Treatment of chronic refractory wound with autologous platelet-rich plasma in a hemophilia A patient after knee joint surgery
-
摘要:
2017年12月22日，1例35岁左膝关节术后继发慢性难愈合创面的血友病A男性患者从茂名市人民医院血液内科转入该院烧伤整形科。体格检查见其左膝关节肿胀，关节外侧有4 cm×4 cm大小的全层皮肤缺损创面，基底有大量暗红色血凝块。予静脉滴注血浆、冷沉淀和人凝血因子Ⅷ控制创面出血，常规清创换药至创面感染控制、坏死组织清除后，左膝关节残留2 cm×2 cm大小、3 cm深的皮下腔隙创面难以愈合。转科19 d后行自体富血小板血浆（PRP）治疗，PRP治疗32 d后左膝关节创面上皮化愈合。该病例提示，对于血友病合并慢性难愈合创面，在无法通过手术修复时，自体PRP治疗会是一个很好的选择。
Abstract:On December 22, 2017, a 35-year-old male hemophilia A patient with a secondary chronic refractory wound after left knee joint surgery was transferred from the Department of Hematology of Maoming People's Hospital to the Department of Burns and Plastic Surgery in the same hospital. The physical examination revealed that the patient's left knee joint was swollen, with a full-thickness skin defect wound of 4 cm×4 cm on the lateral side of the joint and a large number of dark red blood clots at the bottom of the wound. The wound bleeding was controlled by intravenous infusion of plasma, cryoprecipitate, and human coagulation factor Ⅷ. After con- ventional debridement and dressing changes until the wound infection was controlled and necrotic tissue was removed, a subcutaneous cavity wound of 2 cm×2 cm in area and 3 cm in depth remained in the left knee joint and was difficult to heal. Nineteen days after transfer, the patient received autologous platelet-rich plasma (PRP) treatment, and 32 days after PRP treatment, the wound in left knee joint was healed with epithelialization. This case suggests that autologous PRP therapy would be a good option for hemophilia complicated chronic refractory wounds when they could not be repaired by surgery.
-
Key words:
- Platelet-rich plasma /
- Hemophilia A /
- Chronic refractory wound
-
[1] 刘旭盛.慢性创面的诊断与治疗进展[J/CD].中华损伤与修复杂志:电子版,2013,8(6):8-12.DOI: 10.3877/cma.j.issn.1673-9450.2013.06.004. [2] 中华医学会血液学分会血栓与止血学组，中国血友病协作组.血友病诊断与治疗中国专家共识(2017年版)[J].中华血液学杂志,2017,38(5):364-370.DOI: 10.3760/cma.j.issn.0253-2727.2017.05.002. [3] 范猛,马乐,姜文学.血友病性假肿瘤的外科治疗[J].中国矫形外科杂志,2020,28(1):85-87.DOI: 10.3977/j.issn.1005-8478.2020.01.17. [4] 张兵钱,彭代智,李涵,等.甲型血友病慢性溃疡创面一例[J].中华烧伤杂志,2011,27(1):73-74.DOI: 10.3760/cma.j.issn.1009-2587.2011.01.026. [5] 高艳彬,史鹏伟,卢志阳,等.重度烧伤合并血友病A一例[J].中华烧伤杂志,2015,31(1):71-72.DOI: 10.3760/cma.j.issn.1009-2587.2015.01.021. [6] 张文举,郭树章.大腿内侧血肿术前漏诊血友病一例[J/CD].中华临床医师杂志:电子版,2013,7(11):5174.DOI: 10.3877/cma.j.issn.1674-0785.2013.11.089. [7] 刘宸,章宏伟.富血小板血浆促进慢性创面愈合研究进展[J].中华烧伤杂志,2014,30(5):433-436.DOI: 10.3760/cma.j.issn.1009-2587.2014.05.016. [8] 中国老年医学学会烧创伤分会.浓缩血小板制品在创面修复中应用的全国专家共识(2020版)[J].中华烧伤杂志,2020,36(11):993-1002.DOI: 10.3760/cma.j.cn501120-20200507-00256. [9] 秦新愿,王江宁.自体富血小板血浆局部注射治疗糖尿病足溃疡的临床研究[J].中国修复重建外科杂志,2019,33(12):1547-1551.DOI: 10.7507/1002-1892.201905124. [10] 李明,章军辉,李淑敏,等.应用自体富血小板血浆治疗慢性难愈性创面的实验研究[J/CD].中华关节外科杂志:电子版,2016,10(6):624-629.DOI: 10.3877/cma.j.issn.1674-134X.2016.06.008. [11] XuP,WuY,ZhouL,et al.Platelet-rich plasma accelerates skin wound healing by promoting re-epithelialization[J/OL].Burns Trauma,2020,8:tkaa028[2021-02-02]. https://pubmed.ncbi.nlm.nih.gov/32821743/.DOI: 10.1093/burnst/tkaa028. [12] 郝岱峰,冯光,李涛,等.富血小板血浆联合负压伤口疗法治疗患者开胸术后胸骨骨髓炎和窦道的效果[J].中华烧伤杂志,2016,32(6):331-335.DOI: 10.3760/cma.j.issn.1009-2587.2016.06.004. [13] 李红普,王兵,尚文煊. 富血小板血浆联合负压封闭引流治疗慢性难愈性创面的疗效[J]. 郑州大学学报(医学版),2021,56(4):560-563. DOI: 10.13705/j.issn.1671-6825.2020.12.127. [14] 杨彪,王珊,张岩,等. 负压创面治疗技术联合富血小板血浆治疗慢性难愈性创面:加速创面的再上皮化及愈合率[J]. 中国组织工程研究,2019,23(26):4181-4186. DOI: 10.3969/j.issn.2095-4344.1357. [15] 李金虎,孙肇晟,张新合,等. 自体富血小板血浆联合封闭负压引流治疗老年骨外露创面的临床效果观察[J]. 四川医学,2018,39(5):586-589.DOI: 10.16252/j.cnki.issn1004-0501-2018.05.028. [16] 黄山东,费志军,陈俊泽,等.富血小板血浆治疗深部组织外露的外伤性难愈性创面的疗效观察[J/CD].中华关节外科杂志:电子版,2017,11(6):666-670.DOI: 10.3877/cma.j.issn.1674-134X.2017.06.019. -
下载:
点击查看大图
计量
- 文章访问数: 225
- HTML全文浏览量: 55
- PDF下载量: 39
- 被引次数: 0
