抗生素骨水泥覆盖与负压创面疗法对糖尿病足溃疡创面愈合的影响比较

Effects of antibiotic-loaded bone cement coverage versus negative pressure wound therapy on diabetic foot ulcer wound healing

  • 摘要:
    目的 比较抗生素骨水泥覆盖与负压创面疗法(NPWT)对糖尿病足溃疡创面愈合的影响。
    方法 选取113例糖尿病足溃疡患者作为研究对象, 采用双色球随机分组法分为对照组57例(实施NPWT)和试验组56例(实施抗生素骨水泥覆盖治疗), 2组患者均接受常规清创。观察并比较2组患者的治疗效果、创面细菌培养阳性检出情况、下肢神经传导功能(胫神经运动传导速度、腓总神经感觉传导速度)、多普勒超声指标(血管内径、血流速度、阻力指数、搏动指数)、炎症指标(肿瘤坏死因子-α、白细胞介素-6、超敏C反应蛋白)及肉芽组织生长情况。
    结果 试验组患者的治疗有效率为85.71%, 高于对照组的70.18%, 差异有统计学意义(P < 0.05)。治疗前, 2组的创面细菌培养阳性检出率、胫神经运动传导速度、腓总神经感觉传导速度、血流速度、血管内径、阻力指数、搏动指数、肉芽组织生长情况和血清肿瘤坏死因子-α、白细胞介素-6、超敏C反应蛋白水平比较,差异均无统计学意义(P>0.05); 治疗3、7、15 d后,试验组患者的创面细菌培养阳性检出率均低于对照组,差异有统计学意义(P < 0.05); 治疗后, 2组胫神经运动传导速度、腓总神经感觉传导速度、血管内径、血流速度、阻力指数、搏动指数均高于或大于治疗前,且试验组高于或大于对照组,差异有统计学意义(P < 0.05); 治疗后,试验组的肉芽组织面积、覆盖率和肉芽组织生长率均大于或高于对照组,差异有统计学意义(P < 0.05); 治疗后, 2组血清肿瘤坏死因子-α、白细胞介素-6、超敏C反应蛋白水平均低于治疗前,且试验组低于对照组,差异有统计学意义(P < 0.05)。
    结论 相较于NPWT, 抗生素骨水泥覆盖治疗对糖尿病足溃疡的治疗有效率更高,能够提供更有效的局部抗菌环境,促进创面愈合和组织修复,同时改善神经功能和血管状况。

     

    Abstract:
    Objective To compare the effects of antibiotic-loaded bone cement coverage and negative pressure wound therapy (NPWT) on diabetic foot ulcer wound healing.
    Methods A total of 113 patients with diabetic foot ulcers were selected as study subjects and randomly divided into control group (57 patients receiving NPWT) and experimental group (56 patients receiving antibiotic-loaded bone cement coverage) using the double-color ball randomization method. Both groups underwent routine debridement. The treatment outcomes, positive detection rate of wound bacterial culture, lower limb nerve conduction function (tibial nerve motor conduction velocity, common peroneal nerve sensory conduction velocity), Doppler ultrasound indicators (vessel diameter, blood flow velocity, resistance index, pulsatility index), inflammatory indicators (tumor necrosis factor-α, interleukin-6, high-sensitivity C-reactive protein), and granulation tissue growth were observed and compared between the two groups.
    Results The effective treatment rate was 85.71% in the experimental group, which was higher than 70.18% in the control group (P < 0.05). Before treatment, there were no statistically significant differences between the two groups in terms of positive detection rate of wound bacterial culture, tibial nerve motor conduction velocity, common peroneal nerve sensory conduction velocity, blood flow velocity, vessel diameter, resistance index, pulsatility index, granulation tissue growth, and serum levels of tumor necrosis factor-α, interleukin-6, and high-sensitivity C-reactive protein (P>0.05). After 3, 7, and 15 days of treatment, the positive detection rate of wound bacterial culture in the experimental group was lower than that in the control group (P < 0.05). After treatment, the tibial nerve motor conduction velocity, common peroneal nerve sensory conduction velocity, vessel diameter, blood flow velocity, resistance index, and pulsatility index in both groups were higher or greater than those before treatment, and those in the experimental group were higher or greater than those in the control group (P < 0.05). After treatment, the granulation tissue area, coverage rate, and granulation tissue growth rate in the experimental group were higher than those in the control group (P < 0.05). After treatment, the serum levels of tumor necrosis factor-α, interleukin-6, and high-sensitivity C-reactive protein in both groups were lower than those before treatment, and those in the experimental group were lower than those in the control group (P < 0.05).
    Conclusion Compared with NPWT, antibiotic-loaded bone cement coverage has a higher effective treatment rate for diabetic foot ulcers, and provides a more effective local antibacterial environment, thereby promoting wound healing and tissue repair, and simultaneously improving nerve function and vascular status.

     

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