Michailidis Lucia, Bergin Shan M, Haines Terry P, Williams Cylie M
Monash Health, Podiatry Department, Monash Medical Centre, Clayton, VIC, Australia; Monash University, School of Primary and Allied Health Care, Physiotherapy Department, Frankston, VIC, Australia.
Monash Health, Podiatry Department, Monash Medical Centre, Clayton, VIC, Australia.
Ostomy Wound Manage. 2018 Sep;64(9):39-46.
Management of diabetes-related foot ulcers often involves debridement of devitalized tissue, but evidence regarding the most effective debridement method is limited.
A systematic review was conducted to determine the effectiveness of nonsurgical sharp debridement (NSSD) versus low-frequency ultrasonic debridement (LFUD) for diabetes-related foot ulceration in adults.
Published studies (earliest date available to April 2017) comparing healing outcomes of LFUD- and NSSD-treated foot ulcers in adults were considered. The quality of publications that met inclusion criteria were assessed using the PEDro scale, and a meta-analysis was undertaken to compare percentage healed and percentage of ulcer size reduction.
Of the 259 publications identified, 4 met the inclusion criteria but 2 of the 4 did not contain sufficient patient outcomes details for meta-analysis, leaving a sample size of 173 patients. Outcome data for the 2 studies included percentage of ulcers healed between the 2 debridement methods. This difference was not significant (RR = 0.92; 95% CI = 0.76-1.11). The risk of bias for both studies was low.
No difference in healing outcomes between NSSD and LFUD debridement of diabetic foot ulcers was found. Well-designed, controlled clinical studies are needed to address the current paucity of studies examining the efficacy and comparative effectiveness of debridement methods.
糖尿病相关足部溃疡的治疗通常涉及对失活组织的清创，但关于最有效清创方法的证据有限。
进行一项系统评价，以确定非手术锐性清创（NSSD）与低频超声清创（LFUD）对成人糖尿病相关足部溃疡的有效性。
纳入已发表的研究（最早时间至2017年4月），比较LFUD和NSSD治疗的成人足部溃疡的愈合结果。使用PEDro量表评估符合纳入标准的出版物质量，并进行荟萃分析以比较愈合百分比和溃疡面积缩小百分比。
在确定的259篇出版物中，4篇符合纳入标准，但4篇中的2篇没有包含足够的患者结局详细信息用于荟萃分析，最终样本量为173例患者。两项研究的结局数据包括两种清创方法之间的溃疡愈合百分比。这种差异不显著（RR = 0.92；95%CI = 0.76 - 1.11）。两项研究的偏倚风险均较低。
未发现NSSD和LFUD对糖尿病足溃疡清创的愈合结果存在差异。需要设计良好的对照临床研究来解决目前关于清创方法有效性和比较效果研究的不足。
