Taradaj Jakub, Franek Andrzej, Blaszczak Edward, Polak Anna, Chmielewska Daria, Krol Piotr, Dolibog Patrycja
Department of Medical Biophysics, Medical University of Silesia, Katowice, Poland; Department of Physical Therapy, Academy of Physical Education, Katowice, Poland; email:
Department of Medical Biophysics, Medical University of Silesia, Katowice, Poland.
Wounds. 2012 Aug;24(8):215-26.
Venous ulcers are prevalent, challenging wounds; their incidence is rising with the increasing age of the general population. Physical mo- dalities often are used to help heal these chronic wounds. A prospective study was conducted to investigate the application of high-voltage stimu- lation (HVS), ultrasound therapy (US), low-level laser therapy (LLLT, 810 nm, 65 mW, 4 J/cm2), and compression therapy (CT), with and without surgical intervention; along with standard of care comprising drug therapy (micronized flavonoid fraction in two 500-mg tablets once daily) and wet dressings of 0.9% sodium chloride on venous leg ulcer healing.
The 305-patient study was conducted between 1994 and 2008 among persons with venous ulcers in 3 facilities in Poland. After surgery involving crossectomy, partial [short] stripping of the greater or short saphenous vein, local phlebectomy, and ligation of insufficient perforators, 4 groups of patients were treated with the standard of care drug/dressing therapy and HVS, US, LLLT, or CT, and 1 group received the drug/dressing ther- apy only. Four non-surgical groups received HVS, US, LLLT, or CT and drug/dressing therapy, and 1 group received drug/dressing therapy only. Changes in wound area and volume were compared among all the groups receiving the various treatments using the Gilman index. In all groups therapy lasted 7 weeks. The computed planimetry method for observation of healing process was used.
The Gilman index values at 4 weeks were significantly higher in the compression plus surgery compared with other groups (P = 0.01). After therapy for patients from the CT + surgery group, the Gilman index was 1.18 cm (P ≤ 0.001 compared with other groups). The percentage total surface area regression analysis confirmed that compression plus surgery is the most efficient in venous leg ulcer therapy (61.89% reduction after 4 weeks of therapy and 78.19% at the end of study) compared to the other groups (P ≤ 0.001). The HVS and US appeared useful only in conservatively treated patients (P < 0.05). The LLLT did not accelerate reduction of the ulceration surface.
Venous surgery plus compression therapy is the most effi- cient treatment for venous leg ulcers. Compression therapy should be provided to both surgically and conservatively non-surgically treated pa- tients. High-voltage stimulation and ultrasound therapy are useful meth- ods in conservative treatment of venous leg ulcers. For surgically treated patients, these physical modalities are not effective. Low-level laser ther- apy is not an efficient method for treating venous leg ulcers. .
静脉性溃疡是常见且具有挑战性的伤口；随着普通人群年龄的增长，其发病率在上升。物理治疗方法常被用于帮助愈合这些慢性伤口。进行了一项前瞻性研究，以调查高压刺激（HVS）、超声治疗（US）、低强度激光治疗（LLLT，810纳米，65毫瓦，4焦/平方厘米）和加压治疗（CT）在有无手术干预情况下的应用；以及包括药物治疗（每日一次两片500毫克微粉化类黄酮成分片剂）和用0.9%氯化钠进行湿敷在内的标准护理对下肢静脉溃疡愈合的影响。
这项有305名患者的研究于1994年至2008年在波兰的3个机构中对患有静脉性溃疡的患者进行。在进行了包括横切术、大隐静脉或小隐静脉部分[短段]剥脱术、局部静脉切除术以及结扎功能不全的交通静脉的手术后，4组患者接受了标准护理药物/敷料治疗以及HVS、US、LLLT或CT治疗，1组仅接受药物/敷料治疗。4个非手术组接受HVS、US、LLLT或CT以及药物/敷料治疗，1组仅接受药物/敷料治疗。使用吉尔曼指数比较所有接受不同治疗的组之间伤口面积和体积的变化。所有组的治疗持续7周。采用计算机平面测量法观察愈合过程。
与其他组相比，加压联合手术组在4周时的吉尔曼指数值显著更高（P = 0.01）。CT + 手术组患者治疗后，吉尔曼指数为1.18厘米（与其他组相比P ≤ 0.001）。总表面积百分比回归分析证实，与其他组相比（P ≤ 0.001），加压联合手术在下肢静脉溃疡治疗中最有效（治疗4周后减少61.89%，研究结束时减少78.19%）。HVS和US似乎仅在保守治疗的患者中有用（P < 0.05）。LLLT并未加速溃疡表面的缩小。
静脉手术联合加压治疗是下肢静脉溃疡最有效的治疗方法。对于接受手术和非手术保守治疗的患者均应提供加压治疗。高压刺激和超声治疗是下肢静脉溃疡保守治疗中的有用方法。对于接受手术治疗的患者，这些物理治疗方法无效。低强度激光治疗不是治疗下肢静脉溃疡的有效方法。
