射频消融技术用于猪感染创面病灶清除术的初步研究_《中国修复重建外科杂志》

作者：

杨润功 , 左坦坦 , 朱加亮 , 衷鸿宾 , 吴克俭 , 侯树勋

解放军总医院第一附属医院骨科（北京，100048）;

关键词：

感染创面愈合射频消融技术病灶清除猪

DOI：

10.7507/1002-1892.20130243

视频：

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目的观察射频消融技术用于猪感染创面病灶清除的效果，探讨其能否促进感染创面愈合。方法选取8只6月龄小型猪（体重30～35 kg），于脊柱两侧采用Davis等的感染创面制作方法制备全层皮肤缺损感染创面模型（面积约6.15 cm2/孔）。将160个感染创面随机分为4组，每组40个，分别用射频消融技术（A组）、电刀（B组）、普通刀片（C组）对创面进行病灶清除，对照组（D组）不作处理。各组于术后0、2、7、14 d行创面愈合率、组织填充率、细菌定量检查及组织学观察，并记录创面完全愈合时间。结果160个创面接种金黄色葡萄球菌稀释液48 h后均成功制成感染性创面。A组射频消融治疗后的创面出血很少，创面新鲜、平整；创面愈合时间显著短于其余3组，7、14 d时创面愈合率显著高于其余3组，差异均有统计学意义（P lt; 0.05）。术后2 d，A组创面组织填充率高于B、C、D组（P lt; 0.05）；7、14 d时A、B、C组创面组织填充率均高于D组（P lt; 0.05）。术后0、2、7、14 d，各组创面每克组织细菌含量比较差异均有统计学意义（P lt; 0.05），从低到高依次是A、B、C、D组。组织学观察示，术后0 d A组创面平整，优于其余3组；2 d各组创面均有较多渗出物，其中A组最少；7、14 d各组创面新生真皮内均存在不同程度炎性细胞浸润，D组最重、A组最轻，A组新生上皮较厚、胶原束较致密，B、C组次之，D组最差。结论射频消融技术能有效去除猪感染创面的坏死组织，创面细菌数量显著减少，提高了创面愈合率，进而缩短创面愈合时间。

引用本文： 杨润功,左坦坦,朱加亮,衷鸿宾,吴克俭,侯树勋. 射频消融技术用于猪感染创面病灶清除术的初步研究. 中国修复重建外科杂志, 2013, 27(9): 1110-1115. doi: 10.7507/1002-1892.20130243 复制

1.	杨润功, 张伟佳, 侯树勋, 等. Gustilo Ⅲ型开放性骨折早期感染的治疗. 中华创伤骨科杂志, 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.	于东宁, 张国安, 李健宁. 瘢痕面积及其不规则程度的定量测量方法研究. 中国美容医学, 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. 现代创伤修复学. 北京: 人民军医出版社, 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. 杨润功, 张伟佳, 侯树勋, 等. Gustilo Ⅲ型开放性骨折早期感染的治疗. 中华创伤骨科杂志, 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. 于东宁, 张国安, 李健宁. 瘢痕面积及其不规则程度的定量测量方法研究. 中国美容医学, 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. 现代创伤修复学. 北京: 人民军医出版社, 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.

《中国修复重建外科杂志》

射频消融技术用于猪感染创面病灶清除术的初步研究

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《中国修复重建外科杂志》

射频消融技术用于猪感染创面病灶清除术的初步研究

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