探讨内镜下注射自体富血小板血浆（PRP）治疗慢性窦道的临床疗效，分析影响窦道愈合的因素。

回顾性分析2023年6月至2025年6月上海交通大学医学院附属瑞金医院烧伤整形与创面修复科收治的93例慢性窦道患者的临床资料。其中男42例，女51例，年龄（42.2±16.1）岁。根据治疗方式将患者分为PRP组（43例）和对照组（50例），2组患者均行内镜下窦道探查与清创，PRP组根据窦道大小及深度在清创后于窦道底部及窦壁注射PRP 1~10 mL。比较2组窦道愈合率、住院时间及治疗时间，并按窦道类型进行亚组分层分析。采用单因素及多因素Logistic回归分析窦道愈合的影响因素，检验PRP治疗与窦道类型的交互作用，以改良泊松回归进行敏感性分析。采用Enter法构建模型，模型校准度以Hosmer-Lemeshow检验评价，区分度以受试者工作特征（ROC）曲线下面积（AUC）评价。

PRP组窦道愈合率高于对照组（90.7%比58.0%，χ²=12.58，P<0.001）。亚组分析中，难治型窦道PRP获益相对明显（78.6% 比 5.3%，χ²=18.72，P<0.001）。单因素分析显示，PRP治疗、窦道最大深度、病程、细菌检出、窦道类型及解剖部位与窦道愈合相关（P值均<0.05）。多因素Logistic回归分析显示，PRP治疗是窦道愈合的独立保护因素（OR=15.32，95%CI：2.91~80.68，P=0.001）；窦道最大深度增加（OR=0.65，95%CI：0.49~0.86，P=0.002）和病程延长（OR=0.90，95%CI：0.82~0.98，P=0.012）是窦道愈合的独立危险因素，PRP治疗与窦道类型无交互作用（P=0.838）。模型AUC为0.882（95%CI：0.795~0.969），Hosmer-Lemeshow检验结果显示校准度良好（P=0.098）。改良泊松回归验证结论稳健。

内镜下PRP治疗可提高慢性窦道愈合率，是愈合的独立保护因素；窦道深度增加和病程延长是愈合的独立危险因素。PRP对难治型窦道疗效相对明显，推荐在该亚型中优先应用。

To explore the clinical efficacy of endoscopic injection of autologous platelet-rich plasma （PRP） in the treatment of chronic sinus tract，analyze the factors affecting sinus tract healing.

A retrospective analysis was performed on the clinical data of 93 patients with chronic sinus tract admitted to the Department of Burns，Plastic Surgery and Wound Repair，Ruijin Hospital，Shanghai Jiao Tong University School of Medicine，from June 2023 to June 2025，including 42 males and 51 females，with a mean age of （42.2±16.1） years. All patients were divided into the PRP group （43 cases） and the control group （50 cases） according to treatment regimens. Patients in both groups underwent endoscopic sinus tract exploration and debridement. In the PRP group，1-10 mL of PRP was injected into the sinus tract base and wall after debridement based on the size and depth of the sinus tract. The sinus tract healing rate，length of stay and treatment duration were compared between the two groups，and subgroup stratified analysis was conducted according to sinus tract types. Univariate and multivariate Logistic regression analyses were used to identify the influencing factors on sinus tract healing，and the interaction effect between PRP treatment and sinus tract type was tested. Modified Poisson regression was applied for sensitivity analysis. The Enter method was adopted to construct the regression model. The calibration degree and discrimination degree of the model were evaluated by the Hosmer-Lemeshow test and the area under the receiver operating characteristic curve （AUC），respectively.

The sinus tract healing rate of the PRP group was higher than that of the control group （90.7% vs. 58.0%，χ²=12.58，P<0.001）. Subgroup analysis showed that patients with refractory sinus tract derived a relatively greater benifit from PRP treatment （78.6% vs. 5.3%，χ²=18.72，P<0.001）. Univariate analysis indicated that PRP treatment，maximum sinus tract depth，disease course，bacterial detection，sinus tract type and anatomical site were correlated with sinus tract healing （P values all<0.05）. Multivariate Logistic regression analysis revealed that PRP treatment was an independent protective factor for sinus tract healing （OR=15.32，95%CI： 2.91-80.68，P=0.001）. Increased maximum sinus tract depth （OR=0.65，95%CI： 0.49-0.86，P=0.002） and prolonged disease course （OR=0.90，95%CI： 0.82-0.98，P=0.012） were independent risk factors for sinus tract healing. No significant interaction was observed between PRP treatment and sinus tract type （P=0.838）. The AUC of the model was 0.882 （95%CI： 0.795-0.969），and the Hosmer-Lemeshow test verified good calibration of the model （P=0.098）. Modified Poisson regression confirmed the robustness of the conclusions.

Endoscopic PRP treatment can improve the healing rate of chronic sinus tract and serves as an independent protective factor for sinus tract healing. Increased sinus tract depth and prolonged disease course are independent risk factors for sinus tract healing. PRP exhibits a relatively greater efficacy in the treatment of refractory sinus tract，which is recommended as a priority therapy for this subtype.