射頻消融技術用于豬感染創面病灶清除術的初步研究_《中國修復重建外科雜志》

作者：

楊潤功 , 左坦坦 , 朱加亮 , 衷鴻賓 , 吳克儉 , 侯樹勛

解放軍總醫院第一附屬醫院骨科（北京，100048）;

關鍵詞：

感染創面愈合射頻消融技術病灶清除豬

DOI：

10.7507/1002-1892.20130243

視頻：

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目的觀察射頻消融技術用于豬感染創面病灶清除的效果，探討其能否促進感染創面愈合。方法選取8只6月齡小型豬（體重30～35 kg），于脊柱兩側采用Davis等的感染創面制作方法制備全層皮膚缺損感染創面模型（面積約6.15 cm2/孔）。將160個感染創面隨機分為4組，每組40個，分別用射頻消融技術（A組）、電刀（B組）、普通刀片（C組）對創面進行病灶清除，對照組（D組）不作處理。各組于術后0、2、7、14 d行創面愈合率、組織填充率、細菌定量檢查及組織學觀察，并記錄創面完全愈合時間。結果160個創面接種金黃色葡萄球菌稀釋液48 h后均成功制成感染性創面。A組射頻消融治療后的創面出血很少，創面新鮮、平整；創面愈合時間顯著短于其余3組，7、14 d時創面愈合率顯著高于其余3組，差異均有統計學意義（P lt; 0.05）。術后2 d，A組創面組織填充率高于B、C、D組（P lt; 0.05）；7、14 d時A、B、C組創面組織填充率均高于D組（P lt; 0.05）。術后0、2、7、14 d，各組創面每克組織細菌含量比較差異均有統計學意義（P lt; 0.05），從低到高依次是A、B、C、D組。組織學觀察示，術后0 d A組創面平整，優于其余3組；2 d各組創面均有較多滲出物，其中A組最少；7、14 d各組創面新生真皮內均存在不同程度炎性細胞浸潤，D組最重、A組最輕，A組新生上皮較厚、膠原束較致密，B、C組次之，D組最差。結論射頻消融技術能有效去除豬感染創面的壞死組織，創面細菌數量顯著減少，提高了創面愈合率，進而縮短創面愈合時間。

引用本文： 楊潤功,左坦坦,朱加亮,衷鴻賓,吳克儉,侯樹勛. 射頻消融技術用于豬感染創面病灶清除術的初步研究. 中國修復重建外科雜志, 2013, 27(9): 1110-1115. doi: 10.7507/1002-1892.20130243 復制

1.	楊潤功, 張偉佳, 侯樹勛, 等. Gustilo Ⅲ型開放性骨折早期感染的治療. 中華創傷骨科雜志, 2008, 10(12): 1126-1130.
2.	Whitaker IS, Twine C, Whitaker MJ, et al. Larval therapy from antiquity to the present day: mechanisms of action, clinical applications and future potential. Postgrad Med J, 2007, 83(980): 409-413.
3.	Davis SC, Ricotti C, Cazzaniga A, et al. Microscopic and physiologic evidence for biofilm-associated wound colonization in vivo. Wound Repair Regen, 2008, 16(1): 23-29.
4.	Singh KP, Prasad R, Chari PS, et al. Effect of growth hormone therapy in burn patients on conservative treatment. Burns, 1998, 24(8): 733-738.
5.	于東寧, 張國安, 李健寧. 瘢痕面積及其不規則程度的定量測量方法研究. 中國美容醫學, 2006, 15(5): 486-489, i0001.
6.	Greenhalgh DG, Sprugelr KH, Muray MJ, et al. PDGF and FGF stimulate wound healing in the genetically diabetic mouse. Am J Pathol, 1990, 136(6): 1235-1246.
7.	付小兵, 王德文. 現代創傷修復學. 北京: 人民軍醫出版社, 1999: 82-84.
8.	Tomic-Canic M, Ayello EA, Stojadinovic O, et al. Using gene transcription patterns (bar coding scans) to guide wound debridement and healing. Adv Skin Wound Care, 2008, 21(10): 487-494.
9.	Fu X, Sheng Z, Cherry GW, et al. Epidemiological study of chronic dermal ulcers in China. Wound Repair Regen, 1998, 6(1): 21-27.
10.	Hart J. Inflammation.2: its role in the healing of chronic wounds. J Wound Care, 2002, 11(7): 245-249.
11.	Phillps TJ, al-Amoudi HO, Leverkus M, et al. Effect of chronic wound fluid on fibroblasts. J Wound Care, 1998, 7(10): 527-532.
12.	Percival SL, Hill KE, Malic S. Antimicrobial tolerance and the significance of persister cells in recalcitrant chronic wound biofilms. Wound Repair Regen, 2011, 19(1): 1-9.
13.	Robson MC, Barbul A. Guidelines for the best care of chronic wounds. Wound Repair Regen, 2006, 14(6): 647-648.
14.	Werdin F, Tennenhaus M, Schaller HE, et al. Evidence-based management strategies for treatment of chronic wounds. Eplasty, 2009, 9: e19.
15.	Ramundo J, Gray M. Enzymatic wound debridement. J Wound Ostomy Continence Nurs, 2008, 35(3): 273-280.
16.	Bortnick DP, Plastic Surgery Educational Foundation DATA Committee. Coblation: an emerging technology and new technique for soft-tissue surgery. Plast Reconstr Surg, 2001, 107(2): 614-615.
17.	Sergeev VN, Belov SV. A new method of high-frequency electrosurgery (coblation technology). Med Tekh, 2003, 37(1): 21-23.
18.	Kramer A, Hübner NO, Weltmann KD, et al. Polypragmasia in the therapy of infected wounds-conclusions drawn from the perspectives of low temperature plasma technology for plasma wound therapy. GMS Krankenhhyg Interdiszip, 2008, 3(1): Doc13.
19.	Sönnergren HH, Strömbeck L, Faergemann J. Antimicrobial effects of plasma-mediated bipolar radiofrequency ablation on bacteria and fungi relevant for wound infection. Acta Derm Venereol, 2012, 92(1): 29-33.
20.	Nusbaum AG, Gil J, Rippy MK, et al. Effective method to remove wound bacteria: comparison of various debridement modalities in an in vivo porcine model. J Surg Res, 2012, 176(2): 701-707.
21.	Sullivan TP, Eaglstein WH, Davis SC, et al. The pig as a model for human wound healing. Wound Repair Regen, 2001, 9(2): 66-76.
22.	Bowler PG. Wound pathophysiology, infection and therapeutic options. Ann Med, 2002, 34(6): 419-427.
23.	Levine NS, Lindberg RB, Mason AD Jr, et al. The quantitative swab culture and smear: A quick, simple method for determining the number of viable aerobic bacteria on open wounds. J Trauma, 1976, 16(2): 89-94.
24.	Tasto JP. The use of bipolar radiofrequency microtenotomy in the treatment of chronic tendinosis of the foot and ankle. Techniq Foot & Ankle Surg, 2006, 5(2): 110-116.

1. 楊潤功, 張偉佳, 侯樹勛, 等. Gustilo Ⅲ型開放性骨折早期感染的治療. 中華創傷骨科雜志, 2008, 10(12): 1126-1130.
2. Whitaker IS, Twine C, Whitaker MJ, et al. Larval therapy from antiquity to the present day: mechanisms of action, clinical applications and future potential. Postgrad Med J, 2007, 83(980): 409-413.
3. Davis SC, Ricotti C, Cazzaniga A, et al. Microscopic and physiologic evidence for biofilm-associated wound colonization in vivo. Wound Repair Regen, 2008, 16(1): 23-29.
4. Singh KP, Prasad R, Chari PS, et al. Effect of growth hormone therapy in burn patients on conservative treatment. Burns, 1998, 24(8): 733-738.
5. 于東寧, 張國安, 李健寧. 瘢痕面積及其不規則程度的定量測量方法研究. 中國美容醫學, 2006, 15(5): 486-489, i0001.
6. Greenhalgh DG, Sprugelr KH, Muray MJ, et al. PDGF and FGF stimulate wound healing in the genetically diabetic mouse. Am J Pathol, 1990, 136(6): 1235-1246.
7. 付小兵, 王德文. 現代創傷修復學. 北京: 人民軍醫出版社, 1999: 82-84.
8. Tomic-Canic M, Ayello EA, Stojadinovic O, et al. Using gene transcription patterns (bar coding scans) to guide wound debridement and healing. Adv Skin Wound Care, 2008, 21(10): 487-494.
9. Fu X, Sheng Z, Cherry GW, et al. Epidemiological study of chronic dermal ulcers in China. Wound Repair Regen, 1998, 6(1): 21-27.
10. Hart J. Inflammation.2: its role in the healing of chronic wounds. J Wound Care, 2002, 11(7): 245-249.
11. Phillps TJ, al-Amoudi HO, Leverkus M, et al. Effect of chronic wound fluid on fibroblasts. J Wound Care, 1998, 7(10): 527-532.
12. Percival SL, Hill KE, Malic S. Antimicrobial tolerance and the significance of persister cells in recalcitrant chronic wound biofilms. Wound Repair Regen, 2011, 19(1): 1-9.
13. Robson MC, Barbul A. Guidelines for the best care of chronic wounds. Wound Repair Regen, 2006, 14(6): 647-648.
14. Werdin F, Tennenhaus M, Schaller HE, et al. Evidence-based management strategies for treatment of chronic wounds. Eplasty, 2009, 9: e19.
15. Ramundo J, Gray M. Enzymatic wound debridement. J Wound Ostomy Continence Nurs, 2008, 35(3): 273-280.
16. Bortnick DP, Plastic Surgery Educational Foundation DATA Committee. Coblation: an emerging technology and new technique for soft-tissue surgery. Plast Reconstr Surg, 2001, 107(2): 614-615.
17. Sergeev VN, Belov SV. A new method of high-frequency electrosurgery (coblation technology). Med Tekh, 2003, 37(1): 21-23.
18. Kramer A, Hübner NO, Weltmann KD, et al. Polypragmasia in the therapy of infected wounds-conclusions drawn from the perspectives of low temperature plasma technology for plasma wound therapy. GMS Krankenhhyg Interdiszip, 2008, 3(1): Doc13.
19. Sönnergren HH, Strömbeck L, Faergemann J. Antimicrobial effects of plasma-mediated bipolar radiofrequency ablation on bacteria and fungi relevant for wound infection. Acta Derm Venereol, 2012, 92(1): 29-33.
20. Nusbaum AG, Gil J, Rippy MK, et al. Effective method to remove wound bacteria: comparison of various debridement modalities in an in vivo porcine model. J Surg Res, 2012, 176(2): 701-707.
21. Sullivan TP, Eaglstein WH, Davis SC, et al. The pig as a model for human wound healing. Wound Repair Regen, 2001, 9(2): 66-76.
22. Bowler PG. Wound pathophysiology, infection and therapeutic options. Ann Med, 2002, 34(6): 419-427.
23. Levine NS, Lindberg RB, Mason AD Jr, et al. The quantitative swab culture and smear: A quick, simple method for determining the number of viable aerobic bacteria on open wounds. J Trauma, 1976, 16(2): 89-94.
24. Tasto JP. The use of bipolar radiofrequency microtenotomy in the treatment of chronic tendinosis of the foot and ankle. Techniq Foot & Ankle Surg, 2006, 5(2): 110-116.

《中國修復重建外科雜志》

射頻消融技術用于豬感染創面病灶清除術的初步研究

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《中國修復重建外科雜志》

射頻消融技術用于豬感染創面病灶清除術的初步研究

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