Hjerppe A, Saarinen J P, Venermo M A, Huhtala H S, Vaalasti A
Department of Dermatology, Tampere University Hospital, Tampere, Finland.
J Wound Care. 2010 Nov;19(11):474, 476, 478 passim. doi: 10.12968/jowc.2010.19.11.79696.
To assess whether a difference in venous reflux pattern, ulcer size or duration, regular medications or the daily use of walking aids can predict the healing of a chronic venous leg ulcer (VLU).
In this prospective, randomised, single-centre study, 110 consecutive patients with chronic leg ulcers were assessed. Ninety-nine patients met the inclusion criteria and a controlled, conservative 3-month treatment period was initiated, in which 90 patients were managed with standardised local treatment combined with compression therapy. In this group, 62 VLUs healed within 12 weeks and 28 were still open after 12 weeks. The study group consisted of 22 patients with non-healed ulcers and a control group (n=28), which was selected randomly from the healers. In both groups, venous reflux profiles were assessed using colour-flow duplex imaging.
The study and control groups did not differ in smoking habits, age, gender or daily oral medications. On average, the healing wounds were 5cm² before starting controlled treatment (range 1-80cm²) and had been open for 7 months (range 2-48 months); the non-healing wounds were on average 11.2cm² (range 1-31cm²) and had been open for 26 months (range 8-106 months). Venous disease severity scores were similar for both groups (12.6 vs. 13.4). Five patients (18%) with healed ulcers regularly used walking aids, the use of which was more frequent (36%) among non-healers (p<0.001). Venous reflux profiles differed significantly between the groups, with isolated superficial reflux noted in 64% of healers, compared with 36% of non-healers. In addition, isolated deep reflux was found in 14% of the healers, compared with 41% of non-healers (p=0.0002). The rate of popliteal reflux was significantly higher in non-healers (59% versus 21%; p=0.0004).
Long duration of a chronic venous ulcer may predict a poor outcome. The presence of deep venous reflux, especially in the popliteal vein, is typically found in those legs with non-healed ulcers. .
评估静脉反流模式、溃疡大小或持续时间、常规用药或日常助行器使用情况的差异是否能够预测慢性下肢静脉溃疡（VLU）的愈合情况。
在这项前瞻性、随机、单中心研究中，对110例连续性慢性下肢溃疡患者进行了评估。99例患者符合纳入标准，并开始了为期3个月的对照保守治疗期，其中90例患者接受标准化局部治疗联合压迫疗法。在该组中，62例VLU在12周内愈合，28例在12周后仍未愈合。研究组由22例未愈合溃疡患者组成，对照组（n = 28）从愈合患者中随机选取。两组均使用彩色多普勒成像评估静脉反流情况。
研究组和对照组在吸烟习惯、年龄、性别或每日口服药物方面无差异。开始对照治疗前，愈合伤口平均面积为5cm²（范围1 - 80cm²），已开放7个月（范围2 - 48个月）；未愈合伤口平均面积为11.2cm²（范围1 - 31cm²），已开放26个月（范围8 - 106个月）。两组静脉疾病严重程度评分相似（12.6对13.4）。5例（18%）愈合溃疡患者经常使用助行器，未愈合患者中使用助行器的比例更高（36%）（p<0.001）。两组间静脉反流情况有显著差异，64%的愈合患者存在单纯浅静脉反流，未愈合患者中这一比例为36%。此外，14%的愈合患者存在单纯深静脉反流，未愈合患者中这一比例为41%（p = 0.0002）。腘静脉反流率在未愈合患者中显著更高（59%对21%；p = 0.0004）。
慢性静脉溃疡病程长可能预示预后不良。未愈合溃疡的下肢通常存在深静脉反流，尤其是腘静脉反流。
