Moran M E
Assistant Professor; Department of Occupational Therapy Kean University 1000 Morris Avenue Union, New Jersey 0708.
J Wound Care. 2014 Oct;23(10):510-6. doi: 10.12968/jowc.2014.23.10.510.
Digital ulcers are difficult to heal, increasing the chance of infection, gangrene, amputation and limited functional use of hands. They are a complication in scleroderma or systematic sclerosis (SSc) and occur in approximately 50% of patients. This is a systematic review of the evidence supporting the use of non-pharmaceutical therapeutic modalities and their effectiveness to facilitate the healing of chronic digital ulcers in patients with scleroderma.
A comprehensive review of computerised databases from 2000-2013: PubMed/MEDLINE, CINAHL, Pedro, OT Seeker, OT Search, OVID, and Proquest as well as manual review of other resources was completed using the following search terms scleroderma or systemic sclerosis and/or digital ulcers, specific modalities (low level laser therapy, electrical stimulation, intermittent compression, ultrasound, vitamin E, myofascial release, wound dressings, iontophoresis, negative pressure therapy, and exercise), chronic wounds, and wound care. English language studies, from 2000 to January 2013, which used therapeutic modalities to facilitate healing of digital ulcers and use healing of the digital ulcer as an outcome measure were reviewed.
Of the 403 identified articles, only 11 studies addressed non-pharmaceutical treatment modalities to facilitate healing for digital ulcers. Exercise had no direct effect on healing ulcers. The following studies were positive but have limitations in design and sample size:: hyperbaric oxygen therapy (n=2), negative pressure therapy (n=1), intermittent compression (n=27) and acoustic pressure wound healing (n=1). Vitamin E gel showed a significant difference compared to a control group (n=27). Iontophoresis studies have shown that the modality increases blood flow but the results in five different studies are mixed and the application and intensity were inconsistent.
No one modality was proven to be the most effective. Larger efficacy studies on treating digital ulcers are needed in order to develop appropriate care guidelines to improve outcomes, promote function and lower health-care costs.
指端溃疡难以愈合，会增加感染、坏疽、截肢的风险，还会限制手部功能的使用。指端溃疡是硬皮病或系统性硬化症（SSc）的一种并发症，约50%的患者会出现。本文对支持使用非药物治疗方法促进硬皮病患者慢性指端溃疡愈合及其有效性的证据进行系统评价。
对2000年至2013年的计算机数据库进行全面检索：使用以下检索词在PubMed/MEDLINE、CINAHL、Pedro、OT Seeker、OT Search、OVID和Proquest数据库中进行检索，同时对手动检索的其他资源进行回顾，检索词包括硬皮病或系统性硬化症和/或指端溃疡、特定治疗方法（低强度激光治疗、电刺激、间歇性加压、超声、维生素E、肌筋膜松解术、伤口敷料、离子导入疗法、负压疗法和运动）、慢性伤口和伤口护理。纳入2000年至2013年1月间使用治疗方法促进指端溃疡愈合并将指端溃疡愈合作为结局指标的英文研究。
在检索到的403篇文章中，仅有11项研究涉及促进指端溃疡愈合的非药物治疗方法。运动对溃疡愈合无直接作用。以下研究结果为阳性，但在设计和样本量方面存在局限性：高压氧治疗（n = 2）、负压疗法（n = 1）、间歇性加压（n = 27）和声压伤口愈合（n = 1）。与对照组相比，维生素E凝胶显示出显著差异（n = 27）。离子导入疗法的研究表明该方法可增加血流量，但五项不同研究的结果不一，应用方式和强度也不一致。
尚无一种治疗方法被证明是最有效的。需要开展更多关于治疗指端溃疡疗效的研究，以制定合适的护理指南，改善治疗效果、促进功能恢复并降低医疗成本。
