自体脂肪移植联合富血小板纤维蛋白用于糖尿病足修复的近期和远期效果分析

doi:10.3969/j.issn.1005-6483.20241640

摘要/Abstract

摘要： 目的探讨自体脂肪移植（autologous fat grafting，AFG）联合富血小板纤维蛋白（platelet-rich fibrin，PRF）治疗糖尿病足溃疡（diabetic foot ulcer,DFU）的短期疗效和长期效果。方法本研究为前瞻性随机对照研究。2020年7月～2023年12月我院收治的DFU病人116例。按照随机数字表法平均分为脂肪移植组（58例）和联合治疗组（58例）。脂肪移植组给予负压吸引+自体脂肪移植处理溃疡面，联合治疗组给予负压吸引+自体脂肪移植+富血小板纤维蛋白处理溃疡面。收集两组病人临床基线资料，评估两组病人50%溃疡面愈合时间、30天溃疡面愈合百分比、7天肉芽组织评分和VAS评分。随访3个月，采用压疮愈合量表（pressure ulcer scale for healing，PUSH）分别于治疗前、治疗7天、治疗1个月、治疗2个月、治疗3个月对病人溃疡面进行评分，评估治疗效果。结果联合治疗组50%溃疡面愈合时间为（21.44±3.86）天，低于脂肪移植组的（26.39±3.79）天，两组比较差异有统计学意义（P<0.05）。联合治疗组30天溃疡面愈合百分比为（66.39±6.92）%，7天肉芽组织评分为（3.96±0.47）分，高于脂肪移植组的（59.87±7.44）%和（3.58±0.44）分，两组比较差异有统计学意义（P<0.05）；联合治疗组和脂肪移植组治疗7天后血管内皮生长因子分别为（6.52±0.76）ng/ml和（4.96±0.63）ng/ml，转化生长因子-β1分别为（111.37±1.54）ng/ml 和（9.04±1.18）ng/ml，白细胞介素（IL）-1β分别为（84.32±11.28）pg/ml和（113.15±15.32）pg/ml， IL-10分别为（40.39±6.87）pg/ml和（59.67±8.54）pg/ml，两组比较差异有统计学意义（P<0.05）；联合治疗组在治疗后1个月、2个月和3个月的PUSH评分分别为（7.58±1.44）分、（6.27±1.28）分和（2.44±0.72）分，脂肪移植组分别为（8.62±1.39）分、（7.08±1.43）分和（4.12±0.93）分，两组比较差异有统计学意义（P<0.001）。结论 AFG联合PRF治疗糖尿病足溃疡具有良好的短期和长期效果。

关键词: 自体脂肪移植；富血小板纤维蛋白；糖尿病足；溃疡；愈合

Abstract: Objective To investigate the short-term and long-term effects of autologous fat grafting (AFG) combined with platelet-rich fibrin (PRF) in the treatment of diabetic foot ulcers (DFU).Methods This study was designed as a prospective randomized controlled trial (RCT).A total of 116 patients with DFU treated in our hospital from July 2020 to December 2023 were enrolled and divided into a fat grafting group and a combined treatment group with 58 patients in each group according to the randomized numerical table method.The fat grafting group received negative pressure suction and autologous fat grafting to treat the wound,while the combined treatment group received negative pressure suction,autologous fat grafting,and PRF to treat the wound.Clinical baseline data of the two groups were collected.The 50% ulcer healing time,30-day wound healing percentage,7-day granulation tissue score,and VAS score were evaluated in both groups.Follow-up was conducted for 3 months,and the ulcer surface of the patients was scored using the Pressure Ulcer Scale for Healing (PUSH) before treatment,at 7 days,1 month,2 months,and 3 months after treatment to assess the treatment effect.Results The healing time of 50% ulcer surface in the combined treatment group was (21.44±3.86) days, which was lower than that in the fat transplantation group [(26.39±3.79) days], and the difference between the two groups was statistically significant (P<0.05). The percentage of ulcer surface healing in the combined treatment group at 30 days was (66.39±6.92) %, and the granulation tissue score at 7 days was (3.96±0.47) points, which were higher than those in the fat transplantation group [(59.87±7.44) % and (3.58±0.44) points]. There was a statistically significant difference between the two groups (P<0.05).After 7 days of treatment, the vascular endothelial growth factor in the combined treatment group and the fat transplantation group was (6.52±0.76) ng/ml and (4.96±0.63) ng/ml respectively, and the transforming growth factor beta1 was (111.37±1.54) ng/ml and (9.04±1.18) ng/ml respectively. The interleukin (IL) -1β was (84.32±11.28) pg/ml and (113.15±15.32) pg/ml respectively, and the IL-10 was (40.39±6.87) pg/ml and (59.67 ±8.54) pg/ml respectively. There was a statistically significant difference between the two groups (P<0.05).The PUSH scores of the combined treatment group at 1 month, 2 months and 3 months after treatment were (7.58±1.44) points, (6.27±1.28) points and (2.44±0.72) points respectively, while those of the fat transplantation group were (8.62±1.39) points, (7.08±1.43) points and (4.12±0.93) points respectively. There was a statistically significant difference between the two groups (P<0.001).Conclusion AFG combined with PRF shows good short-term and long-term effects in the treatment of diabetic foot ulcers.

Key words: autologous fat grafting; platelet-rich fibrin; diabetic foot; ulcer; healing

王峻岭李欣张冀北. 自体脂肪移植联合富血小板纤维蛋白用于糖尿病足修复的近期和远期效果分析[J]. 临床外科杂志, 2026, 34(3): 345-350.

WANG Junling,LI Xin,ZHANG Jibei. Analysis of the short-term and long-term effects of autologous therapeutic transplantation combinedwith platelet-rich fibrin in the repair of diabetic foot ulcers[J]. JOURNAL OF CLINICAL SURGERY, 2026, 34(3): 345-350.

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