the observation group were (21.54 ± 5.32) days and (27.08 ± 5.97) days, respectively, which were significantly shorter than those in the control group [(26.69 ± 5.66) days, (31.49 ± 6.80) days, t = 4.19, 3.08, both P < 0.05]. The number of dressing changes in the observation group was (5.11 ± 1.14), which was significantly fewer than that in the control group [(8.07 ± 1.59), t = 9.56, P < 0.001]. The progress of granulation tissue growth in the observation group [(3.12 ± 0.64) mm] was faster that in the control group [(2.09 ± 0.48) mm, t = 8.14, P < 0.001]. At 1, 2, and 3 months post-surgery, the Visual Analog Scale scores for the observation group were (3.52 ± 0.65), (2.33 ± 0.42), and (1.40 ± 0.26), respectively, which were significantly lower than those in the control group [(3.96 ± 0.71), (2.74 ± 0.44), (1.78 ± 0.34), t = 2.89, 4.26, 5.615, all P < 0.05). At 3 months post-surgery, the diameter of the dorsalis pedis artery and arterial blood flow velocity in the observation group were (2.64 ± 0.44) mm and (36.42 ± 6.28) cm/s, respectively, which were greater than those in control group [(2.18 ± 0.41) mm, (30.97 ± 5.33) cm/s, t = 4.83, 4.18, both P < 0.001]. At 3 months post-surgery, the scores for pain, foot function, appearance, and range of motion in the observation group were (39.28 ± 6.70), (48.10 ± 7.22), (7.94 ± 1.54), and (12.15 ± 2.35), respectively, which were significantly higher than those in the control group [(33.46 ± 6.89), (43.08 ± 6.68), (5.38 ± 1.06), and (10.69 ± 2.16), t = 3.83, 3.22, 8.66, 2.89, all P < 0.05]. There was no statistically significant difference in the overall incidence of postoperative complications, including skin flap necrosis/dislocation, hematoma accumulation, infection, and ulcer recurrence, between the two groups ( P > 0.05).

ConclusionsStamp skin grafting combined with vacuum sealing drainage can significantly accelerate wound healing in patients with diabetic foot ulcers, reduce postoperative pain, improve dorsalis pedis blood flow dynamics, enhance foot function, and demonstrate good safety.

Diabetic foot;Negative-pressure wound therapy;Skin transplantation;Pain measurement;Hemodynamics
Cai Xiaobin, Email: mocdef.3ab619791niboaixiac
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引用本文

毛幸,蔡晓斌,吴炳林,等. 邮票植皮联合负压封闭引流技术治疗糖尿病足部溃疡的效果观察[J]. 中国基层医药,2025,32(03)：377-381.

DOI:10.3760/cma.j.cn341190-20240712-00896

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糖尿病足部溃疡（diabetic foot ulcer，DFU）是糖尿病最常见、最严重的并发症之一 ［ 1 ］ 。相关研究统计，糖尿病患者足部溃疡的发生率为4%~10%，DFU患者的截肢率和年病死率分别为22%、11% ［ 2 ］ 。目前，DFU尚无特效的治疗方法。负压封闭引流（vacuum sealing drainage，VSD）主要通过VSD材料和生物半透膜将创面封闭，最后通过持续负压吸引促进液体渗出和创面引流，创造一个相对清洁潮湿的环境，加速肉芽组织的生长，控制感染 ［ 3 , 4 ］ 。但相关研究指出，VSD属于物理治疗，对患者的创面愈合没有生物恢复功能 ［ 5 ］ 。邮票植皮指在保持原有血供状态下，使用供区的完整组织修复创面，并建立新的血运关系。研究显示，邮票植皮可显著缩短创面修复时间，促进创面愈合 ［ 6 ］ 。基于此，本研究分析邮票植皮联合VSD技术对DFU患者创面愈合及足部功能水平的影响，现报告如下。
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备注信息
A
蔡晓斌，Email： mocdef.3ab619791niboaixiac
B

毛幸：采集数据、起草文章；蔡晓斌、吴炳林：统计分析；刘舜平、蓝益南：采集数据；江洵：技术支持；设计试验、文章修订

C
毛幸, 蔡晓斌, 吴炳林, 等. 邮票植皮联合负压封闭引流技术治疗糖尿病足部溃疡的效果观察[J]. 中国基层医药,2025,32(3):377-381. DOI:10.3760/cma.j.cn341190-20240712-00896.
D
所有作者声明不存在利益冲突
E
浙江省医药卫生科技计划 (2024KY1850)
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