ホウ酸粒子を含浸させたポリウレタンスポンジによる慢性創傷の治療。無作為化比較試験

Treatment of chronic wounds with polyurethane sponges impregnated with boric acid particles: A randomised controlled trial.

• Rana Kapukaya
• Osman Ciloglu

抄録

本研究の目的は、組織欠損を有する慢性創傷に対するホウ酸粒子入りスポンジと陰圧創傷治療（NPWT）システムの併用の有効性を検討することであった。本研究はプロスペクティブ無作為化研究として計画された。整形外科と外傷・形成外科のクリニックから、慢性創傷のためにNPWTを受ける予定の患者100人を本研究に含めた。患者は2つのグループに分けられた。第1群にはNPWTシステムと組み合わせた新しい方法であるホウ酸含浸スポンジを使用し、第2群には硝酸銀入りスポンジを使用した。硝酸銀の広範な抗菌作用に加えて、ホウ酸の抗菌作用、血管新生作用、上皮効果を巨視的、病理組織学的に検討した。硝酸銀群36名、ホウ酸群44名が試験を終了した。その結果、両群ともに創傷の大きさと肉芽の減少が認められた。マクロ的には、ホウ酸含浸スポンジを使用した第１群では、銀スポンジを使用した第２群よりも創傷サイズの縮小、上皮化、肉芽形成の減少が顕著であった。さらに、顕微鏡的には、第１群では線維芽細胞数、コラーゲン合成、血管新生が有意に増加しており、本臨床試験では、ホウ酸の広範な抗菌性と創傷治癒を担う細胞への好影響が硝酸銀スポンジに比べて顕著であることが明らかになった。ホウ酸スポンジとNPWTシステムの組み合わせは、慢性創傷の代替法となる可能性がある。

The objective of this study was to investigate the effectiveness of the sponge with boric acid particles combined with the negative pressure wound treatment (NPWT) system for chronic wounds with tissue defects. Our study was designed as a prospective randomised study. One hundred patients who were planned to have NPWT due to chronic wounds were included in this study from Orthopaedics and Traumatology and Plastic Surgery clinics. Patients were divided into two groups. In the first group, a new method, boric acid impregnated sponge, combined with the NPWT system, was used, and in the second group, sponge with silver nitrate was used. Besides the wide-broad spectrum antibacterial properties of silver nitrate, the antimicrobial, angiogenetic, and epithelial effects of boric acid were aimed to investigate by macroscopically and histopathologically. Thirty-six patients in the silver nitrate group and 44 patients in the boric acid group completed the study. A decrease in wound size and granulation was observed in both groups. Macroscopically, a decrease in wound size reduction, epithelialization and granulation were more prominent in the first group in which boric acid impregnated sponge was used than the second group in which silver sponge was used. Moreover, microscopically, the number of fibroblasts, collagen synthesis, and angiogenesis were significantly increased in Group 1. In this clinical study, the broad-spectrum antimicrobial properties of boric acid and its positive effect on the cells responsible for wound healing were found to be more pronounced compared to silver nitrate sponges. A combination of boric acid sponges with the NPWT system may be an alternative method for chronic wounds.

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