Foot Ulcer Trials Unit, Nottingham University Hospitals Trust, Nottingham, UK.
Diabetes Metab Res Rev. 2012 Feb;28 Suppl 1:119-41. doi: 10.1002/dmrr.2246.
The outcome of management of diabetic foot ulcers is poor, and there is continuing uncertainty concerning optimal approaches to management. It was for these reasons that in 2006 the International Working Group of the Diabetic Foot (IWGDF) working group on wound healing undertook a systematic review of the evidence to inform protocols for routine care and to highlight areas which should be considered for further study. The same working group has now updated this review by considering papers on the interventions to improve the healing of chronic ulcers published between December 2006 and June 2010. Methodological quality of selected studies was independently assessed by two reviewers using Scottish Intercollegiate Guidelines Network criteria. Selected studies fell into the following ten categories: sharp debridement and wound bed preparation with larvae and hydrotherapy; wound bed preparation using antiseptics, applications and dressing products; resection of the chronic wound; hyperbaric oxygen therapy (HBOT); compression or negative pressure therapy; products designed to correct aspects of wound biochemistry and cell biology associated with impaired wound healing; application of cells, including platelets and stem cells; bioengineered skin and skin grafts; electrical, electromagnetic, lasers, shockwaves and ultrasound; other systemic therapies which did not fit in the above categories. Heterogeneity of studies prevented pooled analysis of results. Of the 1322 papers identified, 43 were selected for grading following full text review. The present report is an update of the earlier IWGDF systematic review, but the conclusion is similar: that with the exception of HBOT and, possibly, negative pressure wound therapy, there is little published evidence to justify the use of newer therapies. This echoes the conclusion of a recent Cochrane review and the systematic review undertaken by the National Institute for Health and Clinical Excellence Guidelines Committee in the UK. Analysis of evidence presents considerable difficulties in this field particularly as controlled studies are few and the majority are of poor methodological quality.
糖尿病足溃疡的治疗效果不佳，对于最佳治疗方法仍存在诸多不确定性。也正是由于这些原因，2006 年国际糖尿病足工作组（IWGDF）的伤口愈合工作组对相关证据进行了系统评价，旨在为常规护理制定方案，并确定应进一步研究的领域。该工作组现在根据 2006 年 12 月至 2010 年 6 月期间发表的有关改善慢性溃疡愈合干预措施的论文对该综述进行了更新。两名评审员使用苏格兰校际指南网络标准独立评估了选定研究的方法学质量。选定的研究归入以下十个类别：清创术和幼虫及水疗伤口床准备；防腐剂、制剂和敷料伤口床准备；慢性伤口切除术；高压氧治疗（HBOT）；压迫或负压治疗；设计用于纠正与伤口愈合受损相关的伤口生物化学和细胞生物学方面的产品；应用细胞，包括血小板和干细胞；生物工程皮肤和皮肤移植物；电、电磁、激光、冲击波和超声；其他不适合上述类别的全身性治疗。研究的异质性使得无法对结果进行汇总分析。在确定的 1322 篇论文中，有 43 篇经过全文审查后被选为进行分级。本报告是对早期 IWGDF 系统评价的更新，但结论相似：除 HBOT 外，可能还有负压伤口治疗，几乎没有发表的证据支持使用新的治疗方法。这与最近的 Cochrane 评价和英国国家卫生与临床优化研究所指南委员会进行的系统评价的结论相呼应。由于对照研究较少，且大多数研究的方法学质量较差，因此该领域的证据分析存在较大困难。
