The LENS four-element diagnostic method and WDSR scoring and grading system applicable to the discipline of wound repair
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摘要: 随着人口老龄化进程加剧,各类老年急慢性创面已成为全球公共健康的重要负担,创面修复学科的成立和发展具有迫切的时代需求。目前创面类疾病的诊断具有描述性和异质性特点,客观上限制了学术交流和学科发展。该文提出普遍适用于局灶性创面的LENS四要素诊断法,包括部位（location）、病因（etiology）、性质（nature）和严重程度（severity）4个要素,期望能够全面、准确地反映创面情况,为创面治疗、疾病分级、预后评价等提供宝贵信息。该文还提出WDSR计分分级系统,选择创面宽度（width）、深度（depth）、窦腔（sinus）及复发情况（recurrence）共4项指标进行计分,并按照总分进行分级（Ⅰ~Ⅳ级）,可对创面局部的严重程度进行量化评估。倡议有条件的创面修复科试点应用LENS四要素诊断法和WDSR计分分级系统,以促进创面修复学科的规范化发展。Abstract: With the acceleration of population aging, various acute and chronic wounds in the elderly have become an important burden on global public health. The establishment and development of the wound repair discipline have become an urgent need of the times. Currently, the diagnosis of various wound diseases is descriptive and heterogeneous, which objectively limits academic exchanges and the development of the discipline. This article proposed the LENS four-element diagnostic method that is universally applicable to focal wounds, including location, etiology, nature, and severity. It is expected to comprehensively and accurately reflect the condition of the wounds and provide valuable information for wound treatment, disease grading, and prognosis evaluation. This article proposed the WDSR scoring and grading system, which selects four indicators for scoring, including wound width, depth, sinus, and recurrence. The system grades the wounds according to the total score (grades Ⅰ-Ⅳ), which can quantitatively assess the severity of the local wounds. It is advocated that the wound repair discipline with conditions pilots the LENS four-element diagnostic method and the WDSR scoring and grading system to promote the standardized development of the wound repair discipline.
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Key words:
- Ulcer /
- Diagnosis /
- Focal wounds /
- Chronic wounds /
- Refractory wounds /
- Wound grading
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参考文献
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图 2 胸部正中切口不愈创面的诊断（感染性,W1D2S2R0,5分Ⅱ级）。2A.入院时,切口下段裂开并探及切口下腔隙；2B.清创术中,可见脂肪层组织感染坏死,无深部组织外露；2C.出院时,切口愈合良好
图 3 左坐骨结节压力性损伤的诊断（失神经性,W1D2S3R1,7分Ⅲ级）和右坐骨结节压力性损伤的诊断（失神经性,W2D2S3R1,8分Ⅲ级）。3A.入院时左侧创面内可见坏死组织和腔隙；3B.入院时右侧创面内可见坏死组织和腔隙；3C.术中清创后,可见深部坐骨结节骨膜部分坏死；3D.左侧复合皮瓣转移术后即刻,可见皮瓣血运良好；3E.右侧复合皮瓣转移术后即刻,可见皮瓣血运良好；3F.出院时,可见双侧创面愈合
图 4 左糖尿病足溃疡的诊断（感染性,W2D3S2R1,8分Ⅲ级）。4A.入院时足内侧创面,见皮肤全层缺损,肌肉组织部分坏死；4B.入院时第2足趾区创面,见第2跖骨外露；4C.足内侧创面清创手术后,见大范围窦腔；4D.第2足趾区创面清创手术后,见第2跖骨部分被咬除；4E.出院时,左足内侧创面愈合；4F.出院时,第2足趾区创面愈合
Table 1. 适用于多类型局灶性创面的WDSR计分系统
评分（分） 宽度 深度 窦腔 复发情况 0 无皮损 无皮损 无窦腔 首发且病程≤3个月 1 0~3 cm 创面基底为皮肤层（表皮层或真皮层） 整个窦腔结构在深筋膜以浅 复发或病程>3个月 2 >3 cm且≤10 cm 创面基底为软组织层（脂肪层或肌肉层） 窦腔结构涉及深筋膜以深 — 3 >10 cm 创面基底可见肌腱、骨膜等深部组织 有瘘管连通关节腔、胸腔、腹腔、肠道等自然腔隙 — 注：WDSR指宽度、深度、窦腔、复发情况；宽度指创面愈合过程中上皮组织需要迁移的最远距离（cm）；深度指在体外直视下活性基底组织的层次；窦腔指创面基底存在的直视不可见,但探查可及的脓肿、窦道、腔隙和瘘管等所有窦腔类结构；复发情况指创面病程和是否出现复发；应将部位、病因和性质均相同的多个创面视为一个大创面进行计分,否则应分别计分；“—”表示无此项 
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Table 2. 适用于多类型局灶性创面的WDSR分级系统和治疗建议
分级 WDSR总分（分） 治疗建议 Ⅰ级 1~3 保守治疗促进愈合 Ⅱ级 4~6 简单手术封闭创面 Ⅲ级 7或8 复杂手术修复创面 Ⅳ级 9或10 联合治疗控制创面 注：WDSR指宽度、深度、窦腔、复发情况
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