富血小板血浆用于糖尿病慢性伤口的证据日益增多:一项综述及新的标准护理方案建议

The growing evidence for the use of platelet-rich plasma on diabetic chronic wounds: A review and a proposal for a new standard care.

作者信息

Picard Frédéric, Hersant Barbara, Bosc Romain, Meningaud Jean-Paul

机构信息

Department of Plastic & Reconstructive Surgery, Henri Mondor Hospital, Créteil, France.

出版信息

Wound Repair Regen. 2015 Sep;23(5):638-43. doi: 10.1111/wrr.12317. Epub 2015 Aug 25.

Abstract

Nonhealing chronic wounds and exposed tendons, bones and joints are very challenging to cure specially for diabetic patients. Plastic surgeons have a new weapon to enhance wound healing with the use of autologous growth factors. Recently, the process of fabrication of platelet-rich plasma (PRP) has been simplified. The goal of this literature review is to summarize the evidenced-based body of knowledge regarding the treatment of diabetic chronic wounds by PRP. A PubMed and Cochrane search (1978-2015) was performed and all studies assessing the clinical effect of PRP on the healing of diabetic chronic wounds were included. The screening retrieved 7,555 articles and 12 studies were included. On six randomized studies included, five found significant benefits for the use of PRP on diabetic chronic foot ulcers and the sixth randomized study did not publish a statistical analysis but found favorable outcomes. The two other controlled studies included found significant benefits regarding the healing rate and the four uncontrolled studies included showed high rates of healing with the adjunction of PRP. Regarding the method of use, PRP was applied on the wound as a gel twice a week (41.7% of studies) or once a week (33.3% of studies). In conclusion, 87.5% of controlled studies found a significant benefit for the adjunction of PRP to treat chronic diabetic wounds. As PRP may be beneficial, we suggest using PRP on diabetic ulcers which remain unhealed after standard treatment.

摘要

难愈合的慢性伤口以及暴露的肌腱、骨骼和关节,对于治愈而言极具挑战性,尤其是对糖尿病患者。整形外科医生有了一种利用自体生长因子促进伤口愈合的新武器。最近,富血小板血浆(PRP)的制备过程已得到简化。这篇文献综述的目的是总结关于PRP治疗糖尿病慢性伤口的循证知识体系。进行了PubMed和Cochrane检索(1978年至2015年),纳入了所有评估PRP对糖尿病慢性伤口愈合临床效果的研究。筛选出7555篇文章,纳入了12项研究。在纳入的6项随机研究中,5项发现使用PRP对糖尿病慢性足部溃疡有显著益处,第6项随机研究未发表统计分析,但发现了有利的结果。纳入的另外2项对照研究发现PRP在愈合率方面有显著益处,纳入的4项非对照研究显示PRP辅助治疗有高愈合率。关于使用方法,PRP作为凝胶每周两次应用于伤口(41.7%的研究)或每周一次(33.3%的研究)。总之,87.5%的对照研究发现PRP辅助治疗慢性糖尿病伤口有显著益处。由于PRP可能有益,我们建议在标准治疗后仍未愈合的糖尿病溃疡上使用PRP。

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