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糖尿病足溃疡患者病灶内应用表皮生长因子后的长期结局

The Long-Term Outcomes Following the Application of Intralesional Epidermal Growth Factor in Patients With Diabetic Foot Ulcers.

作者信息

Kahraman Murat, Misir Abdulhamit, Kizkapan Turan Bilge, Ozcamdalli Mustafa, Uzun Erdal, Mutlu Mahmut

机构信息

Surgeon, Department of Orthopaedics and Traumatology, Necip Fazil City Hospital, Kahramanmaras, Turkey.

Surgeon, Department of Orthopaedics and Traumatology, Sanliurfa Training and Research Hospital, Sanliurfa, Turkey.

出版信息

J Foot Ankle Surg. 2019 Mar;58(2):282-287. doi: 10.1053/j.jfas.2018.08.041. Epub 2019 Jan 3.

Abstract

Epidermal growth factor is used as an adjuvant to close the wound in addition to standard care in diabetic foot ulcers. This study aimed to investigate the long-term outcomes after intralesional epidermal growth factor injections in the treatment of diabetic foot ulcers. Thirty-six feet of 34 patients (n = 34) with diabetic foot ulcers were included. Patient demographics, Wagner classifications, recurrence and amputation rates, Foot Function Index, Short Form 36, and American Academy of Orthopedic Surgeons Foot and Ankle Module scores were evaluated at the final follow-up examination. The mean age was 61.000 ± 13.743 years. The mean duration of wounds was 240.200 ± 146.385 days. A mean of 18.125 ± 4.494 (range 9 to 24) doses were applied. Wound closure was achieved in 33 of the 36 (91.7%) lesions. A complete response (granulation tissue >75% or wound closure) was observed in 29 (87.9%) lesions. The mean time to wound closure was 52.08 ± 10.65 (range 25 to 72) days. At the 5-year follow-up, 4 patients were lost to follow-up because of exitus owing to diabetic complications. Of the remaining 29 patients, 27 were ulcer free. In 2 patients (2 lesions, 6.9%) toe amputation was performed due to ischemic necrosis. The mean Foot Function Index, American Academy of Orthopedic Surgeons Foot and Ankle Core Scale, and AAOS Shoe Comfort Scale scores were 55.40 ± 12.15, 65.92 ± 17.56, and 56.42 ± 11.98, respectively. Complete wound healing and a low recurrence and amputation rates could be obtained with intralesional epidermal growth factor added to the standard treatment protocol.

摘要

除了糖尿病足溃疡的标准护理外,表皮生长因子还用作辅助手段来闭合伤口。本研究旨在调查病灶内注射表皮生长因子治疗糖尿病足溃疡的长期疗效。纳入了34例(n = 34)患有糖尿病足溃疡患者的36只脚。在最终随访检查时评估患者的人口统计学特征、瓦格纳分级、复发率和截肢率、足部功能指数、简明健康状况调查量表(SF-36)以及美国矫形外科医师学会足踝模块评分。平均年龄为61.000 ± 13.743岁。伤口的平均持续时间为240.200 ± 146.385天。平均注射18.125 ± 4.494(范围9至24)剂。36个病灶中的33个(91.7%)实现了伤口闭合。29个(87.9%)病灶观察到完全缓解(肉芽组织>75%或伤口闭合)。伤口闭合的平均时间为52.08 ± 10.65(范围25至72)天。在5年随访时,4例患者因糖尿病并发症死亡而失访。其余29例患者中,27例无溃疡。2例患者(2个病灶,6.9%)因缺血性坏死进行了趾截肢。足部功能指数、美国矫形外科医师学会足踝核心量表和美国矫形外科医师学会鞋类舒适度量表的平均评分分别为55.40 ± 12.15、65.92 ± 17.56和56.42 ± 11.98。在标准治疗方案中添加病灶内表皮生长因子可实现完全伤口愈合以及低复发率和截肢率。

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