探究在高原地区老年慢性小创面治疗中使用富血小板血浆(PRP)联合微粒皮移植的治疗效果。

选取2018年2月至2022年2月青海省人民医院烧伤整形科收治的老年慢性小创面患者60例。根据患者入院时间不同将患者分为观察组和对照组，观察组采用PRP联合微粒皮移植，对照组采用PRP联合刃厚邮状皮移植。采集患者的外周静脉血，采用二次离心法制备PRP；2组患者均于局部浸润麻醉下应用电动取皮机自大腿前内侧根据创面需要取合适大小刃厚皮片，皮片厚度约0.2 mm，观察组供受区比例为1∶4~1∶8，将所取皮片剪碎后切割成直径<1 mm²的微粒皮备用；对照组供受区比例为1∶1~1∶2，将所取皮片制备为大小约1 cm×1 cm的刃厚邮状皮备用。创面清创、止血后，观察组将制备好的微粒皮均匀涂抹在创面后以PRP填充创面，用聚氨酯泡沫敷料或凡士林纱布覆盖创面避免PRP流失及失活，清洁敷料覆盖并固定；对照组将制备好的PRP填充于创面，再将制备好的刃厚邮状皮片移植于PRP之上，用凡士林或聚氨酯泡沫敷料覆盖清洁敷料加压包扎。2组术后均常规行抗感染等治疗，术后第6、11、16、21、26天创面换药，直至创面完全愈合。术后第21天，统计2组患者的治疗有效率；统计2组患者的创面愈合时间；创面愈合后6个月，以温哥华瘢痕评估量表(VSS)对2组患者的瘢痕情况进行评估。数据比较采用Mann-Whitney U检验和χ²检验。

术后第21天，观察组治疗有效27例，无效3例，治疗有效率为90.00%；对照组治疗有效20例，无效10例，治疗有效率为66.67%，2组比较差异有统计学意义(χ²＝6.278，P＝0.043)。观察组创面愈合时间为为26.0(24.0, 27.0) d，短于对照组[43.0(39.8, 47.3) d]，2组比较差异有统计学意义(Z＝－6.531，P<0.05)。创面愈合后6个月，观察组VSS评分中色素沉着、瘢痕厚度、血管分布和柔韧性评分分别为0(0, 0)、0(0, 0)、0(0, 0)、1(0, 1)分，均分别低于对照组[2.0(1.0, 2.3)、1.5(0.8, 2.0)、1(1, 2)、2(1, 3)分]，2组比较差异均有统计学意义(Z＝－6.310、－4.838、－5.624、－4.431，P<0.05)。

在高原地区，对于老年慢性小创面的治疗，PRP联合微粒皮移植的创新技术具有提高治疗有效率、缩短创面愈合时间的疗效，为患者提供更多治愈的选择性。

To explore the effect of platelet-rich plasma (PRP) combined with micro-skin transplantation in the treatment of chronic small wounds in the elderly in plateau area.

From February 2018 to February 2022, sixty elderly patients with chronic minor wounds were selected from Department of Burns and Plastic Surgery, Qinghai Provincial People′s Hospital. Patients were divided into observation group and control group according to the time of admission. The observation group was treated with PRP combined with micro-skin graft, while the control group was treated with PRP combined with blade-thick mail-like skin graft. The peripheral venous blood of patients was collected and PRP was prepared by secondary centrifugation. Under local infiltration anesthesia, all patients in the two groups used an electric skin-taking machine to take a skin piece with a suitable size and a blade thickness of about 0.2 mm from the front inner thigh according to the needs of the wound. The ratio of donor and recipient areas in the observation group was 1∶4 to 1∶8, and the taken skin piece was cut into small pieces with a diameter of < 1 mm for later use. In the control group, the ratio of donor and recipient areas was 1∶1 to 1∶2, and the skin graft was made into mail-like skin with blade thickness of about 1 cm×1 cm for later use. After wound debridement and hemostasis, the observation group evenly smeared the prepared micro-particle skin on the wound, then filled the wound with PRP, covered the wound with polyurethane foam dressing or vaseline gauze to avoid the loss and inactivation of PRP, and covered and fixed with clean dressing; in the control group, the prepared PRP was filled in the wound surface, and then the prepared blade-thick mail-like skin graft was transplanted on the PRP, and the cleaning dressing was covered with vaseline or polyurethane foam dressing for pressure dressing. Both groups were routinely treated with anti-infection therapy after operation, and the wound was changed on the 6th, 11th, 16th, 21st and 26th day after operation until the wound was completely healed. On the 21st day after operation, the effective rate of treatment in the two groups was counted. The wound healing time of the two groups was counted; six months after wound healing, the scars of the two groups were evaluated by Vancouver scar scale(VSS). The data were compared by Mann-Whitney U test and chi-square test.

On the 21st day after operation, 27 cases were effective and 3 cases were ineffective in the observation group, and the effective rate was 90.00%. In the control group, 20 cases were effective, 10 cases were ineffective, and the effective rate was 66.67%. The difference between the two groups was statistically significant (χ²= 6.278, P=0.043). The wound healing time in the observation group was 26.0 (24.0, 27.0) d, which was shorter than that in the control group [43.0 (39.8, 47.3) d], and the difference between the two groups was statistically significant (Z=-6.531, P<0.05). Six months after wound healing, the VSS scores of hyperpigmentation, scar thickness, vascular distribution and flexibility in the observation group were 0 (0, 0), 0 (0, 0), 0 (0, 0), 0 (0, 0), 1 (0, 1) points, respectively, which were lower than those in the control group [2.0 (1.0, 2.3), 1.5 (0.8, 2.0), 1 (1, 2). 2 (1, 3) points], there were statistically significant differences between the two groups (Z=-6.310, -4.838, -5.624, -4.431; P< 0.05).

In plateau area, the innovative technology of PRP combined with micro-skin can improve the effective rate of treatment, shorten the healing time of wounds, and provide patients with more healing options.